Although a safe, effective, and licensed coronavirus vaccine does not yet exist, there is already controversy over how it ought to be allocated. Justice is clearly at stake, but it is unclear what justice requires in the international distribution of a scarce vaccine during a pandemic. Many are condemning ‘vaccine nationalism’ as an obstacle to equitable global distribution. We argue that limited national partiality in allocating vaccines will be a component of justice rather than an obstacle to it. For there (...) are role-based and community-embedded responsibilities to take care of one’s own, which constitute legitimate moral reasons for some identity-related prioritisation. Furthermore, a good form of vaccine nationalism prioritises one’s own without denying or ignoring duties derived from a principle of equal worth, according to which all persons, regardless of citizenship or identity, equally deserve vaccine-induced protection from COVID-19. Rather than dismissing nationalism as a tragic obstacle, it is necessary to acknowledge that a limited form of it is valuable and expresses moral commitments. Only then can one understand our world of competing obligations, a world where cosmopolitan duties of benevolence sometimes conflict with special obligations of community membership. Once these competing obligations are recognised as such, we can begin the work of designing sound ethical frameworks for achieving justice in the global distribution of a coronavirus vaccine and developing practical strategies for avoiding, mitigating or resolving conflicts of duty. (shrink)

Intergovernmental relation is an interaction among different levels of government. Intergovernmental relation is often times conflict-ridden, and the extent of the conflict depends on how they are managed by the actor operating at the government levels. This study examines conflict management in intergovernmental relation in Nigeria. The content analysis method would be used. This will be carried out by analyzing data obtained from extant literature on the subject matter. This paper found that intergovernmental conflicts mainly borders on tax jurisdiction (...) and revenue allocation. Other areas of conflict were found to include domination by the centre of other units, as well as, parallel and vertical misunderstanding among units on administrative, legal, social and economic matters. It was suggested that levels of government should introduce such method as discussion, integration, good management of communication in other to attain a peaceful intergovernmental relations regime. (shrink)

While there has been significant discussion in the health sciences and ethics literatures about problems associated with publication practices (e.g., ghost- and gift-authorship, conflicts of interest), there has been relatively little practical guidance developed to help researchers determine how they should fairly allocate credit for multi-authored publications. Fair allocation of credit requires that participating authors be acknowledged for their contribution and responsibilities, but it is not obvious what contributions should warrant authorship, nor who should be responsible for the (...) quality and content of the scientific research findings presented in a publication. In this paper, we review arguments presented in the ethics and health science literatures, and the policies or guidelines proposed by learned societies and journals, in order to explore the link between author contribution and responsibility in multi-author multidisciplinary health science publications. We then critically examine the various procedures used in the field to help researchers fairly allocate authorship. (shrink)

Several quantitative surveys have been conducted internationally to gather empirical information about physicians’ general attitudes towards health care rationing. Are physicians ready to accept and implement rationing, or are they rather reluctant? Do they prefer implicit bedside rationing that allows the physician–patient relationship broad leeway in individual decisions? Or do physicians prefer strategies that apply explicit criteria and rules?

Many authors in ethics, economics, and political science endorse the Lottery Requirement, that is, the following thesis: where different parties have equal moral claims to one indivisible good, it is morally obligatory to let a fair lottery decide which party is to receive the good. This article defends skepticism about the Lottery Requirement. It distinguishes three broad strategies of defending such a requirement: the surrogate satisfaction account, the procedural account, and the ideal consent account, and argues that none of these (...) strategies succeed. The article then discusses and discharges some remaining grounds for resistance to these skeptical conclusions, as well as the possibility of defending a weaker version of a normative lottery principle. The conclusion is that we have no reason to believe that where equal claims conflict, we are morally required to hold a lottery, as opposed to simply picking one of the parties on more subjective grounds or out of pure whim. In addition to the practical consequences of this skeptical view, the article sketches some theoretical implications for debates about saving the greater number and about axiomatic utilitarianism. (shrink)

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)

Norman Daniels’s theory of ‘accountability for reasonableness’ is an influential conception of fairness in healthcare resource allocation. Although it is widely thought that this theory provides a consistent extension of John Rawls’s general conception of justice, this paper shows that accountability for reasonableness has important points of contact with both utilitarianism and intuitionism, the main targets of Rawls’s argument. My aim is to demonstrate that its overlap with utilitarianism and intuitionism leaves accountability for reasonableness open to damaging critiques. The (...) important role that utilitarian-like cost-effectiveness calculations are allowed to play in resource allocation processes disregards the separateness of persons and is seriously unfair towards individuals whose interests are sacrificed for the sake of groups. Furthermore, the function played by intuitions in settling frequent value conflicts opens the door for sheer custom and vested interests to steer decision-making. (shrink)

The COVID-19 pandemic has been overwhelming public health-care systems around the world. With demand exceeding the availability of medical resources in several regions, hospitals have been forced to invoke triage. To ensure that this difficult task proceeds in a fair and organised manner, governments scrambled experts to draft triage guidelines under enormous time pressure. Although there are similarities between the documents, they vary considerably in how much weight their respective authors place on the different criteria that they propose. Since most (...) of the recommendations do not come with ethical justifications, analysing them requires that one traces back these criteria to their underlying theories of distributive justice. In the literature, COVID-19 triage has been portrayed as a value conflict solely between utilitarian and egalitarian elements. While these two accounts are indeed the main antipodes, I shall show that in fact all four classic theories of distributive justice are involved: utilitarianism, egalitarianism, libertarianism, and communitarianism. Detecting these in the documents and classifying the suggested criteria accordingly enables one to understand the balancing between the different approaches to distributive justice—which is crucial for both managing the current pandemic and in preparation for the next global health crisis. (shrink)

Many philosophers accept the idea that there are duties to promote or create just institutions. But are the addressees of such duties supposed to be individuals – the members of the citizenry? What does it mean for an individual to promote or create just institutions? According to the ‘Simple View’, the citizenry has a collective duty to create or promote just institutions, and each individual citizen has an individual duty to do their part in this collective project. The simple view (...) appears to work well with regard to – you guessed it – ‘simple’ scenarios but it is riddled with further questions and problems. In this chapter, we raise five problems for the Simple View: (a) We suggest that one cannot develop a view concerning the citizenry’s duty to promote just institutions in isolation from a conception of the ontological relationship between the state and its citizens; (b) We argue that it is not obvious that the citizenry is the right entity to be attributed duties in the first place; (c) We show that a plausible account of collective duties to promote just institutions must not remain silent on the complexities and difficulties amorphous, unorganized group face in vis-à-vis collective action; (d) We contend that without allocation principles for contributory duties amongst the citizenry, or – alternatively – a method for practical deliberation that is action-guiding in collective action contexts, the claim that the citizens have a collective duty to promote just institutions remains moot; and, finally, (e) We demonstrate that the problem of reasonable disagreement is a serious threat to a collective duty to promote or create just institutions – it potentially undermines such a duty altogether and allows for conflicting contributory duties amongst the citizenry. We hope that our discussion will ultimately help improve existing theories and conceptual frameworks with a view to better understanding citizens’ obligations to promote justice under non-ideal conditions. (shrink)

When considering the social valuation of a life-year, there is a conflict between two basic intuitions: on the one hand, the intuition of universality, according to which the value of an additional life-year should be universal, and, as such, should be invariant to the context considered; on the other hand, the intuition of complementarity, according to which the value of a life-year should depend on what this extra-life-year allows for, and, hence, on the quality of that life-year, because the quantity (...) of life and the quality of life are complement to each other. This paper proposes three distinct accounts of the intuition of universality, and shows that those accounts either conflict with a basic monotonicity property, or lead to indifference with respect to how life-years are distributed within the population. Those results support the abandon of the intuition of universality. But abandoning the intuition of universality does not prevent a social evaluator from giving priority, when allocating life-years, to individuals with the lowest quality of life. (shrink)

(Expected) adverse effects of the ‘ICT Revolution’ on work and opportunities for individuals to use and develop their capacities give a new impetus to the debate on the societal implications of technology and raise questions regarding the ‘responsibility’ of research and innovation (RRI) and the possibility of achieving ‘inclusive and sustainable society’. However, missing in this debate is an examination of a possible conflict between the quest for ‘inclusive and sustainable society’ and conventional economic principles guiding capital allocation (including (...) the funding of research and innovation). We propose that such conflict can be resolved by re-examining the nature and purpose of capital, and by recognising mainstream economics’ utilitarian foundations as an unduly restrictive subset of a wider Aristotelian understanding of choice. (shrink)

The experience of Costa Rica highlights the potential for conflicts between the right to health and fair priority setting. For example, one study found that most favorable rulings by the Costa Rican constitutional court concerning claims for medications under the right to health were either for experimental treatments or for medicines that should have low priority based on health gain per unit of expenditure and severity of disease. In order to better align rulings with priority setting criteria, in 2014, (...) the court initiated a reform in its assessment of claims for medicine. This paper assesses this reform’s impact on the fairness of resource allocation. It finds three effects. First, a reduction in successful claims for experimental medication, which is beneficial. Second, an increase in the success rate of medication lawsuits, which is detrimental because most claims are for extremely cost-ineffective medications. Third, a decline in the number of claims for medicine, which is beneficial because it forestalls such low-priority spending. This paper estimates that, taking all three effects into account, the reform has had a modest net positive impact on overall resource allocation. However, it also argues that there is a need for further reforms to lower the number of claims to low-priority medicines that are granted. (shrink)

Egalitarians must address two questions: i. What should there be an equality of, which concerns the currency of the ‘equalisandum’; and ii. How should this thing be allocated to achieve the so-called equal distribution? A plausible initial composite answer to these two questions is that resources should be allocated in accordance with choice, because this way the resulting distribution of the said equalisandum will ‘track responsibility’ — responsibility will be tracked in the sense that only we will be responsible for (...) the resources that are available to us, since our allocation of resources will be a consequence of our own choices. But the effects of actual choices should not be preserved until the prior effects of luck in constitution and circumstance are first eliminated. For instance, people can choose badly because their choice-making capacity was compromised due to a lack of intelligence (i.e. due to constitutional bad luck), or because only bad options were open to them (i.e. due to circumstantial bad luck), and under such conditions we are not responsible for our choices. So perhaps a better composite answer to our two questions (from the perspective of tracking responsibility) might be that resources should be allocated so as to reflect people’s choices, but only once those choices have been corrected for the distorting effects of constitutional and circumstantial luck, and on this account choice preservation and luck elimination are two complementary aims of the egalitarian ideal. Nevertheless, it is one thing to say that luck’s effects should be eliminated, but quite another to figure out just how much resource redistribution would be required to achieve this outcome, and so it was precisely for this purpose that in 1981 Ronald Dworkin developed the ingenuous hypothetical insurance market argumentative device (HIMAD), which he then used in conjunction with the talent slavery (TS) argument, to arrive at an estimate of the amount of redistribution that would be required to reduce the extent of luck’s effects. However recently Daniel Markovits has cast doubt over Dworkin’s estimates of the amount of redistribution that would be required, by pointing out flaws with his understanding of how the hypothetical insurance market would function. Nevertheless, Markovits patched it up and he used this patched-up version of Dworkin’s HIMAD together with his own version of the TS argument to reach his own conservative estimate of how much redistribution there ought to be in an egalitarian society. Notably though, on Markovits’ account once the HIMAD is patched-up and properly understood, the TS argument will also allegedly show that the two aims of egalitarianism are not necessarily complementary, but rather that they can actually compete with one another. According to his own ‘equal-agent’ egalitarian theory, the aim of choice preservation is more important than the aim of luck elimination, and so he alleges that when the latter aim comes into conflict with the former aim then the latter will need to be sacrificed to ensure that people are not subordinated to one another as agents. I believe that Markovits’ critique of Dworkin is spot on, but I also think that his own positive thesis — and hence his conclusion about how much redistribution there ought to be in an egalitarian society — is flawed. Hence, this paper will begin in Section I by explaining how Dworkin uses the HIMAD and his TS argument to estimate the amount of redistribution that there ought to be in an egalitarian society — this section will be largely expository in content. Markovits’ critique of Dworkin will then be outlined in Section II, as will be his own positive thesis. My critique of Markovits, and my own positive thesis, will then make a fleeting appearance in Section III. Finally, I will conclude by rejecting both Dworkin’s and Markovits’ estimates of the amount of redistribution that there ought to be in an egalitarian society, and by reaffirming the responsibility-tracking egalitarian claim that choice preservation and luck elimination are complementary and not competing egalitarian aims. (shrink)

Does individual desert matter for distributive justice? Is it relevant, for purposes of justice, that the pattern of distribution of justice’s “currency” (be it well-being, resources, preference-satisfaction, capabilities, or something else) is aligned in one or another way with the pattern of individual desert? -/- This paper examines the nexus between desert and distributive justice through the lens of individual claims. The concept of claims (specifically “claims across outcomes”) is a fruitful way to flesh out the content of distributive justice (...) so as to be grounded in the separateness of persons. A claim is a relation between a person and a pair of outcomes. If someone is better off in one outcome than a second, she has a claim in favor of the first. If she is equally well off in the two outcomes, she has a null claim between the two. In turn, whether one outcome is more just than a second depends upon the pattern of claims between them. -/- In prior work, I have elaborated the concept of claims across outcomes, and have used it to provide a unified defense of the Pareto and Pigou-Dalton axioms. Adding some further, plausible, axioms, we arrive at prioritarianism. -/- Here, I consider the possibility of desert-modulated claims—whereby the strength of an individual’s claim between two outcomes is determined not only by her well-being levels in the two outcomes, and her well-being difference between them, but also by her desert. This generalization of the notion of claims suggests a new axiom of justice: Priority for the More Deserving, requiring that, as between two individuals at the same well-being level, a given increment in well-being be allocated to the more deserving one. -/- If individual desert is intrapersonally fixed, this new axiom, together with a desert-modulated version of the Pigou-Dalton principle, and the Pareto axioms, yields a desert-modulated prioritarian account of distributive justice. Trouble arises, however, if an individual’s desert level can be different in different outcomes. In this case of intrapersonally variable desert, Priority for the More Deserving can conflict with the Pareto axioms (both Pareto indifference and strong Pareto). -/- This conflict, I believe, is sufficient reason to abandon the proposal to make claim strength a function of individual desert on top of well-being levels and differences. If distributive justice is truly sensitive to each individual’s separate perspective—if the justice ranking of outcomes is built up from the totality of individual rankings—we should embrace the Pareto axioms as axioms of justice and reject Priority for the More Deserving. In short: desert-modulated prioritarianism is a nonstarter. Rawls was right to sever distributive justice from desert. (shrink)

Water is a finite resource held in common by the community yet coveted by individuals and special interests. The water management field is filled with disputes about water allocation, rights, and pollution. Environmental ethics is a basis for equitable water policy making in Delaware. The resource allocation dilemma is examined in relation to conflicting objectives imposed by a market economy between individual self-interests and community environmental well being. Two forms of water law are practiced in the USA—eastern riparianrights (...) and western prior appropriation. Both forms seek an ethical balance to resolve conflicts and protect individual water rights while protecting downstream users (the common good). Delaware Valley case studies discuss how environmental ethics can help the water policy specialist make difficult decisions during conflicts. Surveys polls indicate that 81 percent have values supportive of a balance between the economy and environment, or pro-environment, indicating that an environmental ethic is central to decisions concerning water policy. (shrink)

This article considers some different views of fairness and whether they conflict with the use of a version of Cost Effectiveness Analysis (CEA) that calls for maximizing health benefits per dollar spent. Among the concerns addressed are whether this version of CEA ignores the concerns of the worst off and inappropriately aggregates small benefits to many people. I critically examine the views of Daniel Hausman and Peter Singer who defend this version of CEA and Eric Nord among others who criticize (...) it. I come to focus in particular on the use of CEA in allocating scarce resources to the disabled. (shrink)

The thesis aims to provide an interpretation of John Rawls’ social bases of self-respect from the debate on redistribution and recognition in the current state of the art of theories of justice. The first chapter reenacts the reception of Rawlsian theory in the debate based on three critiques: (a) Iris Young's critique of the allocative-distributive paradigm, (b) Axel Honneth’s critique of the legal-political limitation, (c) Nancy Fraser's critique of the redistributive-reductionism. Far from considering the conception of ‘justice as fairness’ as (...) an insensitive terrain for dealing with matters of recognition, criticisms point out, on the contrary, the attempts of liberal Rawlsian theory to move into these issues, mainly taking the social bases of self-respect into account. However, these criticisms agree that Rawls' theory of justice would fail for several reasons. In the following chapters, each of these criticisms is addressed. The second chapter replies to Young's criticism. Contrary to what the author have supposed, ‘justice as fairness’ is better understood as a relational conception of justice rather than an allocative-distributive one. The third chapter addresses Honneth's criticism. On the one hand, the Critical Theorist is right in stating the limitations of Rawls' theory of justice; however, on the other hand, a deontological theory of justice – like the Rawlsian one – conceives these limitations as a normative advantage rather than as a theoretical flaw. The fourth chapter focuses on Fraser's critique. Likewise in her deontological model, it is argued that ‘justice as fairness’ would also have taken the cultural dimension of justice duly into account as well as, more specifically, status inequalities and cultural conflicts. Given the compatibility between their normative models, in the fifth and last chapter, a return to Fraser's deontological recognition via Rawls is advocated. (shrink)

Allocation of very scarce medical interventions such as organs and vaccines is a persistent ethical challenge. We evaluate eight simple allocation principles that can be classified into four categories: treating people equally, favouring the worst-off, maximising total benefits, and promoting and rewarding social usefulness. No single principle is sufficient to incorporate all morally relevant considerations and therefore individual principles must be combined into multiprinciple allocation systems. We evaluate three systems: the United Network for Organ Sharing points systems, (...) quality-adjusted life-years, and disability-adjusted life-years. We recommend an alternative system—the complete lives system—which prioritises younger people who have not yet lived a complete life, and also incorporates prognosis, save the most lives, lottery, and instrumental value principles. (shrink)

There are at least two different aspects of our rational evaluation of agents’ doxastic attitudes. First, we evaluate these attitudes according to whether they are supported by one’s evidence (substantive rationality). Second, we evaluate these attitudes according to how well they cohere with one another (structural rationality). In previous work, I’ve argued that substantive and structural rationality really are distinct, sui generis, kinds of rationality – call this view ‘dualism’, as opposed to ‘monism’, about rationality – by arguing that the (...) requirements of substantive and structural rationality can come into conflict. In this paper, I push the dialectic on this issue forward in two main ways. First, I argue that the most promising ways of resisting the diagnosis of my cases as conflicts still end up undermining monism in different ways. Second, supposing for the sake of argument that we should understand the cases as conflicts, I address the question of what we should do when such conflicts arise. I argue that, at least in a prominent kind of conflict case, the coherence requirements take precedence over the evidential requirements. (shrink)

As the federal government distributed remdesivir to some of the states COVID-19 hit hardest, policymakers scrambled to develop criteria to allocate the drug to their hospitals. Our state, Michigan, was among those states to receive an initial quantity of the drug from the U.S. government. The disparities in burden of disease in Michigan are striking. Detroit has a death rate more than three times the state average. Our recommendation to the state was that it should prioritize the communities that bear (...) a disproportionate burden of suffering in the allocation of the new potential treatment. This recommendation is justified not only for new drugs with uncertain effects, but also for drugs of certain benefit or vaccines. For states with significant health disparities, such as Michigan, this allocation priority may help to repair them. In fact, any other allocation strategy may make them worse. (shrink)

Countermeasures for mpox (formerly known as monkeypox), primarily vaccines, have been in limited supply in many countries during outbreaks. Equitable allocation of scarce resources during public health emergencies is a complex challenge. Identifying the objectives and core values for the allocation of mpox countermeasures, using those values to provide guidance for priority groups and prioritisation tiers, and optimising allocation implementation are important. The fundamental values for the allocation of mpox countermeasures are: preventing death and illness; reducing (...) the association between death or illness and unjust disparities; prioritising those who prevent harm or mitigate disparities; recognising contributions to combating an outbreak; and treating similar individuals similarly. Ethically and equitably marshalling available countermeasures requires articulating these fundamental objectives, identifying priority tiers, and recognising trade-offs between prioritising the people at the highest risk of infection and the people at the highest risk of harm if infected. These five values can provide guidance on preferable priority categories for a more ethically sound response and suggest methods for optimising allocation of countermeasures for mpox and other diseases for which countermeasures are in short supply. Properly marshalling available countermeasures will be crucial for future effective and equitable national responses to outbreaks. (shrink)

Glucagon-like peptide-1 (GLP-1) receptor agonists, such as semaglutide, and dual GLP-1 and glucose-dependent insulinotropic polypeptide (GIP) receptor agonists, such as tirzepatide, have been found to be effective for treating obesity and diabetes, significantly reducing weight and the risk or predicted risk of adverse cardiovascular events. There is a global shortage of these medications that could last several years and raises questions about how limited supplies should be allocated. We propose a fair-allocation framework that enables evaluation of the ethics of (...) current practices and could guide governments, professional societies, and physicians in allocation decisions. (shrink)

Action must be taken to combat climate change. Yet, how the costs of climate action should be allocated among states remains a question. One popular answer—the polluter-pays principle (PPP)—stipulates that those responsible for causing the problem should pay to address it. While intuitively plausible, the PPP has been subjected to withering criticism in recent years. It is timely, following the Paris Agreement, to develop a new version: one that does not focus on historical production-based emissions but rather allocates climate burdens (...) in proportion to each state’s annual consumption-based emissions. This change in carbon accounting results in a fairer and more environmentally effective principle for distributing climate duties. (shrink)

Hundreds of millions of rare biospecimens are stored in laboratories and biobanks around the world. Often, the researchers who possess these specimens do not plan to use them, while other researchers limit the scope of their work because they cannot acquire biospecimens that meet their needs. This situation raises an important and underexplored question: how should scientists allocate biospecimens that they do not intend to use? We argue that allocators should aim to maximise the social value of the research enterprise (...) when allocating scarce biospecimens. We provide an ethical framework for assessing the social value of proposed research projects and describe how the framework could be implemented. (shrink)

The U.S. FDA has issued emergency use authorizations for monoclonal antibodies for non-hospitalized patients with mild or moderate COVID-19 disease and for individuals exposed to COVID-19 as post-exposure prophylaxis. One EUA for an oral antiviral drug, molnupiravir, has also been recommended by FDA’s Antimicrobial Drugs Advisory Committee, and others appear likely in the near future. Due to increased demand because of the Delta variant, the federal government resumed control over the supply and asked states to ration doses. As future variants (...) with increased infectivity and/or severity emerge, further rationing may be required. We identify relevant ethical principles and priority groups for access to therapies based on an integrated approach to population health and medical factors. Using priority categories to allocate scarce therapies effectively operationalizes important ethical values. This strategy is preferable to the current approach of categorical rules based on vaccination, immunocompromise status, or older age, or the ad hoc consideration of clinical risk factors. (shrink)

Some Comments on de Melo-Martin and Harris.

The evolution of altruism in human societies has been intensively investigated in social and natural sciences. A widely acknowledged recent idea is the “parochial altruism model,” which suggests that inter- group hostility and intragroup altruism can coevolve through lethal intergroup conflicts. The current article critically examines this idea by reviewing research relevant to intergroup conflicts in human evolutionary history from evolutionary biology, psychology, cultural anthropology, and archaeology. After a brief intro- duction, section 2 illustrates the mathematical model of (...) parochial altruism and some critiques of the model and its interpretation, primarily from an evolutionary biology point of view. Section 3 delves into the archaeological evidence of prehistoric intergroup conflicts in the Japanese archipelago’s Jomon and Yayoi periods, Europe’s Mesolithic period, and North America’s Pacific period as counter examples of the paro- chial altruism model. In section 4, the ethnographies of intergroup relationships and conflicts reveal that intergroup relationships in many ethnic groups are not as simple as the assumption in the mathematical model of parochial altruism. In section 5, we outline psychological research on intergroup conflicts which suggest that intergroup hostility and ingroup altruism are not necessarily correlated. In conclusion, we argue that the assumption and parameter settings of the parochial altruism model are inconsistent with 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)

This paper considers the relation between the sources of normativity, reasons, and normative conflicts. It argues that common views about how normative reasons relate to their sources have important consequences for how we can understand putative normative conflicts.

In this paper, we address the moral justification problem concerning the use of age as a criterion for the allocation of scarce life-saving medical resources. We present and discuss four justifications that stand out in philosophical literature: efficiency, sufficiency, egalitarian, and prioritarian. We aim to demonstrate that all these justifications are unsatisfactory since they entail counterintuitive implications in cases involving fetuses and newborns. We then suggest another justification for the relevance of age based on the Time-Relative Interest Account of (...) the harm of death. Finally, we evaluate an objection that could limit the scope of the defended justification, leading us to draw a distinction between justification of harm and strict justification of harm. (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)

One of the popular albeit controversial ideas in the last century of moral philosophy is that what we ought to do is explained by our reasons. And one of the central features of reasons that accounts for their popularity among normative theorists is that they can conflict. But I argue that the fact that reasons conflict actually also poses two closely related problems for this popular idea in moral philosophy. The first problem is a generalization of a problem in deontic (...) logic concerning the existence of conflicting obligations. The second problem arises from a tension between the fact that reasons can conflict and a model of how reasons explain ‘ought’s that has been widely accepted. Having presented each of these problems, I develop a unified solution to them that is informed by results in both ethics and deontic logic. An important implication of this solution is that we must distinguish between derivative and nonderivative reasons and revise our conception how it is that reasons explain ‘ought’s. (shrink)

US citizens perceive their society to be one of the most diverse and religiously tolerant in the world today. Yet seemingly intractable religious intolerance and moral conflict abound throughout contemporary US public life - from abortion law battles, same-sex marriage, post-9/11 Islamophobia, public school curriculum controversies, to moral and religious dimensions of the Black Lives Matter and Occupy Wall Street movements, and Tea Party populism. Healthy Conflict in Contemporary American Society develops an approach to democratic discourse and coalition-building across deep (...) moral and religious divisions. Drawing on conflict transformation in peace studies, recent American pragmatist thought, and models of agonistic democracy, Jason Springs argues that, in circumstances riven with conflict between strong religious identities and deep moral and political commitments, productive engagement may depend on thinking creatively about how to constructively utilize conflict and intolerance. The result is an approach oriented by the recognition of conflict as a constituent and life-giving feature of social and political relationships. (shrink)

The thesis contains my early work arguing against evidentialism for reasons for belief (chapter 1), my early argument that rationality is not normative (chapter 2), an argument that rationality is not responding reasons, at least understood in one way (chapter 2), a general discussion of how normative conflicts might (appear to) arise in many different ways (chapter 3), a discussion of how to weigh pragmatic and evidential reasons for belief (chapter 4), and a discussion of the general structure of (...) normativity and its ramifications for understanding putative normative conflicts (chapter 4). At a more general level, the thesis aims to explore how putative normative conflicts might arise and whether they are genuine conflicts or only apparent. It also offers a defence of the view that there are genuine state-given reasons for propositional attitudes, including pragmatic reasons for belief. (shrink)

This paper shows that our popular account of weakness of will is inconsistent with dilemmas. In dilemmas, agents judge that they ought to do one thing, that they ought to do something else, and that they cannot do both. They must act against either of their two judgments. But such action is commonly understood as weakness of will. An agent is weak-willed in doing something if she judges that she ought to and could do something else instead. Thus, it seems (...) that, in a dilemma, the agent is weak-willed by definition. But this is puzzling: clearly, the two are different phenomena. The puzzle may support scepticism about weakness of will or dilemmas. Here, I argue that the two are consistent on a revised understanding of weakness of will. To do so, I further distinguish the mental states of an agent in a dilemma from those of a weak-willed person. (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)

The study investigated conflict management strategies and secondary school teachers’ job effectiveness in Obubra Local Government Area of Cross River State. Six null hypotheses were formulated to guide the study. The study adopted correlational and factorial research designs. Purposive sampling technique was used to select a sample of 222 teachers from a population of 352 secondary school teachers. Conflict Management Strategies Questionnaire (CMSQ) and Secondary School Teachers’ Job Effectiveness Questionnaire (SSTJEQ) were used respectively, as instruments for data collection. The hypotheses (...) were tested at .05 level of significance using Population t-test, Pearson Product Moment Correlation and Multiple Regression analyses. Findings revealed that, teachers’ job effectiveness level in Obubra Local Government Area is significantly high. Findings also revealed that arbitration, dialogue, and effective communication strategies respectively, had a significant relationship with secondary school teachers’ job effectiveness. Smoothing strategy had no significant relationship to secondary school teachers’ job effectiveness. The findings also revealed among others that; the four conflict management strategies (arbitration, dialogue, effective communication and smoothing) had a joint significant influence on secondary school teachers’ job effectiveness. Based on these findings, it was recommended among others that; secondary school principals should not rely totally on one conflict management strategy as the best for all situations, instead they should learn how to use various conflict management strategies, and apply them in any given conflict situation in their schools. (shrink)

Reserve systems are a tool to allocate scarce resources when stakeholders do not have a single objective. This paper introduces some basic concepts about reserve systems for pandemic medical resource allocation. At the onset of the Covid-19 pandemic, we proposed that reserve systems can help practitioners arrive at compromises between competing stakeholders. More than a dozen states and local jurisdictions adopted reserve systems in initial phases of vaccine distribution. We highlight several design issues arising in some of these implementations. (...) We also offer suggestions about ways practitioners can take advantage of the flexibility offered by reserve systems. (shrink)

Do epistemic and aesthetic values ever conflict? The answer might appear to be no, given that background knowledge generally enhances aesthetic experience, and aesthetic experience in turn generates new knowledge. As Keats writes, ‘Beauty is truth, truth beauty’ (Keats, 1996). Contra this line of thought, I argue that epistemic and aesthetic values can conflict when we over-rely on aesthetically enhancing background beliefs. The true and the beautiful can pull in different directions, forcing us to choose between flavours of normativity.

The study investigated administrators’ conflict management strategies utilization and job effectiveness of secondary school teachers in Obubra Local Government Area, Cross River State, Nigeria. Two research questions and null hypotheses were developed to guide the study. The study adopted factorial research design. Census technique was used in selecting the entire population of 464 secondary school teachers in the area. Conflict Management Strategies Utilization Questionnaire (CMSUQ) and Secondary School Teachers’ Job Effectiveness Questionnaire (SSTJEQ) were used respectively, as instruments for data collection. (...) The hypotheses were tested at .05 level of significance using Population t-test, and Multiple Regression analyses. Findings revealed that, teachers’ job effectiveness level in Obubra Local Government Area is significantly high. The findings also revealed among others that; the utilization of the three conflict management strategies (arbitration, dialogue, and effective communication) had a joint significant influence on secondary school teachers’ job effectiveness. Based on these findings, it was recommended among others that; secondary school principal should not rely wholly on one conflict management strategy, instead they should learn how to use various conflict management strategies and apply them based on the nature of conflict. (shrink)

Non‐governmental aid programs are an important source of health care for many people in the developing world. Despite the central role non‐governmental organizations play in the delivery of these vital services, for the most part they either lack formal systems of accountability to their recipients altogether, or have only very weak requirements in this regard. This is because most NGOs are both self‐mandating and self‐regulating. What is needed in terms of accountability is some means by which all the relevant stakeholders (...) can have their interests represented and considered. An ideally accountable decision‐making process for NGOs should identify acceptable justifications and rule out unacceptable ones. Thus, the point of this paper is to evaluate three prominent types of justification given for decisions taken at the Dutch headquarters of Médecins sans Frontières. They are: population health justifications, mandate‐based justifications and advocacy‐based justifications. The central question at issue is whether these justifications are sufficiently robust to answer the concerns and objections that various stakeholders may have. I am particularly concerned with the legitimacy these justifications have in the eyes of project beneficiaries. I argue that special responsibilities to certain communities can arise out of long‐term engagement with them, but that this type of priority needs to be constrained such that it does not exclude other potential beneficiaries to an undesirable extent. Finally, I suggest several new institutional mechanisms that would enhance the overall equity of decisions and so would ultimately contribute to the legitimacy of the organization as a whole. (shrink)

One hundred and ninety participants (95 undergraduates and 95 employees) responded to a factorial survey in which a number of case-based organizational allocation tasks were described. Participants were asked to imagine themselves as employees in fictitious organizations and chose among three allocations of employee development schemes invested by the manager in different work groups. The allocations regarded how such investments should be allocated between two parties. Participants chose twice, once picking the fairest and once the best allocation. One (...) between-subjects factor varied whether the parties represented social (i.e., choosing among allocations between two different work groups) or temporal comparisons (i.e., choosing among allocations between the present and the following year). Another between-subjects factor varied whether participants’ in-group was represented by the parties or not. One allocation maximized the outcome to one party, another maximized the joint outcome received by both parties, and a third provided both parties with equal but lower outcomes. It was predicted that equality, although always deficient to both parties, would be the preferred allocation when parties represented social comparisons and when choices were based on fairness. When parties represented temporal comparisons, and when choices were based on preference, maximizing the joint outcome was hypothesized to be the preferred allocation. Results supported these hypotheses. Against what was predicted, whether the in-group was represented by the parties or not did not moderate the results, indicating that participants’ allocation preferences were not affected by self-interest. The main message is that people make sensible distinctions between what they prefer and what they regard as fair. The results were the same for participating students who imagined themselves as being employees and participants who were true employees, suggesting that no serious threats to external validity are committed when university students are used as participants. (shrink)

With an increased emphasis on upstream activity and Defence Engagement, it has become increasingly more important for the UK Ministry of Defence (MOD) and government to understand the relationship between conflict and regional instability. As part of this process, the Historical and Operational Data Analysis Team (HODA) in Defence Science and Technology Laboratory (Dstl) was tasked to look at factors that influenced the regional spread of internal conflicts to help aid the decision making of government. Conflict contagion is the (...) process by which a conflict in one state (State A) influences the outbreak of conflict in another state (State B). The aim of looking at these factors was to produce a tool to assist in the cost/benefit analysis of intervening in future conflicts. The task was carried out by quantitatively studying a selection of contagion and non-contagion case studies over a set of 14 numerical variables that covered structural, political, socioeconomic and cultural factors of both States A and B. All case studies took place after the end of the Cold War. The dataset used contained both binary and continuous data. A range of statistical techniques were used including correlation, regression and principal component analyses along with graphical analytical methods. Unfortunately creating a tool to predict contagion has proven difficult and so the scope of the study was changed-as no statistically relevant link was found. However, it was shown that some links do exists between the variables and the existence of contagion, and it also appears it is a combination of variables which has an effect on the likelihood of contagion. Conflict contagion is a rare event and was only recorded in less than 1% of cases present in the dataset. Of the variables analysed, the most significant factor was the number of refugees present in State B who originated in State A for the year before the case study. It is recommended that further work be conducted. It is possible that a more detailed investigation, using a broader range of techniques and/or a wider selection of variables might be successful in assessing the likelihood of conflict contagion. (shrink)

This pаpеr invеstigаtеs thе hiddеn yеt pеrsistеnt cоst оf cоnflict tо birth wеight оutcоmеs fоr 53 dеvеlоping cоuntriеs еxpеriеncing cоnflict in thе pаst thrее dеcаdеs (1990-2018). Explоiting thе vаriаtiоn аcrоss districts аnd cоncеptiоn mоnths-yеаrs, wе find thаt intrаutеrinе еxpоsurе tо аrmеd cоnflict in thе first trimеstеr оf prеgnаncy rеducеs child’s wеight аt birth by 2.8% аnd rаisеs thе incidеncе оf lоw birth wеight by 3.2 pеrcеntаgе pоints. Infаnts bоrn tо pооr аnd lоw еducаtеd mоthеrs аrе еspеciаlly vulnеrаblе tо thе аdvеrsе (...) rеpеrcussiоns оf аrmеd cоnflict. Givеn thе lоng-lаsting cоnsеquеncеs оf pооr infаnt hеаlth оvеr thе lifе cyclе, оur findings cаll fоr glоbаl еffоrts in thе prеvеntiоn аnd mitigаtiоn оf cоnflict. Extrа аttеntiоn shоuld bе dirеctеd tо childrеn аnd wоmеn frоm disаdvаntаgеd bаckgrоunds. (shrink)

Suppose that two competing norms, N1 and N2, can be identified such that a given person’s response can be interpreted as correct according to N1 but incorrect according to N2. Which of these two norms, if any, should one use to interpret such a response? In this paper we seek to address this fundamental problem by studying individual variation in the interpretation of conditionals by establishing individual profiles of the participants based on their case judgments and reflective attitudes. To investigate (...) the participants’ reflective attitudes we introduce a new experimental paradigm called the Scorekeeping Task. As a case study, we identify the participants who follow the Suppositional Theory of conditionals (N1) versus Inferentialism (N2) and investigate to what extent internally consistent competence models can be reconstructed for the participants on this basis. After extensive empirical investigations, an apparent reasoning error with and-to-if inferences was found in one of these two groups. The implications of this case study for debates on the proper role of normative considerations in psychology are discussed. (shrink)

My paper provides reasons in support of the view that vague identity claims originate from a conflict between rigidity and precision in designation. To put this stricly, let x be the referent of the referential terms P and Q. Then, that the proposition “that any x being both a P and a Q” is vague involves that the semantic intuitions at work in P and Q reveal a conflict between P and Q being simultaneously rigid and precise designators. After having (...) shortly commented on an example of vague identity claim, I make the case for my proposal, by discussing how reference by baptism conflicts with descriptive attitudes towards understanding conceptual contents. (shrink)

This note is part of a discussion of Mark Solm's 'The Conscious Id'. -/- It seconds Solms' claim that recent work in neuroscience indicates that the subcortical mechanisms that generate motives also generate consciousness, and that his enables us to integrate neuroscience with the Freudian Ego and Id. -/- Still this is not reason to regard the Id as conscious. If we take full account of the role of conflict, as described in terms of the Freudian superego, we can see (...) that the complex role of aggression in human life ensures that much of our emotional life is unconscious. (shrink)

According to epistemic reductionism about practical reasons, facts about practical reasons can be reduced to facts about evidence for ought-judgements. We argue that this view misconstrues practical conflicts. At least some conflicts between practical reasons put us in a position to know that an action ϕ is optional, i.e. that we neither ought to perform nor ought to refrain from performing the action. By understanding conflicts of practical reasons as conflicts of evidence about what one ought (...) to do, epistemic reductionism fails to account for this. In conflict cases in which ϕ-ing is optional, epistemic reductionism suggests that we have equally strong evidence for and against assuming that we ought to ϕ, and thus cannot be in a position to know that it is not the case that we ought to ϕ. This is a serious flaw. (shrink)

This paper aims to show how Paul Ricoeur's hermeneutics, namely in the specificity of the Conflict of interpretations category, is a fruitful resource in the constitution of Women's Studies as well as to legitimize the need for its full integration in the canons of humanistic knowledge. In general, they continue to ignore the immense body of knowledge and perspectives that Women's Studies have produced in recent decades. In this sense, it begins by presenting the general features of the hermeneutic problematic (...) and the theme of Conflict of Interpretations, and then showing its proven contribution to the development of Women's Studies and defending its possible contribution to enhancing their integration into canons. (shrink)