Vulnerability has been extensively discussed in medical research, but less so in health care. Thus, who the vulnerable in this domain are still remains an open question. One difficulty in their identification is due to the general criticism that vulnerability is not a property of only some, but rather of everyone. By presenting a philosophical analysis of the conditions of vulnerability ascription, we show that these seemingly irreconcilable understandings of vulnerability are not contradictory. Rather, they are interdependent: they refer to (...) the same concept with different likelihoods of manifestation. We argue that the general vulnerability of living beings relies on their having certain types of interests. In health care, those individuals are particularly vulnerable who are more likely to have these interests unjustly considered. They should be afforded special protection in order to receive what is due to everyone, but which they are likely to fail to receive. (shrink)

Sometimes physicians lie to third-party payers in order to grant their patients treatment they would otherwise not receive. This strategy, commonly known as gaming the system, is generally condemned for three reasons. First, it may hurt the patient for the sake of whom gaming was intended. Second, it may hurt other patients. Third, it offends contractual and distributive justice. Hence, gaming is considered to be immoral behavior. This article is an attempt to show that, on the contrary, gaming may sometimes (...) be a physician's duty. Under specific circumstances, gaming may be necessary from the viewpoint of the internal morality of medicine. Moreover, the objections against gaming are examples of what we call the idealistic fallacy, that is, the fallacy of passing judgments in a nonideal world according to ideal standards. Hence, the objections are inconclusive. Gaming is sometimes justified, and may even be required in the name of beneficence. (shrink)

In the literature on medical ethics, it is generally admitted that vulnerable persons or groups deserve special attention, care or protection. One can define vulnerable persons as those having a greater likelihood of being wronged – that is, of being denied adequate satisfaction of certain legitimate claims. The conjunction of these two points entails what we call the Special Protection Thesis. It asserts that persons with a greater likelihood of being denied adequate satisfaction of their legitimate claims deserve special attention, (...) care or protection. Such a thesis remains vague, however, as long as we do not know what legitimate claims are. This article aims at dispelling this vagueness by exploring what claims we have in relation to health care – thus fleshing out a claim-based conception of vulnerability. We argue that the Special Protection Thesis must be enriched as follows: If individual or group X has a greater likelihood of being denied adequate satisfaction of some of their legitimate claims to physical integrity, autonomy, freedom, social provision, impartial quality of government, social bases of self-respect or communal belonging, then X deserves special attention, care or protection. With this improved understanding of vulnerability, vulnerability talk in healthcare ethics can escape vagueness and serve as an adequate basis for practice. (shrink)

Il s’agit ici de présenter une version raffinée du libéralisme de la peur de Judith Shklar : le libéralisme de la prudence. Après en avoir brièvement présenté les grandes lignes et les principales faiblesses, j’esquisse les contours du libéralisme de la prudence et montre comment il réalise, mieux que libéralisme de la peur, le programme minimaliste poursuivi par Shklar. Je montre ensuite comment le libéralisme de la prudence nous permet de sortir du dilemme libéral posé par la tradition postrawlsienne : (...) justifier le libéralisme sur des bases morales, au risque de le priver de neutralité, ou le justifier sur des bases réalistes hobbesiennes, au risque d’en faire l’otage des rapports de force changeants. Enfin, j’examine comme le principal défaut apparent du libéralisme de la prudence – à savoir son ascétisme programmatique – est en fait son principal mérite. (shrink)

Je propose ici un argument « dilemmatique » en faveur de l’anti-paternalisme libéral. Soit il est vrai, comme le soutiennent les kantiens, que les règles impersonnelles, impartiales et universelles jouissent d’une priorité éthique ; soit il est vrai, comme le soutiennent des communautariens comme MacIntyre, que de telles règles ne jouissent pas d’une priorité éthique. Si les kantiens ont raison, alors – comme le veut la sagesse conventionnelle des manuels de philosophie politique – la neutralité de l’Etat à l’endroit des (...) conceptions du bien est justifiée. Et si les communautariens ont raison, alors – étonnamment – la neutralité de l’Etat est aussi justifiée. Donc la neutralité de l’Etat est justifiée. La première prémisse étant tautologique, elle s’impose d’elle-même. La seconde prémisse, établissant un lien entre priorité des règles universelles et neutralité de l’Etat, est trop connue pour retenir ici notre attention. La troisième prémisse, en revanche, établissant un lien entre la non-priorité des règles universelles et la neutralité de l’Etat, sonne comme un paradoxe. C’est donc sur elle que portera l’examen.I shall offer here a “dilemmatic” argument for liberal anti-paternalism. Either it is the case – as Kantians maintain – that impersonal, impartial and universal rules enjoy ethical priority ; or it is the case – as Communitarians like MacIntyre maintain – that universal rules do not enjoy any such priority. If Kantians are right, then – as suggested by the conventional wisdom of textbooks in political philosophy – State-neutrality towards conceptions of the good is justified. And if Communitarians are right, then – surprisingly – State-neutrality is justified too. Therefore State-neutrality is justified. The first premiss is tautological, and needs no special study. The second premiss, linking the priority of universal rules to State-neutrality, is too well known to deserve our attention. But the third premiss, linking the non-priority of universal rules to State-neutrality, sounds like a paradox. The paper thus focuses on that third controversial premiss. (shrink)