The COVID-19 pandemic is a global contagion of unprecedented proportions and health, economic, and social consequences. As with many health problems, its impact is uneven. This article argues the C...

Health and Social Justice (Ruger 2009a) developed the ?health capability paradigm,? a conception of justice and health in domestic societies. This idea undergirds an alternative framework of social cooperation called ?shared health governance? (SHG). SHG puts forth a set of moral responsibilities, motivational aspirations, and institutional arrangements, and apportions roles for implementation in striving for health justice. This article develops further the SHG framework and explains its importance and implications for governing health domestically.

What are the respective roles and responsibilities of global, national, and local communities as well as individuals themselves to address health deprivations and avert health threats? This article offers the beginnings of a theory of global health justice, arguing for universal ethical norms (general duty) with shared global and domestic responsibility (specific duties) for health. It offers a global minimalist view I call ‘ provincial globalism ’ as a mean between nationalism and cosmopolitanism, in which a provincial consensus must accompany (...) a global consensus on health morality. This minimalist account asserts global and national duties to promote human flourishing and, more specifically, individuals’ central health capabilities. In this view, justice requires prioritizing responsibilities through shared health governance to reduce shortfall inequalities in central health capabilities — a general duty to reduce premature mortality and escapable morbidity. It examines the difficulties presented by the philosophical principles of connectedness, causality, remediation, partiality, and capacity in the allocation of responsibility for global health. It offers a theory of responsibility allocation based on a functional, health agency centered and homeostatic balanced understanding of the analytical components required to solve global health problems and parcels out roles and responsibilities at the global, national, local, and individual levels accordingly. Allocations of responsibility rest on the effectiveness and special obligations of different actors, respecting self-determination by groups and individuals and seeking voluntary commitments . This view understands that the remedy for global health problems must be sustainable to take nations and the global health community to a new global health equilibrium that remedies current problems and prepares for new health threats to come. (shrink)

While there is a growing body of work on moral issues and global governance in the fields of global justice and international relations, little work has connected principles of global health justice with those of global health governance for a theory of global health. Such a theory would enable analysis and evaluation of the current global health system and would ethically and empirically ground proposals for reforming it to more closely align with moral values. Global health governance has been framed (...) as an issue of national security, human security, human rights, and global public goods. The global health governance literature is essentially untethered to a theorized framework to illuminate or evaluate governance. This article ties global health justice and ethics to principles for governing the global health realm, developing a theoretical framework for global and domestic institutions and actors. (shrink)

The proper object of global health governance should be the common good, ensuring that all people have the opportunity to flourish. A well-organized global society that promotes the common good is to everyone’s advantage. Enabling people to flourish includes enabling their ability to be healthy. Thus, we must assess health governance by its effectiveness in enhancing health capabilities. Current GHG fails to support human flourishing, diminishes health capabilities and thus does not serve the common good. The provincial globalism theory of (...) health governance proposes a Global Health Constitution and an accompanying Global Institute of Health and Medicine that together propose to transform health governance. Multiple lines of empirical research suggest that these institutions would be effective, offering the most promising path to a healthier, more just world. (shrink)

Against a backdrop of non-ideal political and legal conditions, this article examines the health capability paradigm and how its principles can help determine what aspects of health care might legitimately constitute positive health care rights—and if indeed human rights are even the best approach to equitable health care provision. This article addresses the long American preoccupation with negative rights rather than positive rights in health care. Positive health care rights are an exception to the overall moral range and general thrust (...) of U.S. legal doctrine. Some positive rights to health care have arisen from U.S. Constitutional Eighth Amendment cases and federal and state laws like Medicare, Medicaid, the State Children’s Health Insurance Program, the Emergency Medical Treatment and Active Labor Act, and the Patient Protection and Affordable Care Act. Finally, this article discusses some of the difficulties inherent in implementing a positive right to health care in the U.S. (shrink)

There is a special need for solidarity at the global level to address global health disparities. Ter Meulen argues that solidarity must complement justice, and is, in fact, more fundamental than justice to the arrangement of health care practices. We argue that PG/SHG, though a theory of justice, is fundamentally synergistic with solidarity. We relate PG/SHG to Jodi Dean’s conceptual work on reflective solidarity, contrasted with conventional solidarity, as an approach to transnational solidarity that dovetails with PG/SHG. We argue that (...) PG/SHG meets both the need for solidarity at the global level and the need for solidarity within theories of the arrangement of health care practices. (shrink)

The American Journal of Bioethics, Volume 12, Issue 7, Page 65, July 2012.

In the past three decades, levels of and contributors to global health aid have increased at an unprecedented pace. Development assistance for health—financial contributions from public and private institutions to low‐ and middle‐income countries to help improve health and health systems—nearly quintupled from 1990 to 2012 (from $5.7 billion to $28.1 billion). DAH is now provided by more than one hundred seventy major global health agencies and organizations, 15 percent of which are private entities (such as the Bill and Melinda (...) Gates Foundation), other not‐for‐profit organizations, and public‐private partnerships. Governments are still the largest source for DAH. While increased DAH is essential and welcome, these system developments raise numerous ethical questions. Are the resources sustainable, and do expenditures target correct priorities? Who should decide, and how should these decisions be made?. (shrink)

While there is a growing body of work on moral issues and global governance in the fields of global justice and international relations, little work has connected principles of global health justice with those of global health governance for a theory of global health. Such a theory would enable analysis and evaluation of the current global health system and would ethically and empirically ground proposals for reforming it to more closely align with moral values. Global health governance has been framed (...) as an issue of national security, human security, human rights, and global public goods. The global health governance literature is essentially untethered to a theorized framework to illuminate or evaluate governance. This article ties global health justice and ethics to principles for governing the global health realm, developing a theoretical framework for global and domestic institutions and actors. (shrink)

The American Journal of Bioethics, Volume 11, Issue 7, Page W1-W3, July 2011.

This volume comprises a collection of ten essays by Allen Buchanan, and in some cases Buchanan and co-authors as well, on various topics under the general rubric of justice and health care. The essays were originally published over the span of some twenty-four years in various publication venues including edited books and journals in bioethics, public affairs, and law and policy. As Buchanan notes, the selected essays do not comprise an overall theory of justice and health care or justice and (...) health, and indeed a major motivation of this effort is to project a deep skepticism about the very task of attempting to put forth such a theory, which Buchanan eschews as too ambitious. He offers instead a more "modest" "thought-journey" to gain "a deeper appreciation of the complexities of thinking systematically, self-critically, and realistically about justice in health care". (shrink)

Jennifer Prah Ruger (2011) rightly points out that social cooperation is essential for achieving health justice. But she is unhappy with the approach to cooperation that social scientists and philosophers have taken. Her main objection is that their models are based on narrow self-interest. Her own proposal, which she calls "shared health governance", is based on public moral norms instead. If individuals and institutions internalized and followed such norms, justice in health could be achieved. -/- In this (...) commentary, I show that Ruger fundamentally misdiagnoses the problem of social cooperation and health justice. Because of the faulty diagnosis, her own proposal is at best unworkable, at worst utopian. (shrink)

Jennifer Prah Ruger's book Health and Social Justice is a substantial contribution to the emerging scholarship at the intersection of health issues and the philosophy of social justice. This area has been getting increasing attention which is partially evidenced by the growing number of monographs being published on the subject. Prah Ruger proposes a bold and expansive theory of justice and health care policy that is informed by health economics, public policy, political science, and legal (...) and political philosophy. The book should interest individuals seeking to bridge health care policy with social justice debates, public health ethicists, and political philosophers interested in population level health issues. (shrink)

Do we have a legal and moral right to health care against others? There are international conventions and institutions that say emphatically yes, and they summarize this in the expression of “the right to health,” which is an established part of the international human rights canon. The International Covenant on Social and Economic Rights outlines this as “the right of everyone to the enjoyment of the highest attainable standard of physical and mental health,” but declarations such as this remain tragically (...) unfulfilled. According to recent figures, roughly two billion people lack access to essential drugs or to primary health care. Millions are afflicted by infections and illnesses that are easily avoidable or treatable. In the developing world many children die or grow stunted and damaged for lack of available treatments. Tropical diseases receive little or no attention by the major pharmaceutical companies’ research departments. Is this a massive violation of the right to health? And if so, why does it attract so little attention? Is it because our supposed commitment to human rights and the rule of law is hypocritical and hollow? Or is it because the right to health is a special case of a right, so that these tragedies are no violation at all? Jennifer Prah Ruger summarized this puzzle when she wrote: “one would be hard pressed to find a more controversial or nebulous human right than the right to health.” In this essay I discuss three different theories of a right to health care. I conclude by offering my own reconstruction of one such theory. (shrink)

The need for informed analyses of health policy is now greater than ever. The twelve essays in this volume show that public debates routinely bypass complex ethical, sociocultural, historical, and political questions about how we should address ideals of justice and equality in health care. Integrating perspectives from the humanities, social sciences, medicine, and public health, this volume illuminates the relationships between justice and health inequalities to enrich debates. Understanding Health Inequalities and Justice explores three questions: How do scholars approach (...) relations between health inequalities and ideals of justice? When do justice considerations inform solutions to health inequalities, and how do specific health inequalities affect perceptions of injustice? And how can diverse scholarly approaches contribute to better health policy? From addressing patient agency in an inequitable health care environment to examining how scholars of social justice and health care amass evidence, this volume promotes a richer understanding of health and justice and how to achieve both. -/- The contributors are Judith C. Barker, Paula Braveman, Paul Brodwin, Jami Suki Chang, Debra DeBruin, Leslie A. Dubbin, Sarah Horton, Carla C. Keirns, J. Paul Kelleher, Nicholas B. King, Eva Feder Kittay, Joan Liaschenko, Anne Drapkin Lyerly, Mary Faith Marshall, Carolyn Moxley Rouse, Jennifer Prah Ruger, and Janet K. Shim. (shrink)

The central role of Health Care Analysis is to advance discourses between philosophy, health, and policy. Within that very wide-ranging agenda, perhaps the most complex challenges are in global health. In countries across the world, many, many populations are unable to enjoy conditions in which they can be healthy. The barriers to change are political, economic, social, regulatory, legal, and philosophical. Lawrence Gostin’s recent book on Global Health Law therefore marks a contribution of the highest importance, marrying practical and philosophical (...) agendas, and aiming at achieving global health with justice. -/- To progress the important work of Gostin’s book, the current journal issue draws together leading scholars in moral and political philosophy, economics, and law, with a shared interest in questions of global justice. In the first paper, Eric Friedman and Lawrence Gostin provide a clear overview of the practical and theoretical global health challenges and their response to these. Their analysis is followed by stimulating contributions from Norman Daniels, Jennifer Prah Ruger, Shawn Harmon, Attiya Waris and Laila Abdul Latif, Heather Widdows, and A.M. Viens, each engaging with questions raised by Global Health Law. The different papers underscore the significance of this area of inquiry, and the imperative to bring insights from scholarly work into global health practice. (shrink)

In her target article “Shared health governance” (AJOB 11(7): 32-45, 2011) and in her book Health and Social Justice (2009), Jennifer Prah Ruger defends an original model of governance dubbed “Shared Health Governance” (SHG). This model borrows elements from many other models of governance, and one may wonder what is the secret sauce that holds together these diverse ingredients. In response, Ruger would perhaps ultimately turn to public moral norms. My comment raises some concerns about the (...) function and content of these norms in her model and their connection to her claims about shared sovereignty within SHG. (shrink)

Contemporary literature in philosophy of action seems to be divided overthe place of action in the natural causal world. I think that a disagreementabout ontology underlies the division. I argue here that human action isproperly understood only by reference to a category of process or activity,where this is not a category of particulars.

Utilitarianism is often criticized because of its reliance on the interpersonal aggregation of harms and benefits. However, since the rejection of all forms of interpersonal aggregation strikes most people as implausible, some critics of utilitarianism have proposed theories of Limited Aggregation. These occupy the middle ground between fully aggregative and non-aggregative views. Recently, Limited Aggregation has been criticized for having counterintuitive implications that seem even worse than the counterintuitive implications of fully aggregative and non-aggregative views it tried to escape. I (...) here propose a new view of Limited Aggregation that does better than existing accounts in this regard. It is more modest than existing accounts of Limited Aggregation, but it retains the view's core idea. This, I claim, is the thought that sometimes very strong individual claims stand in the way of realizing the best outcome. (shrink)

Ex ante contractualism holds that in situations involving risk we ought to act in accordance with principles that license the action that satisfies the strongest individual claim, where those claims are a function of the expected value that a given policy gives each person ex ante. I here challenge ex ante contractualism on contractualist grounds. I argue that adopting ex ante contractualism would have far reaching implications that contractualists, or many nonconsequentialist in general, would find very hard to accept. I (...) conclude that to block these implications, contractualists should adopt an ex post approach to deal with decisions under risk. (shrink)

Testimony is an invaluable source of knowledge. We rely on the reports of those around us for everything from the ingredients in our food and medicine to the identity of our family members. Recent years have seen an explosion of interest in the epistemology of testimony. Despite the multitude of views offered, a single thesis is nearly universally accepted: testimonial knowledge is acquired through the process of transmission from speaker to hearer. In this book, Jennifer Lackey shows that this (...) thesis is false and, hence, that the literature on testimony has been shaped at its core by a view that is fundamentally misguided. She then defends a detailed alternative to this conception of testimony: whereas the views currently dominant focus on the epistemic status of what speakers believe, Lackey advances a theory that instead centers on what speakers say. The upshot is that, strictly speaking, we do not learn from one another's beliefs - we learn from one another's words. Once this shift in focus is in place, Lackey goes on to argue that, though positive reasons are necessary for testimonial knowledge, testimony itself is an irreducible epistemic source. This leads to the development of a theory that gives proper credence to testimony's epistemologically dual nature: both the speaker and the hearer must make a positive epistemic contribution to testimonial knowledge. The resulting view not only reveals that testimony has the capacity to generate knowledge, but it also gives appropriate weight to our nature as both socially indebted and individually rational creatures. The approach found in this book will, then, represent a radical departure from the views currently dominating the epistemology of testimony, and thus is intended to reshape our understanding of the deep and ubiquitous reliance we have on the testimony of those around us. (shrink)

Intuitively, there is a difference between knowledge and mere belief. Contemporary philosophical work on the nature of this difference has focused on scenarios known as “Gettier cases.” Designed as counterexamples to the classical theory that knowledge is justified true belief, these cases feature agents who arrive at true beliefs in ways which seem reasonable or justified, while nevertheless seeming to lack knowledge. Prior empirical investigation of these cases has raised questions about whether lay people generally share philosophers’ intuitions about these (...) cases, or whether lay intuitions vary depending on individual factors (e.g. ethnicity) or factors related to specific types of Gettier cases (e.g. cases that include apparent evidence). We report an experiment on lay attributions of knowledge and justification for a wide range of Gettier Cases and for a related class of controversial cases known as Skeptical Pressure cases, which are also thought by philosophers to elicit intuitive denials of knowledge. Although participants rated true beliefs in Gettier and Skeptical Pressure cases as being justified, they were significantly less likely to attribute knowledge for these cases than for matched true belief cases. This pattern of response was consistent across different variations of Gettier cases and did not vary by ethnicity or gender, although attributions of justification were found to be positively related to measures of empathy. These findings therefore suggest that across demographic groups, laypeople share similar epistemic concepts with philosophers, recognizing a difference between knowledge and justified true belief. (shrink)

Civil society organizations (CSOs) have significantly impacted on the politics of health research and the field of bioethics. In the globalHIVepidemic,CSOs have served a pivotal stakeholder role. The dire need for development of new prevention technologies has raised critical challenges for the ethical engagement of community stakeholders inHIVresearch. This study explored the perspectives ofCSOrepresentatives involved inHIVprevention trials (HPTs) on the impact of premature trial closures on stakeholder engagement. Fourteen respondents fromSouthAfrican and internationalCSOs representing activist and advocacy groups, community mobilisation initiatives, (...) and human and legal rights groups were purposively sampled based on involvement inHPTs. Interviews were conducted fromFebruary‐May 2010. Descriptive analysis was undertaken across interviews and key themes were developed inductively.CSOrepresentatives largely described positive outcomes of recent microbicide andHIVvaccine trial terminations, particularly inSouthAfrica, which they attributed to improvements in stakeholder engagement. Ongoing challenges to community engagement included the need for principled justifications for selective stakeholder engagement at strategic time‐points, as well as the need for legitimate alternatives toCABs as mechanisms for engagement. Key issues forCSOs in relation to research were also raised. (shrink)

Once symbolized by a burning armchair, experimental philosophy has in recent years shifted away from its original hostility to traditional methods. Starting with a brief historical review of the experimentalist challenge to traditional philosophical practice, this chapter looks at research undercutting that challenge, and at ways in which experimental work has evolved to complement and strengthen traditional approaches to philosophical questions.

Introduction -- Elucidating complexity theories -- Complexity in the natural sciences -- Complexity in social theory -- Towards transdisciplinarity -- Complexity in philosophy: complexification and the limits to knowledge -- Complexity in ethics -- Earth in the anthropocene -- Complexity and climate change -- American dreams, ecological nightmares and new visions -- Complexity and sustainability: wicked problems, gordian knots and synergistic solutions -- Conclusion.

Jennifer Hornsby offers here detailed discussions of ontology, human agency, and everyday psychological explanation. In her distinctive view of questions about the mind's place in nature she argues for a particular position in philosophy of mind: naive naturalism.

In this collection of original essays, international scholars put Asian traditions, such as Hinduism, Buddhism, Daoism, and Confucianism, into conversation with one or more contemporary feminist philosophies, founding a new mode of inquiry that attends to diverse voices and the complex global relationships that define our world. -/- These cross-cultural meditations focus on the liberation of persons from suffering, oppression, illusion, harmful conventions and desires, and other impediments to full personhood by deploying a methodology that traverses multiple philosophical styles, historical (...) texts, and frames of reference. Hailing from the discipline of philosophy in addition to Asian, gender, and religious studies, the contributors offer a fresh take on the classic concerns of free will, consciousness, knowledge, objectivity, sexual difference, embodiment, selfhood, the state, morality, and hermeneutics. One of the first anthologies to embody the practice of feminist comparative philosophy, this collection creatively and effectively engages with global, cultural, and gender differences within the realms of scholarly inquiry and theory construction. -/- http://cup.columbia.edu/book/978-0-231-16624-9/asian-and-feminist-philosophies-in-dialogue. (shrink)

A disjunctivist conception of acting for reasons is introduced by way of showing that a view of acting for reasons must give a place to knowledge. Two principal claims are made. 1. This conception has a rôle analogous to that of the disjunctive conception that John McDowell recommends in thinking about perception; and when the two disjunctivist conceptions are treated as counterparts, they can be shown to have work to do in combination. 2. This conception of acting for reasons safeguards (...) the connection between considerations that move us to act in particular ways and considerations that favour our acting in particular ways. (shrink)

Popular science in Nuremberg at the end of the 18th century exemplifies a little known German scientific culture: as in English und French towns, public lectures in natural philosophy and experimental demonstrations were offered to an interested bourgeois audience; the production of scientific toys flourished. The career of Johann Konrad Gütle, private teacher, itinerant lecturer and instrument maker, illustrates the popular scientific scene in Enlightenment Nuremberg.

How, in a secular world, should we resolve ethically controversial and troubling issues relating to health care? Should we, as some argue, make a clean sweep, getting rid of the Hippocratic ethic, such vestiges of it as remain? Jennifer Jackson seeks to answer these significant questions, establishing new foundations for a traditional and secular ethic which would not require a radical and problematic overhaul of the old. These new foundations rest on familiar observations of human nature and human needs. (...) Jackson presents morality as a loose anatomy of constituent virtues that are related in different ways to how we fare in life, and suggests that in order to address problems in medical ethics, a virtues-based approach is needed. Throughout, attention is paid to the role of philosophy in medical ethics, and how it can be used to clarify key notions and distinctions that underlie current debates and controversial issues. By reinstating such concepts as justice, cardinal virtue, and moral duty, Jackson lays the groundwork for an ethics of health care that makes headway toward resolving seeming dilemmas in medical ethics today. This penetrating and accessible book will be invaluable to students of sociology and health care, as well as those who are interested in the ethical uncertainties faced by the medical world. (shrink)

Do epistemic intuitions tell us anything about knowledge? Stich has argued that we respond to cases according to our contingent cultural programming, and not in a manner that tends to reveal anything significant about knowledge itself. I’ve argued that a cross-culturally universal capacity for mindreading produces the intuitive sense that the subject of a case has or lacks knowledge. This paper responds to Stich’s charge that mindreading is cross-culturally varied in a way that will strip epistemic intuitions of their evidential (...) value. I argue that existing work on cross-cultural variation in mindreading favors my position over Stich’s. (shrink)

The apparent underdetermination of the formalism of quantum field theory (QFT) as between a particle and a field interpretation is studied in this paper through a detour over the problem of unifying QFT with general relativity. All we have at present is a partial or approximate unification, QFT in non-Minkowskian spaces. The nature of this hybrid and the problem of its internal consistency are discussed. One of its most striking implications is that particles do not have an observer-independent existence. We (...) trace the ways in which physicists reacted to this at first highly implausible ontological consequence. We conclude that quantum fields rather than particles are after all the basic entities in QFT. (shrink)

This essay explores the speech act of dogwhistling (sometimes referred to as ‘using coded language’). Dogwhistles may be overt or covert, and within each of these categories may be intentional or unintentional. Dogwhistles are a powerful form of political speech, allowing people to be manipulated in ways they would resist if the manipulation was carried outmore openly—often drawing on racist attitudes that are consciously rejected. If philosophers focus only on content expressed or otherwise consciously conveyed they may miss what is (...) most powerful and pernicious in the speech of political culture. This essay is a call to start paying attention to these more covert speech acts, and a first attempt at beginning to theorize them. It argues that dogwhistles present a complex and interesting case for the philosopher of language, and explores their implications for democratic politics. (shrink)

'This book not only revises the interpretation of Dewey's ethics but also has relevance to recent discussions about the possibility of naturalistic, ...

To what extent should we trust our natural instincts about knowledge? The question has special urgency for epistemologists who want to draw evidential support for their theories from certain intuitive epistemic assessments while discounting others as misleading. This paper focuses on the viability of endorsing the legitimacy of Gettier intuitions while resisting the intuitive pull of skepticism – a combination of moves that most mainstream epistemologists find appealing. Awkwardly enough, the “good” Gettier intuitions and the “bad” skeptical intuitions seem to (...) be equally strong. This chapter argues that it is not a coincidence that these two types of intuition register with equal force: they are generated by a common mechanism. However, the input to this mechanism is interestingly different in the two types of case, and different in a way that can support the mainstream view that Gettier cases tell us something about knowledge where skeptical intuitions involve systematic error. (shrink)

In this article I explore various facets of Nozick’s famous thought experiment involving the experience machine. Nozick’s original target is hedonism—the view that the only intrinsic prudential value is pleasure. But the argument, if successful, undermines any experientialist theory, i.e. any theory that limits intrinsic prudential value to mental states. I first highlight problems arising from the way Nozick sets up the thought experiment. He asks us to imagine choosing whether or not to enter the machine and uses our choice (...) (or rather the choice he assumes most people will have) as evidence against experientialist theories. But for this strategy to succeed it must be possible to distinguish between self-interested and non-self-interested reasons for declining to enter the machine, and there is no obvious way to do this without begging the question against the hedonist. In successive sections I then (a) consider a common misconception of Nozick’s conclusion (that he thinks machine life is the worst life), (b) consider different intuitions about what is important to well-being but missing from machine life, and finally (c) explain what “the experience requirement” is, and describe its relationship to debates about experientialist theories. (shrink)

Timothy Murphy argues in his article “In Defense of Irreligious Bioethics” (2012) that the role of religion in normative bioethics should be limited and that a viable means for limiting its role (o...

Despite the conceptual problems in identifying the placebo effect, an increasing number of multidisciplinary inquiries rest on the assumption that there is a distinct class of effects, placebo effects. In this chapter, I argue against this assumption. I present cases and characterizations of the placebo effect as offered in the literature, and argue that the latter are subject to insurmountable problems. Moreover, I argue that identification of placebo effects as such is not useful for the three main purposes offered in (...) the literature. I then offer suggestions for why it may remain intuitive that some effects are placebo effects and close by noting the potential benefits of ultimately explaining away these intuitions. (shrink)

This chapter explores radical personal change and its relationship to well-being, welfare, or prudential value. Many theorists of welfare are committed to what is here called the future-based reasons view (FBR), which holds (1) that the best prudential choice in a situation is determined by which possible future has the greatest net welfare value for the subject and (2) what determines facts about future welfare are facts about the subject and the world at that future time. Although some cases of (...) radical change are intuitively prudentially good, many cases of really radical change are not. Yet FBR has trouble explaining this. Many people instinctively reach for the notion of identity to solve this problem—arguing that really radical change cannot be good because it alters who someone is. Yet, as the chapter argues, there are reasons to doubt that appeals to identity are appropriate. The chapter ends with the suggestion that prudential facts may explain why and when retaining identity matters, rather than the other way around, and points to a possible way forward for a theorist of welfare committed to FBR. (shrink)