The arguments used by Gavin Mooney in his scornful response to Castigating QALYs, are examined. In spite of the rhetoric there is a broad measure of agreement about the deficiencies of QALYs as a means of distributing scarce resources. The main area of conflict is that John Rawles favours compaigning for more resources while Gavin Mooney, constrained by his remit as a health economist, favours acceptance of the present level of funding and better methods of distributing resources.

The “prescription” of humans' social learning bifocals is fine-tuned by cultural norms and, as a result, the readiness with which the instrumental or conventional lenses are used to view behavior differs across cultures. We present evidence for this possibility from cross-cultural work examining children's imitation and innovation.

The ethical problem of how to apportion limited resources amongst the needy has been forced on us by arbitrary limitation of health expenditure. Its solution would not be required if health expenditure were higher. Distribution of resources according to best value for money, assessed as Quality Adjusted Life Years (QALYs) per unit cost, has been suggested as a possible solution, but leads to absurd anomalies. In the calculation of QALYs the implied value of life is no more than the absence (...) of suffering. The use of QALYs for the comparison of treatments that are symptomatic or life-saving therefore leads to serious undervaluation of life and treatments that prolong it. Moreover, distribution of resources by best value for money, however assessed, is inequitable since for a given degree of suffering those whose illnesses happen to be cheaper to treat will be treated in preference to those whose treatments are more expensive. (shrink)

Editors provide a substantive introduction to the history and theories of perfectionism and neutrality, expertly contextualizing the essays and making the collection accessible.

The Last Gift is an observational HIV cure-related research study conducted with people with HIV at the end of life (EOL) at the University of California San Diego. Participants agree to voluntarily donate blood and other biospecimens while living and their bodies for a rapid research autopsy postmortem to better understand HIV reservoir dynamics throughout the entire body. The Last Gift study was initiated in 2017. Since then, 30 volunteers were enrolled who are either (1) terminally ill with a concomitant (...) condition and have a prognosis of 6 months or less or (2) chronically ill with multiple comorbidities and nearing the EOL.Multiple ethical and logistical challenges have been revealed during this time; here, we share our lessons learnt and ethical analysis. Issues relevant to healthcare research include surrogate informed consent, personal and professional boundaries, challenges posed conducting research in a pandemic, and clinician burnout and emotional support. Issues more specific to EOL and postmortem research include dual roles of clinical care and research teams, communication between research personnel and clinical teams, legally required versus rapid research autopsy, identification of next of kin/loved ones and issues of inclusion. Issues specific to the Last Gift include logistics of body donation and rapid research autopsy, and disposition of the body as a study benefit.We recommend EOL research teams to have clear provisions around surrogate informed consent, rotate personnel to maintain boundaries, limit direct contact with staff associated with clinical care and have a clear plan for legally required versus research autopsies, among other recommendations. (shrink)

The question 'Why should I obey the law?' introduces a contemporary puzzle that is as old as philosophy itself. The puzzle is especially troublesome if we think of cases in which breaking the law is not otherwise wrongful, and in which the chances of getting caught are negligible. Philosophers from Socrates to H.L.A. Hart have struggled to give reasoned support to the idea that we do have a general moral duty to obey the law but, more recently, the greater number (...) of learned voices has expressed doubt that there is any such duty, at least as traditionally conceived. (shrink)

The Rawls–Habermas debate is having a revival. In this article I argue that both philosophers develop different freestanding conceptions of political legitimacy, and show how they diverge when it comes to how political legitimacy can be justified. Habermas is looking for a deeper justification than Rawls will allow for. I then proceed to show how the different meta-ethical positions yield two different versions of democratic theory, focusing in particular on rights and popular sovereignty. I demonstrate how both conceive (...) of the co-originality of private and public autonomy, and subsequently take issue with Habermas’ reading of Rawls. I argue that Rawls should not be understood as a natural rights theorist, that Habermas misunderstands the role of the original position, and that Rawls cannot be considered a strong constitutionalist. Thus, the real difference between Rawls and Habermas revolves around their different conceptions of political legitimacy. (shrink)

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

In 1971 John Rawls's A Theory of Justice transformed twentieth-century political philosophy, and it ranks among the most influential works in the history of the subject. This volume marks the 50th anniversary of the book's publication by offering a multi-faceted exploration of this important work.

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

Scanlon suggests a buck-passing account of goodness. To say that something is good is not to give a reason to, say, favour it; rather it is to say that there are such reasons. When it comes to wrongness, however, Scanlon rejects a buck-passing account: to say that j ing is wrong is, on his view, to give a sufficient moral reason not to j. Philip Stratton-Lake 2003 argues that Scanlon can evade a redundancy objection against his (Scanlon’s) view of wrongness (...) by adopting a buck-passing account of wrongness. We argue that this manoeuvre does not succeed. Scanlon’s notion of wrongness rests on the idea of a reasonably rejectable principle. As Stratton-Lake points out, Scanlon offers two accounts, one in terms of permission, the other in terms of proscription. The permission account is tricky to formulate. Scanlon’s account (quoted in Stratton-Lake 2003: 71) might suggest any of the following four formulations (where the principles in question are principles ‘governing how one may act’ (Scanlon.. (shrink)

The fragility of democracy and the political aesthetics of public art -- Voices and places: the space of public art and Wodiczko's the homeless projection -- Democracy's "empty place": Rawls's political liberalism and Derrida's democracy to come -- Public art's "plain tablet": the political aesthetics of contemporary art -- Democracy and public art: Badiou and Ranciere -- The political aesthetics of Chicago's Millennium Park -- The political aesthetics of New York's National 9/11 Memorial -- Public art as an act (...) of citizenship -- Badiou on "being and the void.". (shrink)

Equality and Liberty: Analysing Rawls and Nozick is an indispensable source for those seriously interested in some rigorous assessments of the ideas of America's two most popular political philosophers. The essays in this volume cover a wide range of topics, some engaging each other in their analyses of particular Rawlsian or Nozickian themes. This collection of recent essays brings the student up-to-date concerning some of the more recent developments and assessments of Rawlsian and Nozickian ideas.

Several areas of welfare economics seek to evaluate states of affairs as a function of interpersonally comparable individual utilities. The aim is to map each state of affairs onto a vector of individual utilities, and then to produce an ordering of these vectors that can be represented by a mathematical function assigning a real number to each. When this approach is used in intertemporal contexts, a central theoretical question concerns the evaluative weight to be applied to utility coming at different (...) times. This question concerns the rate of pure time preference, which is one key determinant of the social discount rate. This article argues that the standard philosophical account of pure time preference is mistaken, because it ascribes to economists a methodological commitment they need not, and often do not, accept. This in turn undercuts the most common philosophical objection to pure time preference, which traces at least to Rawls’s A Theory of Justice. The article then evaluates three further objections to pure time preference, concluding that it might still be defensible under certain circumstances. The article closes by articulating a final argument that is suggested by the “Social, Economic and Ethical Concepts and Methods” chapter of the most recent Intergovernmental Panel on Climate Change report. If this further argument is sound, it would constitute a decisive objection to pure time preference as it currently figures in much intertemporal welfare economics. (shrink)

After some preliminaries concerning the original character of Rawls's formulation of the problem of social justice the author discusses the question, whether the proposed principles of justice for the basic structure of society bear the marks of a liberal theory.The conclusion of this part (IA) is that Rawls seems to have in view a mixed society, or perhaps rather a society which transcends the contrast between liberalism and socialism.Some critics have ascribed to Rawls the view of man (...) of classical liberalism and for this reason have considered him a liberal. The author contends that these critics do not seem to have grasped the purely methodological significance of the concept of the original position. After some preliminaries concerning the original character of Rawls's formulation of the problem of social justice the author discusses the question, whether the proposed principles of justice for the basic structure of society bear the marks of a liberal theory.The conclusion of this part (IA) is that Rawls seems to have in view a mixed society, or perhaps rather a society which transcends the contrast between liberalism and socialism.Some critics have ascribed to Rawls the view of man of classical liberalism and for this reason have considered him a liberal. The author contends that these critics do not seem to have grasped the purely methodological significance of the concept of the original position. After a short interlude in which the conceptions of justice of Marx and Rawls are compared (IB) the author presents some considerations of a critical nature as regards the principles of justice (IC). The distinction between the general and the special conception of justice hinges on the lixical priority of freedom. Now, a contradiction seems to emerge between the fact that the choice in favor of the special conception is an absolute one, valid for all societies regardless of time and place, and the fact that the general conception is sometimes presented as a first phase in the evolution of a well-ordered society (sect.82). This is an indication that in Rawl's theory the priority of freedom is not as absolute as he thinks it to be. The decisive point in this respect seems to be the fact that the „fair value of liberty” (Sect. 36) would demand that a subsistence minimum is lexically prior to freedom. These seem to be serious inconsistencies for which nnno remedy can be found and which are apt to lead us back to „instuitionism” The author considers next (and this is his main point) the logical structure of Rawls's contract theory, which in his opinion stands in urgent need of clarification. It is argued that the concept of contract as such implies a certain indifference or indeterminateness as regards its result. At the other hand, the result (that which is agreed upon, i.e. the principles of justice) is ex hypothesi considered to explain „our considered judgements” in reflective equilibrium. In this way it appears that Rawl's central idea (rather implicitly) is : there exists a consensus as regards our considered judgements concerning justice and this consensus may be explained as resulting from a (hypothetical) contract. So the argument really is of a hypothetico-deductive nature and it would have been much better if Rawls had been clear about it himself. Some critical considerations follow. First attention is paid to the fact that strict observance is an essential element of the concept of contract and that from this point of view the three psychological laws (chapt. VIII) are of crucial importance to the theory. Their nature, however, is not altogether clear. They are neither empirical laws (because they presuppose a just institutional structure and a just society is said not to exist), nor are they a priori ones. So it is only left for us to say that they are construed as empirical laws. Now, the difficulty for Rawls with this must be that reliance on such laws is inconsistent with the rationality of the parties in the original position, because as a matter of fact these laws have not been tested empirically (the fact that they can not be tested in this way makes no difference at all). Secondly it is asked whether we are dealing with a contract doctrine at all. Starting from the question, whether in this theory the notion of contract (intended to explain our considered judgements as givens) really is an ultimate explanatory concept, it is argued that there are some anthropological presuppositions, which rather point in the direction of a theory of self-realization. This seems to be confirmed by some other features of the theory, e. g. the Aristotelian principle, the Kantian interpretation, the concept of natural rights, and society as a social union of social unions. In conclusion, neither Rawls's principles of justice nor his contract theory are sufficiently consistent to escape the need of reconsideration. (shrink)

Harris levels two main criticisms against our original defence of QALYs (Quality Adjusted Life Years). First, he rejects the assumption implicit in the QALY approach that not all lives are of equal value. Second, he rejects our appeal to Rawls's veil of ignorance test in support of the QALY method. In the present article we defend QALYs against Harris's criticisms. We argue that some of the conclusions Harris draws from our view that resources should be allocated on the basis (...) of potential improvements in quality of life and quantity of life are erroneous, and that others lack the moral implications Harris claims for them. On the other hand, we defend our claim that a rational egoist, behind a veil of ignorance, could consistently choose to allocate life-saving resources in accordance with the QALY method, despite Harris's claim that a rational egoist would allocate randomly if there is no better than a 50% chance of being the recipient. (shrink)

Should scientific facts and methods have an epistemically privileged status in public reason? In Rawls’s public reason account he asserts what we will label the Scientific Standard Stricture: citizens engaged in public reason must be guided by non-controversial scientific methods, and public reason must be in line with non-controversial scientific conclusions. The Scientific Standard Stricture is meant to fulfill important tasks such as enabling the determinateness and publicity of the public reason framework. However, Rawls leaves us without elucidation (...) with regard to when science is and is not ‘non-controversial’ and more importantly, we are left without a justification for a stricture which excludes certain controversial beliefs and methods of inquiry from the realm of political justification. In this article, we offer what we deem to be the most plausible interpretation of Rawls’s Scientific Standards Stricture. We then use Rawls’s general theoretical framework to examine various potential justifications for privileging these ‘non-controversial’ scientific methods and conclusions. We conclude that no viable justification is available to Rawls. (shrink)

This paper discusses the attempt in this issue of the journal by Peter Singer, John McKie, Helga Kuhse and Jeff Richardson, to defend QALYs against the argument from double jeopardy which I first outlined in 1987. In showing how the QALY and other similar measures which combine life expectancy and quality of life and use these to justify particular allocations of health care resource, remain vulnerable to the charge of double jeopardy I am able to clarify some of the central (...) issues concerning the value of life. In particular, the idea that the value of a life varies with its life expectancy and with its quality, understood in terms of its richness, variety, success etc, is subjected to special examination. It is shown how defenders of QALYs are committed to the view that so far from all lives being of equal value, all lives are necessarily of subtly different value. The paper then analyses the use to which the notorious 'veil of ignorance' has been put both by Singer et al and by others and shows how this device of John Rawls's cannot do the work so often assigned to it. The paper then considers the issue of hypothetical consent and the role that it can play in justifying disposing of the lives of people who have not in fact consented to their lives being disposed of in particular ways. Finally, the paper makes some points about the comprehensive nature of the data collection and storage which would be required by QALY advocates and points out the independent problems attaching to licensing such comprehensive collection and use of personal data. (shrink)

A liberal society seeks not to impose a single way of life, but to leave its citizens as free as possible to choose their own values and ends. It therefore must govern by principles of justice that do not presuppose any particular vision of the good life. But can any such principles be found? And if not, what are the consequences for justice as a moral and political ideal? These are the questions Michael Sandel takes up in this penetrating critique (...) of contemporary liberalism. Sandel locates modern liberalism in the tradition of Kant, and focuses on its most influential recent expression in the work of John Rawls. In the most important challenge yet to Rawls' theory of justice, Sandel traces the limits of liberalism to the conception of the person that underlies it, and argues for a deeper understanding of community than liberalism allows. (shrink)

This paper explicates and challenges John Rawl's argument concerning a rule-utilitarian theory of punishment. In so doing, it argues in favour of a retributivist theory of punishment, one that seeks to justify, not only particular forms of punishment, but the institution of punishment itself. Some crucial objections to retributivism are then considered: one regarding the adverse effects of punishment on the innocent, another concerning proportional punishment, a third pertaining to vengeance and retribution, a Marxian concern with retributive punishment, and a (...) concern with the concept of desert. Each objection is deflected in order to ward-off what seem to be the most serious criticisms of a retributivist view of punishment and to clarify the depth of the retributivist position. (shrink)

Here I argue that the hyper-individualistic and rationalistic ethical paradigms – originating in the late eighteenth century and dominating moral philosophy, in various permutations, ever since – cannot capture the moral concerns evoked by the prospect of global climate change. Those paradigms are undone by the temporal and spatial scales of climate change. To press my argument, I deploy two famous philosophical tropes – John Rawls's notion of the original position and Derek Parfit's paradox – and another that promises (...) to become famous: Dale Jamieson's six little ditties about Jack and Jill. I then go on to argue that the spatial and especially the temporal scales of global climate change demand a shift in moral philosophy from a hyper-individualistic ontology to a thoroughly holistic ontology. It also demands a shift from a reason-based to a sentiment-based moral psychology. Holism in environmental ethics is usually coupled with non-anthropocentrism in theories constructed to provide moral considerability for transorganismic entities – such as species, biotic communities, and ecosystems. The spatial and temporal scales of climate, however, render non-anthropocentric environmental ethics otiose, as I more fully explain. Thus the environmental ethic here proposed to meet the moral challenge of global climate change is holistic but anthropocentric. I start with Jamieson's six little ditties about Jack and Jill. (shrink)

Introduction: Doing the right thing -- Utilitarianism : Bentham and J.S. Mill -- Libertarianism -- John Locke -- Markets and morals -- Immanuel Kant -- John Rawls -- Affirmative action -- Aristotle -- Liberals and communitarians -- Conclusion: Reconnecting politics and morals.

Vallentyne 2010 and Zwolinski 2008 are internet encyclopaedia articles on “libertarianism” which include various serious faults. Vallentyne 2010 has the following ones. It does not properly explain mainstream libertarianism or consider criticisms of it. Instead, it mainly discusses self-ownership and natural-resource egalitarianism. Every aspect of the alleged “strict sense” of “libertarianism” is dubi ous, at best. So- called “left - libertarianism” is not made sense of as any kind of liberty-based libertarianism. Problems arise because self-ownership is assumed to be libertarian (...) without an explicit theory of libertarian liberty. The replies to “five impor tant objections to full self- ownership” are confused and mistaken; both as regards philosophical analysis and as regards empirical assumptions. The long discussion about various ways to “Appropriate Natural Resources” is rendered muddled and barren by the lack of a clear libertarian theory of liberty, the mere presumption of some form of egalitarianism, and the inclusion of various non-libertarian criteria. The remaining sections are largely uninformed by any relevant libertarian literature. It reaches a justificationist conclusion that cites mistaken welfare concerns and ignores the productivity of free markets. Zwolinski 2008 shares some errors with Vallentyne 2010, but also includes the following ones. It is even less clear about what libertarian liberty is. It fails to understand that libertarianism (private-property anarchy and, possibly, minarchy) is a subset of classical liberalism. It asserts that libertarianism is about “the proper role of government.” It assumes (illogical) justificationist/foundationalist epistemology and does not mention critical-rationalist libertarianism. It eventually faults justificationism and unwittingly assumes something approaching critical rationalism. Finally, it embraces John Rawls’s “overlapping consensus” as a “justification” (i.e., defence) of libertarianism oblivious to the similar position in Lester 1996 and 2000. (shrink)

G.A. Cohen criticizes Rawls’s account of justice because his difference principle permits inequalities that reflect the relative scarcity of different skills and natural abilities. Instead of viewing the ‘basic structure’ as the primary subject of justice, Cohen argues that individual citizens should cultivate an egalitarian ethos, which would enable a just society to dispense with the use of incentive payments to induce individuals to use their talents in socially ideal ways. This study examines Cohen’s critique, including his rejection of (...) ‘incentives,’ and vindicates Rawls’s approach. Ultimately, Cohen’s argument fails to grapple with the moral pluralism that characterizes modern, democratic societies, whereas Rawls’s theory is constructed to accommodate such pluralism. (shrink)

The most relevant and plausible conceptions of economic rationality, interpersonal liberty, human welfare, and private-property anarchy do not conflict in theory or practice. Using philosophy and social science, Escape from Leviathan defends this bold, non-normative, thesis from contrary positions in the scholarly literature. Writers considered include David Friedman, John Gray, R. M. Hare, Robert Nozick, Karl Popper, John Rawls, Murray Rothbard, Alan Ryan, Amartya Sen, and Bernard Williams. *** The rationality assumptions of neoclassical and Austrian School economics are reconciled (...) and related to liberty and welfare. A new pre-propertarian theory of interpersonal liberty as the absence of (initiated or proactively) imposed cost is argued to be libertarian. Human welfare is defended as the satisfaction of unimposed wants. Practical anarchy is simply unconstrained private property. Related topics include free will, weakness of will, the nature of moralizing, intellectual property, and restitution and retribution. Critical-rationalist epistemology (theories can only be criticized and tested, not justified or supported) is applied throughout. This is a ground-breaking work that is also an excellent introduction to libertarianism and social thought. (shrink)