The available resources for global health assistance are far outstripped by need. In the face of such scarcity, many people endorse a principle according to which highest priority should be given to the worst off. However, in order for this prioritarian principle to be useful for allocation decisions, policy-makers need to know what it means to be badly off. In this article, we outline a conception of disadvantage suitable for identifying the worst off for the purpose of making health resource (...) allocation decisions. According to our total advantage view: the worst off are those who have the greatest total lifetime disadvantage; advantage foregone due to premature death should be treated in the same way as other ways of being disadvantaged at a time; how badly off someone is depends on the actual outcomes that will befall her without intervention, not her prospects at a time; and all significant forms of disadvantage count for determining who is worst off, not just disadvantage relating to health. We conclude by noting two important implications of the total advantage view: first, that those who die young are among the globally worst off, and second, that the epidemiological shift in the global burden of disease from communicable to non-communicable diseases should not lead to a corresponding shift in global health spending priorities. (shrink)

We commonly explain the distinctive prudential and moral status of persons in terms of our mental capacities. I draw from recent work to argue that the common explanation is incomplete. I then develop a new explanation: We are ethically important because we are the object of a pattern of self-concern. I argue that the view solves moral problems posed by permissive ontologies, such as the recent personite problem.

Don Marquis has argued most abortions are immoral, for the same reason that killing you or me is immoral: abortion deprives the fetus of a valuable future. Call this account the FLOA. A rival account is Jeff McMahan’s, time-relative interest account of the wrongness of killing. According to this account, an act of killing is wrong to the extent that it deprives the victim of future value and the relation of psychological unity would have held between the victim at the (...) time of death and herself at a later time if she had lived. The TRIA supposedly has two chief advantages over Marquis’s FLOA. First, unlike the FLOA, the TRIA does not rely on the controversial thesis that identity is what matters in survival. Second, the TRIA yields more plausible verdicts about cases. Proponents of the TRIA use the account to argue that abortion is generally permissible, because there would be little to no psychological unity between the fetus and later selves if it lived. I argue that advocates of the TRIA have failed to establish its superiority to the FLOA, for two reasons. First, the two views are on a par with respect to the thesis that identity is what matters in survival. Second, Marquis’s FLOA does not yield the counterintuitive implications about cases that advocates of the TRIA have attributed to it, and the TRIA yields its own share of implausible judgments about cases. (shrink)

According to standard comparativist views, death is bad insofar as it deprives someone of goods she would otherwise have had. In The Ethics of Killing, Jeff McMahan argues against such views and in favor of a gradualist account according to which how bad it is to die is a function of both the future goods of which the decedent is deprived and her cognitive development when she dies. Comparativists and gradualists therefore disagree about how bad it is to die at (...) different ages. In this paper I examine two prominent criticisms of gradualism and show that both misconstrue McMahan. I develop a related criticism that seems to show that a gradualist cannot coherently relate morbidity and mortality. This criticism also fails, but has an instructive implication for how policy-makers setting priorities for health care investments should regard choices between life-saving interventions and interventions against non-fatal diseases in the very young. (shrink)

As zoos have developed more successful captive breeding programs, they now face a question of what to do about “surplus” animals. One strategy used by European zoos in recent years has been to allow animals to breed freely, then kill unwanted offspring. I argue that this strategy wrongs the animals in question and that the justifications that have been offered for the practice are inadequate. I provide background on the practice, discuss the moral status of animals and potential grounds for (...) the prima facie duty not to kill, and then examine and ultimately dismiss justifications for killing in this case. (shrink)

This article discusses the relationship between two theories about the badness of death, the Life-Comparative Account and the Gradualist Account, and two methods of operationalizing severity in health care priority setting, Absolute Shortfall and Proportional Shortfall. The aim is that theories about the badness of death can influence and inform the idea of the basis of severity as a priority setting criterion. I argue that there are strong similarities between the Life-Comparative Account and Absolute Shortfall, and since the Life-Comparative Account (...) is one of the most reasonable accounts of the badness of death, this provides some support for using Absolute Shortfall. I also argue that it is difficult to find support for Proportional Shortfall from theories about the badness of death, and also, that it is difficult to find support for Gradualist Account from theories about severity. (shrink)

In this paper, we present three necessary conditions for morally responsible animal research that we believe people on both sides of this debate can accept. Specifically, we argue that, even if human beings have higher moral status than nonhuman animals, animal research is morally permissible only if it satisfies (a) an expectation of sufficient net benefit, (b) a worthwhile-life condition, and (c) a no unnecessary-harm/qualified-basic-needs condition. We then claim that, whether or not these necessary conditions are jointly sufficient conditions of (...) justified animal research, they are relatively demanding with the consequence that many animal experiments may fail to satisfy them. (shrink)

Responding to several leading ideas from a paper by Allen Buchanan, the present essay explores the implications of genetic enhancement for moral status. Contrary to doubts expressed by Buchanan, I argue that genetic enhancement could lead to the existence of beings so superior to contemporary human beings that we might aptly describe them as post-persons. If such post-persons emerged, how should we understand their moral status in relation to ours? The answer depends in part on which of two general models (...) of moral status—one based on respect and one based on interests—is more adequate. Buchanan tentatively argues that a respect-based model is preferable. I challenge Buchanan's view, along these lines: If we embrace a respect-based model of moral status featuring a threshold that divides persons, who are thought to have full and equal moral status, from sentient nonpersons, thought to have less moral status, then we should acknowledge a second threshold and a level of moral status higher than ours. A better option, I tentatively suggest, is to drop the idea of levels of moral status, accept that all sentient beings have moral status, and allow that some differences in interests and capacities justify some significant differences in how we should treat beings of different kinds. (shrink)

We commonly explain the distinctive prudential and moral status of persons in terms of our mental capacities. I draw from recent work to argue that the common explanation is incomplete. I then develop a new explanation: We are ethically important because we are the object of a pattern of self-concern. I argue that the view solves moral problems posed by permissive ontologies, such as the recent personite problem.