When one faces competing claims of varying strength on public resources for health, which claims count? This paper proposes the following answer. One should count, or aggregate, a person’s claim just in case one could sympathize with her desire to prioritize her own claim over the strongest competing claim. It argues that this principle yields appealing case judgments and has a plausible grounding in both sympathetic identification with each person, taken separately, and respect for the person for whom most is (...) at stake. It also defends this principle against several heretofore unanswered objections. (shrink)

It is common to distinguish moral rules, reasons, or values that are agent-relative from those that are agent-neutral. One can also distinguish moral rules, reasons, or values that are moment-relative from those that are moment-neutral. In this article, I introduce a third distinction that stands alongside these two distinctions—the distinction between moral rules, reasons, or values that are patient-relative and those that are patient-neutral. I then show how patient-relativity plays an important role in several moral theories, gives us a better (...) understanding of agent-relativity and moment-relativity, and provides a novel objection to Derek Parfit’s “appeal to full relativity” argument. (shrink)

The numbers problem concerns the question of what is the right thing to do in trade-off cases where one can save different non-overlapping groups of persons, but not everyone. Proponents of mixed solutions argue that both saving the many and holding a lottery to determine whom to save can each be morally right in such cases, depending on the relative sizes of the groups involved. In his book The Dimensions of Consequentialism, Martin Peterson presents an ingenious version of such an (...) approach that avoids a commitment to interpersonal value aggregation, which is highly controversial and rejected by many philosophers for a number of reasons. I criticise Peterson’s proposal by first arguing that it cannot account for the idea that holding a lottery is morally wrong if differences in numbers are very large, and by second pointing out that it relies on implausible assumptions about what is good for an individual. Given the shortcomings of Peterson’s non-aggregationist version of a mixed solution, I next address the issue of how problematic a commitment to interpersonal aggregation really is. To this end, I present an aggregationist version of a mixed solution that is reason-based and bypasses most standard objections to interpersonal value aggregation. I conclude that although there is reason to be optimistic, it remains to be seen whether a mixed solution can be worked out in a fully satisfying way. (shrink)

Common principles for resource allocation in health care can prioritize the alleviation of small health burdens over lifesaving treatment. I argue that there is some evidence that these principles are at odds with a sizable share of public opinion, which holds that saving a life should take priority over any number of cures for minor ailments. I propose two possible explanations for this opinion, one debunking and one vindicatory. I also outline how well-designed surveys and moral inquiry could help decide (...) between them. Finally, I consider how priority-setting principles could be adjusted if the view that saving a life always trumps alleviating small burdens were vindicated. (shrink)