It seems rather intuitive that if I can save either one stranger or five strangers, I must save the five. However, Kantian (and other non-consequentialist) views have a difficult time explaining why this is the case, as they seem committed to what Parfit calls “innumeracy”: roughly, the view that the values of lives (or the reasons to save them) don’t get greater (or stronger) in proportion to the number of lives saved. This chapter first shows that in various cases, it (...) is permissible to save fewer lives, contrary to what is implied by “numerate” views. Then it argues that in the cases in which it is intuitive that we must save the greater number, Kantians (and other deontologists) can not only deliver this verdict but also explain why it is correct, without presupposing that the value of our action depends on “adding up” the values of the lives saved. (shrink)

After 50 years of debate, the ethics of aggregation has reached a curious stalemate, with both sides arguing that only their theory treats people as equals. I argue that, on the issue of equality, both sides are wrong. From the premise that “each counts for one,” we cannot derive the conclusion that “more count for more”—or its negation. The familiar arguments from equality to aggregation presuppose more than equality: the Kamm/Scanlon “Balancing Argument” rests on what social choice theorists call “(Positive) (...) Responsiveness,” Kamm’s “Aggregation Argument” assumes that “equal” lives are fungible, and Hsieh et al. have it that spreading goods broadly best approximates equality. In each case, the crucial premise is not equality itself but a further idea that Taurek, I argue, can safely reject. I conclude with a conjecture: there is no theory-neutral argument that settles the question of whether the numbers count. (shrink)

In this paper, we argue that our moral concern for future well-being should reduce over time due to important practical considerations about how humans interact with spacetime. After surveying several of these considerations (around equality, special duties, existential contingency, and overlapping moral concern) we develop a set of core principles that can both explain their moral significance and highlight why this is inherently bound up with our relationship with spacetime. These relate to the equitable distribution of (1) moral concern in (...) a universe that we can only causally affect in one temporal direction; (2) access to the benefits from using spacetime as a resource; and (3) the burdens of care given (1) and (2). We conclude by considering the practical implications of our argument and find that, while it is often assumed that a preference for present over future well-being weakens the case for existential risk mitigation, this likely is not the case. (shrink)

Suppose you can save only one of two groups of people from harm, with one person in one group, and five persons in the other group. Are you obligated to save the greater number? While common sense seems to say ‘yes’, the numbers skeptic says ‘no’. Numbers Skepticism has been partly motivated by the anti-consequentialist thought that the goods, harms and well-being of individual people do not aggregate in any morally significant way. However, even many non-consequentialists think that Numbers Skepticism (...) goes too far in rejecting the claim that you ought to save the greater number. Besides the prima facie implausibility of Numbers Skepticism, Michael Otsuka has developed an intriguing argument against this position. Otsuka argues that Numbers Skepticism, in conjunction with an independently plausible moral principle, leads to inconsistent choices regarding what ought to be done in certain circumstances. This inconsistency in turn provides us with a good reason to reject Numbers Skepticism. Kirsten Meyer offers a notable challenge to Otsuka’s argument. I argue that Meyer’s challenge can be met, and then offer my own reasons for rejecting Otsuka’s argument. In light of these criticisms, I then develop an improved, yet structurally similar argument to Otsuka’s argument. I argue for the slightly different conclusion that the view proposed by John Taurek that ‘the numbers don’t count’ leads to inconsistent choices, which in turn provides us with a good reason to reject Taurek’s position. (shrink)

Utilitarianism focuses on the optimization of personal well being in ways that seems to make the practice of medicine irrelevant to the well being of the practitioners, unless given external incentives such as money or honor. Care based on indirect incentives is considered inferior to care motivated internally. This leads to the paradox of utilitarian care. Following Nozick's conceptual Pleasure Machine it is argued that in addition to the promotion of personal well being, people care about fulfilling their well being (...) in a world which is real, just, good, and beautiful. Complete mechanization of social and personal life in accordance with a strict utilitarian regime is also incompatible with the kind of world people desire, even if it promises more fulfillments in terms of personal well being. This explains the so-called Taurek-Parfit paradox, according to which sometimes ethics seems “to count the numbers” and sometimes not. The very pursuit of utilitarianism does not contribute to any personal life plan. The helping professions make the world a better place for us to live in, even though they do not necessarily bear directly on the well being of any individual other than the recipients of care. This resolves the paradox of utilitarian care. (shrink)

The global Covid-19 crisis raises at least three moral questions, which my contribution answers as follows: (1) Which patient should get treatment according to triage criteria? The patient whose treatment has the best prospect of success. (2) How should we resolve the conflict between public health measures and economic needs? Public health should have priority, but reaches its limits where the individual right to stay afloat through one’s own work is violated. (3) How should we resolve the conflict between public (...) health measures and civil liberties? Public health should have priority, but reaches its limits where the restriction of freedom violates the integrity of individual health and personal freedom. The answers and the arguments behind these are developed through the discussion of a wide range of current public health policies, concrete measures, and competing approaches to moral questions in the Covid-19 pandemic. (shrink)

In early 2020, a number of countries developed and published intensive care triage guidelines for the pandemic. Several of those guidelines, especially in the UK, encouraged the explicit assessment...

Disability might be relevant to decisions about life support in intensive care in several ways. It might affect the chance of treatment being successful, or a patient’s life expectancy with treatment. It may affect whether treatment is in a patient’s best interests. However, even if treatment would be of overall benefit it may be unaffordable and consequently unable to be provided. In this paper we will draw on the example of neonatal intensive care, and ask whether or when it is (...) justified to ration life-saving treatment on the basis of disability. We argue that predicted disability is relevant both indirectly and directly to rationing decisions. (shrink)

In this article, I critique a moral argument developed in Frances Kamm’s Intricate Ethics: Rights, Responsibilities, and Permissible Harm. The argument, which I label the Best Outcome Argument, aims to criticize the Taurekian idea that it is not worse if more people die than if fewer do in conflict situations, where it is hard to distinguish individuals from one another solely by reference to the relative strength of their claims. I argue that the Best Outcome Argument is flawed for three (...) reasons: the symmetry feature defined by the impartiality principle holds only in a limited class of conflict situations; individuals should be treated in a consistent way throughout the whole process of reasoning; comparative evaluations gained in different contexts, at least in some cases, cannot be used in one and the same argument. (shrink)

Proportionality is widely accepted as a necessary condition of justified self-defense. What gives rise to this particular condition and what role it plays in the justification of self-defense seldom receive focused critical attention. In this paper I address the standard of proportionality applicable to personal self-defense and the role that proportionality plays in justifying the use of harmful force in self-defense. I argue against an equivalent harm view of proportionality in self-defense, and in favor of a standard of proportionality in (...) self-defense that requires comparable seriousness and takes into account the wrong, as opposed simply to the harm that the victim is fending off. I distinguish the standard of proportionality in self-defense from proportionality in circumstances of necessity, and I discuss whether proportionality is an internal or an external constraint on the right of self-defense. (shrink)

Argues that there is no one it is irrational to love, that it is rational to act with partiality to those we love, and that the rationality of doing so is not conditional on love. It follows that Anscombe and Taurek are right: you are not required to save three instead of one, even when those you could save are perfect strangers.

There is no large number of very small bads that is worse than a small number of very large bads – or so, some maintain, it seems plausible to say. In this article, I criticize and reject two recently proposed vindications of the above intuition put forth by Dale Dorsey and Alex Voorhoeve. Dorsey advocates for a threshold marked by the interference with a person's global life projects: any bad that interferes with the satisfaction of a life project is worse (...) than any number of bads that don't interfere with such a life project. Such thresholds, I argue, are broadly implausible. Voorhoeve gives a contractualist account for the irrelevance of minor bads. His account, I argue, does not, among other things, provide the right kind of reason in defence of the above intuition. (shrink)

This article addresses a dilemma about autonomous vehicles: how to respond to trade-off scenarios in which all possible responses involve the loss of life but there is a choice about whose life or lives are lost. I consider four options: kill fewer people, protect passengers, equal concern for survival, and recognize everyone’s interests. I solve this dilemma via what I call the new trolley problem, which seeks a rationale for the intuition that it is unethical to kill a smaller number (...) of people to avoid killing a greater number of people based on numbers alone. I argue that killing a smaller number of people to avoid killing a greater number of people based on numbers alone is unethical because it disrespects the humanity of the individuals in the smaller-numbered group. I defend the recognize-everyone’s-interests algorithm, which will probably kill fewer people but will not do so based on numbers alone. (shrink)

The three most common responses to Taurek’s ‘numbers problem’ are saving the greater number, equal chance lotteries and weighted lotteries. Weighted lotteries have perhaps received the least support, having been criticized by Scanlon What We Owe to Each Other ( 1998 ) and Hirose ‘Fairness in Life and Death Cases’ ( 2007 ). This article considers these objections in turn, and argues that they do not succeed in refuting the fairness of a weighted lottery, which remains a potential solution to (...) cases of conflict. Moreover, it shows how these responses actually lead to a new argument for weighted lotteries, appealing to fairness and Pareto-optimality. (shrink)

On the face of it, causal responsibility seems to be “additive” in the following sense: if I cause some effects, then it seems that I also cause the sum (aggregate, conjunction, etc.) of those effects. Let’s call the claim that causation behaves in this way, Additivity.

First responders to chemical, biological, radiological, or nuclear (CBRN) events face decisions having significant human consequences. Some operational decisions are supported by standard operating procedures, yet these may not suffice for ethical decisions. Responders will be forced to weigh their options, factoring-in contextual peculiarities; they will require guidance on how they can approach novel (indeed unique) ethical problems: they need strategies for “on the spot” ethical decision making. The primary aim of this paper is to examine how first responders should (...) approach on the spot ethical decision-making amid the stress and uncertainty of a CBRN event. Drawing on the long-term professional CBRN experience of one of the authors, this paper sets out a series of practical ethical dilemmas potentially arising in the context of a large-scale chemical incident. We propose a broadly consequentialist approach to on the spot ethical decision-making, but one which incorporates ethical values and rights as “side-constraints”. (shrink)

In the first wave of the COVID-19 pandemic, healthcare workers in some countries were forced to make distressing triaging decisions about which individual patients should receive potentially life-saving treatment. Much of the ethical discussion prompted by the pandemic has concerned which moral principles should ground our response to these individual triage questions. In this paper we aim to broaden the scope of this discussion by considering the ethics of broader structural allocation decisions raised by the COVID-19 pandemic. More specifically, we (...) consider how nations ought to distribute a scarce life-saving resource across healthcare regions in a public health emergency, particularly in view of regional differences in projected need and existing capacity. We call this the regional triage question. Using the case study of ventilators in the COVID-19 pandemic, we show how the moral frameworks that we might adopt in response to individual triage decisions do not translate straightforwardly to this regional-level triage question. Having outlined what we take to be a plausible egalitarian approach to the regional triage question, we go on to propose a novel way of operationalising the ‘save the most lives’ principle in this context. We claim that the latter principle ought to take some precedence in the regional triage question, but also note important limitations to the extent of the influence that it should have in regional allocation decisions. (shrink)

In response to the COVID‐19 pandemic philosophers and governments have proposed scarce resource allocation guidelines. Their purpose is to advise healthcare professionals on how to ethically allocate scarce medical resources. One challenging feature of the pandemic has been the large numbers of patients needing mechanical ventilatory support. Guidelines have paradigmatically focused on the question of what doctors should do if they have fewer ventilators than patients who need respiratory support: which patient should get the ventilator? There is, however, an important (...) higher level allocation problem. Namely, how are we to ethically distribute newly obtained ventilators across hospitals: which hospital should get the ventilator(s)? In this paper, we identify a set of principles for allocating newly obtained ventilators across hospitals. We focus particularly on low and middle income countries, who frequently have limited pre‐existing intensive care capacity, and have needed to source additional ventilators. We first provide some background. Second, we argue that the main population healthcare aim during the COVID‐19 pandemic should be to save the most lives. Next, we assess a series of potential heuristics or principles that could be used to guide allocation: allocation to the most densely populated cities, random allocation, allocation based on the ratio of patients to ICU personnel, prioritisation in terms of intrahospital mortality, prioritisation of younger populations, and prioritisation in terms of population mortality. We conclude by providing a plausible ranking of the principles, while noting a number of epistemological challenges, in terms of how they best further the aim of increasing the probability of saving the most lives. (shrink)

John Taurek argues that, in a choice between saving the many or the few, the numbers should not count. Some object that this view clashes with the transitivity of ‘better than’; others insist the clash can be avoided. I defend a middle ground: Taurek cannot have transitivity, but that doesn’t doom his view, given a suitable conception of value. I then formalize and explore two conceptions: one context-sensitive, one multidimensional.

In this paper, I concentrate on two themes: to what extent numbers bear on an agent's duties, and how numbers should relate to social policy. In the first half of the paper I consider the abstract case of a choice between saving two people and saving one, and my focus is on the contrast between a duty to act and a reason which merely makes an action intelligible. In the second half, I turn to the issue of social policy and (...) investigate how if at all numbers can have a bearing there, if there is no obvious duty on individuals to save the greater number. My proposal is that it is not the bare numbers themselves which explain our intuitions in such cases, but rather considerations of the extent to which each of us can make a reasonable claim on others. In short, I argue: numbers don't count, people do. (shrink)

In this paper, I concentrate on two themes: to what extent numbers bear on an agent's duties, and how numbers should relate to social policy. In the first half of the paper I consider the abstract case of a choice between saving two people and saving one, and my focus is on the contrast between a duty to act and a reason which merely makes an action intelligible. In the second half, I turn to the issue of social policy and (...) investigate how if at all numbers can have a bearing there, if there is no obvious duty on individuals to save the greater number. My proposal is that it is not the bare numbers themselves (or even the ratio of claimants on either side of the dilemma) which explain our intuitions in such cases, but rather considerations of the extent to which each of us can make a reasonable claim on others. In short, I argue: numbers don't count, people do. (shrink)

Consulting the public about the ethical approaches underlying health policies can seem an appealing means of addressing concerns about limited public participation in development of health policy. However ambiguity surrounds questions of whether, or how consultation can really contribute to more defensible decisions about ethical aspects of policy. This paper clarifies the role and limits of public consultation on ethics, beginning by separating different senses of defensibility in decisions on ethics. Defensibility of ethical decisions could be understood either in the (...) sense of legitimacy in virtue of reflecting the opinions of the public whose interests are affected, or in the sense of being able to withstand and respond to challenges presented in ethical debate. The question then is whether there are forms of consultation which have the potential to realise more defensible decisions in either of these senses. Problems of adequately accounting for the views of those affected by policy decisions casts doubt on the plausibility of using consultation as a means of determining the opinions of the public. Consultation can have a role by bringing new ideas and challenges to debate, although it is uncertain whether this will increase the defensibility of any decision on ethics. (shrink)

In , John Broome defends a very weak consequentialist account of the value of saving lives. This paper challenges the commitments of this kind of account and describes some reasons for saving lives that would appeal to a non-consequentialist.

Zusammenfassung. Der Beitrag diskutiert die ethischen Grundlagen der sogenannten Triage (der Sortierung von Behandlungsbedürftigen in Dringlichkeitskategorien beim Massenanfall Verwundeter) und prüft, inwieweit eine Übertragung dieser Praxis auf eine unter Rationierungsdruck geratende Alltagsmedizin begründbar bzw. zu erwarten ist. Insbesondere wird der ethische Status der sog. Maximierungsregel („rette so viele Menschenleben wie möglich”) erläutert, und es werden die bereits in der katastrophenmedizinischen Praxis nicht ganz unwirksamen Grenzen der Orientierung an dieser Regel deutlich gemacht.

In his paper, “Should the Numbers Count?" John Taurek imagines that we are in a position such that we can either save a group of five people, or we can save one individual, David. We cannot save David and the five. This is because they each require a life-saving drug. However, David needs all of the drug if he is to survive, while the other five need only a fifth each.Typically, people have argued as if there was a choice to (...) be made: either numbers matter, in which case we should save the greater number, or numbers don't matter, but rather there is moral value in giving each person an equal chance of survival, and therefore we should toss a coin. My claim is that we do not have to make a choice in this way. Rather, numbers do matter, but it doesn't follow that we should always save the greater number. And likewise, there is moral value in giving each person an equal chance of survival, but it doesn't follow that we should always toss a coin. (shrink)

Partiality is the special concern that we display for ourselves and other people with whom we stand in some special personal relationship. It is a central theme in moral philosophy, both ancient and modern. Questions about the justification of partiality arise in the context of enquiry into several moral topics, including the good life and the role in it of our personal commitments; the demands of impartial morality, equality, and other moral ideals; and commonsense ideas about supererogation. This paper provides (...) an overview of the debate on the ethics of partiality through the lens of the domains of permissible and required partiality. After outlining the conceptual space, I first discuss agent-centred moral options that concern permissions not to do what would be impartially optimal. I then focus on required partiality, which concerns associative duties that go beyond our general duties to others and require us to give special priority to people who are close to us. I discuss some notable features of associative duties and the two main objections that have been raised against them: the Voluntarist and the Distributive objections. I then turn to the justification of partiality, focusing on underivative approaches and reasons-based frameworks. I discuss the reductionism and non-reductionism debate: the question whether partiality is derivative or fundamental. I survey arguments for ‘the big three’, according to which partiality is justified by appeal to the special value of either projects, personal relationships, or individuals. I conclude by discussing four newly emerging areas in the debate: normative transitions of various personal relationships, relationships with AI, epistemic partiality, and negative partiality, which concerns the negative analogue of our positive personal relationships. (shrink)

I argue that you can be permitted to discount the interests of your adversaries even though doing so would be impartially suboptimal. This means that, in addition to the kinds of moral options that the literature traditionally recognises, there exist what I call other-sacrificing options. I explore the idea that you cannot discount the interests of your adversaries as much as you can favour the interests of your intimates; if this is correct, then there is an asymmetry between negative partiality (...) toward your adversaries and positive partiality toward your intimates. (shrink)

John Taurek famously argued that, in ‘conflict cases’, where we are confronted with a smaller and a larger group of individuals, and can choose which group to save from harm, we should toss a coin, rather than saving the larger group. This is primarily because coin-tossing is fairer: it ensures that each individual, regardless of the group to which he or she belongs, has an equal chance of being saved. This article provides a new response to Taurek’s argument. It proposes (...) that there are two possible types of unfairness that have to be avoided in conflict cases, as far as possible: ‘selection unfairness’, which is the unfairness of not giving individuals an equal chance of being saved; and ‘outcome unfairness’, which is the unfairness of not actually saving them, when others are saved. Since saving the greater number generates less outcome unfa-irness than coin-tossing, it is argued that, in many conflict cases, fairness demands that we save the greater number. (shrink)

Recent moral philosophy has been characterized by some serious attempts to show that both Kantian and utilitarian moralities leave us with insufficient room to pursue our personal projects and relationships. These moralities have been charged with demanding a kind of impartiality that leaves us with too little space for developing ourselves and our friendships, family relations, communities, and nations in the ways best suited for us. Critics claim these theories implausibly maintain that if our personal relationships and affinities do not (...) further the ends of moral duty or maximum utility, they are of no value and hence we lack reason to devote ourselves to them. In what follows, I will assume that a conception of morality would indeed be implausible if it were to demand impartiality in the strong sense that it would be impermissible to favor our own projects and ambitions, to care especially about the welfare of certain persons rather than others, and sometimes to give preference to those we care most about, even when we could benefit strangers more. (shrink)

Recent moral philosophy has been characterized by some serious attempts to show that both Kantian and utilitarian moralities leave us with insufficient room to pursue our personal projects and relationships. These moralities have been charged with demanding a kind of impartiality that leaves us with too little space for developing ourselves and our friendships, family relations, communities, and nations in the ways best suited for us. Critics claim these theories implausibly maintain that if our personal relationships and affinities do not (...) further the ends of moral duty or maximum utility, they are of no value and hence we lack reason to devote ourselves to them. In what follows, I will assume that a conception of morality would indeed be implausible if it were to demand impartiality in the strong sense that it would be impermissible to favor our own projects and ambitions, to care especially about the welfare of certain persons rather than others, and sometimes to give preference to those we care most about, even when we could benefit strangers more. (shrink)

In the Case for Animal Rights, Tom Regan considers a scenario where one must choose between killing either a human being or any number of dogs by throwing them from a lifeboat. Regan chooses the human being. His justification for this prescription is that the human being will suffer a greater harm from death than any of the dogs would. This prescription has met opposition on the grounds that the combined intrinsic value of the dogs’ experiences outweighs those of a (...) human being. This objection assumes that the intrinsic value of a whole is simply the sum of the intrinsic values of its parts. This paper offers a justification for Regan’s prescription that rejects this assumption. It argues that the combined intrinsic value of a human being’s possible experiences might be greater than those of any number of dogs’ because the experiences of dogs do not exhibit sufficient variety for their intrinsic value to be additive. (shrink)

This paper sets out to discuss what precisely is meant by ‘‘benefit" when we talk of the requirement that the health care system concern itself with health gain or with maximizing beneficial health care. In particular I argue that in discharging the duty to do what is most beneficial we need to choose between rival conceptions of what is meant by beneficial. One is the patient's conception of benefit and the second is the provider's or funder's conception of benefit. I (...) argue that it is the patient's conception of benefit which is paramount and that if this is followed it commits us to a conception of patient care which must be blind to prognosis in so far as prognosis is thought to bear upon issues of prioritisation or resource allocation. (shrink)

This paper sets out to discuss what precisely is meant by ‘‘benefit" when we talk of the requirement that the health care system concern itself with health gain or with maximizing beneficial health care. In particular I argue that in discharging the duty to do what is most beneficial we need to choose between rival conceptions of what is meant by beneficial. One is the patient's conception of benefit and the second is the provider's or funder's conception of benefit. I (...) argue that it is the patient's conception of benefit which is paramount and that if this is followed it commits us to a conception of patient care which must be blind to prognosis in so far as prognosis is thought to bear upon issues of prioritisation or resource allocation. (shrink)

In den moralphilosophischen Debatten der letzten Jahrzehnte spielen die sogenannten Trolley-Fälle eine große Rolle. Sie kommen zum Einsatz in Diskussionen der Frage, welcher Schaden Personen im Rahmen medizinischer oder politischer Maßnahmen zugefügt werden darf, und in Diskussionen darüber, welches die richtige normative Moraltheorie ist. Allerdings kritisieren viele Philosophinnen und Philosophen diese Gedankenexperimente wegen ihrer Konstruiertheit, Künstlichkeit, Abstraktheit und ihrer Lebensferne. In diesem Beitrag werden die Einwände eines prominenten Kritikers, Allen Wood, diskutiert. Er attestiert den Trolley-Gedankenexperimenten neben den genannten Punkten außerdem, (...) dass sie moralisch nicht neutral sind, indem sie uns mit einem rhetorischen Trick dazu bringen, bestimmte Faktoren für moralisch relevant zu halten. Wood fordert deshalb, dass man auf die Verwendung dieser Gedankenexperimente in der praktischen Philosophie verzichten solle. Ich werde seine Einwände entkräften, dann aber zeigen, dass er dennoch einen wunden Punkt nennt: Die Trolley-Fälle sind aufgrund der vorgegebenen Antwortoptionen in der Hinsicht nicht moralisch neutral, dass sie voraussetzen, dass die Anzahl der zu rettenden Menschen moralisch relevant ist. Sie eignen sich daher nicht, um ebendiese Behauptung zu begründen. Dieser Mangel kann aber durch eine Modifikation der Gedankenexperimente behoben werden; ein vollständiger Verzicht auf derartige Gedankenexperimente ist also entgegen Woods Ansicht nicht notwendigerweise geboten. (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)

In this discussion, I claim that the debate over ‘the bias towards the present’ turns on an axiological question. Is the value of a present experience greater than its value when past? I argue not and hold that our bias towards the present, understood as a pure time preference, is irrational.

This paper examines the efforts of contractualists to develop an alternative to aggregation to govern our duty not to harm (duty to rescue) others. I conclude that many of the moral principles articulated in the literature seem to reduce to aggregation by a different name. Those that do not are viable only as long as they are limited to a handful of oddball cases at the margins of social life. If extended to run-of-the-mill conduct that accounts for virtually all unintended (...) (in the sense of undesired) harm to others—noncriminal activities that impose some risk of harm on others—they would rule out all action. Moreover, because such conduct poses an irreducible conflict between freedom of action and freedom from expected harm, it can be regulated only by principles that accept the necessity of making precisely the sorts of interpersonal trade-offs that contractualism is foundationally committed to reject: trade-offs in which the numbers count, such that a risk of serious harm to one person can be justified by small benefits to the many. (shrink)

We shall focus on moral theories that are solely concerned with promoting the benefits (e.g., wellbeing) of individuals and explore the possibility of such theories ascribing some priority to benefits to those who are worse off—without this priority being absolute. Utilitarianism (which evaluates alternatives on the basis of total or average benefits) ascribes no priority to the worse off, and leximin (which evaluates alternatives by giving lexical priority to the worst off, and then the second worst off, and so on) (...) ascribes absolute priority to the worse off (i.e., favors even a very small benefit to a worse off person over very large benefits to large numbers of better off people). Neither extreme view, we assume, is plausible. (shrink)

Most arguments in support of act utilitarianism are elaborations of one of two basic strategies. One is the consequentialist strategy. This strategy relies on the consequentialist premise that an act is right if and only if it produces the best possible consequences and the welfarist premise that the value of a state of affairs is entirely determined by its overall amount of well-being. The other strategy is based on the idea of treating individuals respectfully and resolving conflicts among individuals in (...) whatever way best conforms to that idea. Although both of these strategies can be used to argue for the principle of act utilitarianism, they are significantly different from each other, and these differences cause them to have different strengths and weaknesses. It emerges that which argumentative strategy is chosen by a proponent of act utilitarianism has a large impact on which virtues her view has and which objections it is vulnerable to. (shrink)

This paper expands on “An Ethics Framework for Making Resource Allocation Decisions within Clinical Care: Responding to COVID-19,” which is also published in this special issue of the Journal of Bioethical Inquiry. I first describe and explain the steps we took to develop this framework, drawing on previous experience and literature to explain what frameworks can and cannot do. I distinguish frameworks from other kinds of guidance and justify why our framework takes the form it does. Our key aim was (...) to help answer practical questions faced by frontline clinicians. I then explain some of the normative issues that shape the content of the framework itself. Here, I engage critically with the resource allocation literature and justify the particular positions that we take in the framework. Although we undertook this work to address resource allocation decisions anticipated during the unfolding COVID-19 pandemic, it will also serve as an example for others who wish to design practical ethics frameworks for other bioethical issues that will emerge in the future. (shrink)

Queen Mary, University of London, School of Law, Mile End Road, London E1 4NS, UK. Tel: +442078825126, Fax: +442089818733, Email: r.ashcroft{at}qmul.ac.uk ' + u + '@' + d + ' '//--> Abstract Recent doctrine in both national and international organisations concerned with public health planning and resource allocation has it that direct ethical justification of substantive decisions is so difficult as to be impossible. Instead, we should agree on criteria of procedural justice and reach decisions whose justification lies in how (...) they are arrived at, rather than any direct ethical justification on the ground of substantive moral principles. In this polemical article, I argue that this amounts to a serious dereliction of intellectual duty on the part of the bioethics community. Our role in these settings is to produce and defend the best substantive arguments we can. Failing to do this makes bioethicists at best redundant and at worst leads us to seriously defective conclusions. The argument is illustrated by analysis of the ethical frameworks for resource allocation under the UNAIDS ‘3 by 5’ programme and for pandemic influenza planning. CiteULike Connotea Del.icio.us What's this? (shrink)

This thesis discusses the possibility of limited moral trade-offs between different people’s welfare. In chapter 2, I introduce the two central limited trade-off conditions. First, according to minimal infinite superiority, significantly benefiting one person matters more than slightly benefiting each of any number of better-off people. Second, according to minimal finite superiority, significantly benefiting many people matters more than slightly benefiting one person. I consider both axiological and deontic interpretations of these conditions. However, I explain why none of the simple (...) classic moral principles—the simple total and the maximin principles—satisfy both conditions. Furthermore, in chapter 3, I strengthen several proved impossibility results according to which no moral theory satisfies weak interpretations of these central trade-off conditions and several other seemingly plausible minimal conditions. I show that giving up structural axiological and deontic conditions is not a satisfactory solution to these paradoxes. In chapter 4, I discuss the modification of a background assumption of these impossibility results on the measurement of welfare. I show that, given a modification that allows for lexicographically ordered welfare components, a total principle can satisfy all the conditions of the impossibility results. However, I argue that such a modification is not entirely satisfactory because it does not apply in certain instances of the paradoxes. In chapter 5, I discuss a further weakening of minimal infinite superiority. However, I show that a suggested possibility result based on this modification is not valid and that further moral conditions, such as minimal finite superiority, need to be modified. Moreover, I argue that these modified conditions and the principle suggested in the possibility proof—a minimax complaint principle—do not capture the basic idea of the two central limited trade-off conditions sufficiently well. In chapter 6, I argue that other principles suggested for the task—the total claim principles—share the same fate as the simple total principles or the minimax complaint principle. In chapter 7, I propose new principles that take their structural roots from voting theory. I show that, in contrast to the other principles discussed, these principles give plausible verdicts where the other principles failed. Finally, in chapter 8, I consider possible objections levelled against this proposal, and I suggest solutions and avenues for future research. (shrink)