Population axiology is the study of the conditions under which one state of affairs is better than another, when the states of affairs in ques- tion may differ over the numbers and the identities of the persons who ever live. Extant theories include totalism, averagism, variable value theories, critical level theories, and “person-affecting” theories. Each of these the- ories is open to objections that are at least prima facie serious. A series of impossibility theorems shows that this is (...) no coincidence: it can be proved, for various sets of prima facie intuitively compelling desiderata, that no axiology can simultaneously satisfy all the desiderata on the list. One’s choice of population axiology appears to be a choice of which intuition one is least unwilling to give up. (shrink)

Critical-Range Utilitarianism is a variant of Total Utilitarianism which can avoid both the Repugnant Conclusion and the Sadistic Conclusion in population ethics. Yet Standard Critical-Range Utilitarianism entails the Weak Sadistic Conclusion, that is, it entails that each population consisting of lives at a bad well-being level is not worse than some population consisting of lives at a good well-being level. In this paper, I defend a version of Critical-Range Utilitarianism which does not entail the Weak Sadistic Conclusion. (...) This is made possible by a fourth category of absolute value in addition to goodness, badness, and neutrality. (shrink)

Two related asymmetries have been discussed in relation to the ethics of creating new lives: First, we seem to have strong moral reason to avoid creating lives that are not worth living, but no moral reason to create lives that are worth living. Second, we seem to have strong moral reason to improve the wellbeing of existing lives, but, again, no moral reason to create lives that are worth living. Both asymmetries have proven very difficult to account for in any (...) coherent moral framework. I propose an impersonal population axiology to underpin the asymmetries, which sidesteps the problematic issue of whether or not people can be harmed or benefited by creation or non-creation. This axiology yields perfect asymmetry from a deliberative perspective, in terms of expected value. The axiology also yields substantial asymmetry for large and realistic populations in terms of their actual value, beyond deliberative relevance. (shrink)

It is notoriously difficult to find an intuitively satisfactory rule for evaluating populations based on the welfare of the people in them. Standard examples, like total utilitarianism, either entail the Repugnant Conclusion or in some other way contradict common intuitions about the relative value of populations. Several philosophers have presented formal arguments that seem to show that this happens of necessity: our core intuitions stand in contradiction. This paper assesses the state of play, focusing on the most powerful of these (...) ‘impossibility theorems’, as developed by Gustaf Arrhenius. I highlight two ways in which these theorems fall short of their goal: some appeal to a supposedly egalitarian condition which, however, does not properly reflect egalitarian intuitions; the others rely on a background assumption about the structure of welfare which cannot be taken for granted. Nonetheless, the theorems remain important: they give insight into the difficulty, if not perhaps the impossibility, of constructing a satisfactory population axiology. We should aim for reflective equilibrium between intuitions and more theoretical considerations. I conclude by highlighting one possible ingredient in this equilibrium, which, I argue, leaves open a still wider range of acceptable theories: the possibility of vague or otherwise indeterminate value relations. (shrink)

Given the deep disagreement surrounding population axiology, one should remain uncertain about which theory is best. However, this uncertainty need not leave one neutral about which acts are better or worse. We show that, as the number of lives at stake grows, the Expected Moral Value approach to axiological uncertainty systematically pushes one toward choosing the option preferred by the Total View and critical-level views, even if one’s credence in those theories is low.

Non-Archimedean population axiologies – also known as lexical views – claim (i) that a sufficient number of lives at a very high positive welfare level would be better than any number of lives at a very low positive welfare level and/or (ii) that a sufficient number of lives at a very low negative welfare level would be worse than any number of lives at a very high negative welfare level. Such axiologies are popular because they can avoid the (Negative) (...) Repugnant Conclusion and satisfy the adequacy conditions given in the central impossibility result in population axiology due to Gustaf Arrhenius. I provide a novel argument against them which appeals to the way that good and bad lives can intuitively outweigh one other. (shrink)

Lexical views in population axiology can avoid the Repugnant Conclusion without violating Transitivity or Separability. However, they imply a dilemma: either some good life is better than any number of slightly worse lives, or else the ‘at least as good as’ relation on populations is radically incomplete. In this paper, I argue that Archimedean views face an analogous dilemma. I thus conclude that the lexical dilemma gives us little reason to prefer Archimedean views. Even if we give up (...) on lexicality, problems of the same kind remain. (shrink)

According to Critical-Level Views in population axiology, an extra life improves a population only if that life’s welfare exceeds some fixed ‘critical level.’ An extra life at the critical level leaves the new population equally good as the original. According to Critical-Range Views, an extra life improves a population only if that life’s welfare exceeds some fixed ‘critical range.’ An extra life within the critical range leaves the new population incommensurable with the original. -/- (...) In this paper, I sharpen some old objections to these views and offer some new ones. Critical-Level Views cannot avoid certain Repugnant and Sadistic Conclusions. Critical-Range Views imply that lives featuring no good or bad components whatsoever can nevertheless swallow up and neutralise goodness or badness. Both classes of view entail that certain small changes in welfare correspond to worryingly large differences in contributive value. -/- I then offer a view that retains much of the appeal of Critical-Level and Critical-Range Views while avoiding the above pitfalls. On the Imprecise Exchange Rates View, the quantity of some good required to outweigh a given unit of some bad is imprecise. This imprecision is the source of incommensurability between lives and populations. (shrink)

My thesis demonstrates that, despite a number of impossibility results, a satisfactory and coherent theory of population ethics is possible. It achieves this by exposing and undermining certain key assumptions that relate to the nature of welfare and personal identity. I analyse a range of arguments against the possibility of producing a satisfactory population axiology that have been proposed by Derek Parfit, Larry Temkin, Tyler Cowen and Gustaf Arrhenius. I conclude that these results pose a real and (...) significant challenge. However, in the absence of further evidence I reject the conclusion that they imply that the value of populations is either not precise or not transitive. Instead, I expose some fundamental assumptions behind these results. One key assumption is that something can only make a life better or worse if it makes that life better or worse for the person living it, i.e. it raises or lowers the ‘welfare level’ of that life. Although intuitively highly plausible, this assumption ignores the possibility that perspectives other than that of the person living a life may be relevant for evaluating the components of that life and that these should be incorporated into our all things considered judgements. I argue that episodes within a person’s life that are strongly psychologically connected may have a special normative significance, particularly if these episodes involve such things as the enjoyment of ‘the best things in life’ or the experience of great suffering. We have reason to assign an all things considered value to such strongly psychologically connected phases of a person’s life, where this value is not exhausted by the contributions these make to the welfare level of that person’s life as a whole. It follows that our all things considered evaluations of populations are often underdetermined by information about the welfare levels of the lives they contain. However, in certain cases, most notably in that of ‘the Repugnant Conclusion’, there is nevertheless sufficient information provided by the welfare levels of persons’ lives to allow us to infer facts about these components that make an all things considered difference to these evaluations. I argue that a failure to acknowledge these facts is the cause of the aforementioned impossibility results and that once they are taken into account it is possible to produce a satisfactory theory of population ethics. (shrink)

Arrhenius’s impossibility theorems purport to demonstrate that no population axiology can satisfy each of a small number of intuitively compelling adequacy conditions. However, it has recently been pointed out that each theorem depends on a dubious assumption: Finite Fine-Grainedness. This assumption states that there exists a finite sequence of slight welfare differences between any two welfare levels. Denying Finite Fine-Grainedness makes room for a lexical population axiology which satisfies all of the compelling adequacy conditions in each (...) theorem. Therefore, Arrhenius’s theorems fail to prove that there is no satisfactory population axiology. In this paper, I argue that Arrhenius’s theorems can be repurposed. Since all of our population-affecting actions have a non-zero probability of bringing about more than one distinct population, it is population prospect axiologies that are of practical relevance, and amended versions of Arrhenius’s theorems demonstrate that there is no satisfactory population prospect axiology. These impossibility theorems do not depend on Finite Fine-Grainedness, so lexical views do not escape them. (shrink)

Population axiology concerns how to evaluate populations in regard to their goodness, that is, how to order populations by the relations “is better than” and “is as good as”. This field has been riddled with impossibility results which seem to show that our considered beliefs are inconsistent in cases where the number of people and their welfare varies.1 All of these results have one thing in common, however. They all involve an adequacy condition that rules out Derek Parfit’s (...) Repugnant Conclusion: The Repugnant Conclusion: For any perfectly equal population with very high positive welfare, there is a population with very low positive welfare which is better, other things being equal.2 1 The informal Mere Addition Paradox in Parfit (1984), pp. 419ff is the locus classicus. For an informal proof of a similar result with stronger assumptions, see Ng (1989), p. 240. A formal proof with slightly stronger assumptions than Ng’s can be found in Blackorby and Donaldson (1991). For theorems with much weaker assumptions, see my (1999), (2000b), and especially (2000a), (2001), and (2009). 2 See Parfit (1984), p. 388. My formulation is more general than Parfit’s apart from that he doesn’t demand that the people with very high welfare are equally well off. Expressions such as “a population with very high positive welfare”, “a population with very low positive welfare”, etc., are elliptical for the more cumbersome phrases “a population consisting only of lives with.. (shrink)

Population axiology concerns how to evaluate populations in terms of their moral goodness, that is, how to order populations by the relations “is better than” and “is as good as”. The task has been to find an adequate theory about the moral value of states of affairs where the number of people, the quality of their lives, and their identities may vary. So far, this field has largely ignored issues about uncertainty and the conditions that have been discussed (...) mostly pertain to the ranking of risk-free outcomes. Most public policy choices, however, are decisions under uncertainty, including policy choices that affect the size of a population. Here, we shall address the question of how to rank population prospects—that is, alternatives that contain uncertainty as to which population they will bring about—by the relations “is better than” and “is as good as”. We start by illustrating how well-known population axiologies can be extended to population prospect axiologies. And we show that new problems arise when extending population axiologies to prospects. In particular, traditional population axiologies lead to prospect-versions of the problems that they praised for avoiding in the risk-free settings. Finally, we identify an intuitive adequacy condition that, we contend, should be satisfied by any population prospect axiology, and show how given this condition, the impossibility theorems in population axiology can be extended to (non-trivial) impossibility theorems for population prospect axiology. (shrink)

Population axiology concerns how to evaluate populations in regard to their goodness, that is, how to order populations by the relations \is better than" and \is as good as". This eld has been riddled with para- doxes and impossibility results which seem to show that our considered beliefs are inconsistent in cases where the number of people and their welfare varies. All of these results have one thing in common, however. They all involve an adequacy condition that rules (...) out Derek Par t's Repugnant Conclusion. Moreover, some theorists have argued that we should accept the Repugnant Conclusion and hence that avoidance of this conclusion is not a convincing adequacy condition for a population axiology. As I shall show in this chapter, however, one can replace avoid- ance of the Repugnant Conclusion with a logically weaker and intuitively more convincing condition. The resulting theorem involves, to the best of my knowledge, logically weaker and intuitively more compelling con- ditions than the other theorems presented in the literature. As such, it challenges the very existence of a satisfactory population ethics. (shrink)

According to axiological retributivism, people can deserve what is bad for them and an outcome in which someone gets what she deserves, even if it is bad for her, can thereby have intrinsic positive value. A question seldom asked is how axiological retributivism should deal with comparisons of outcomes that differ with respect to the number and identities of deserving agents. Attempting to answer this question exposes a problem for axiological retributivism that parallels a well-known problem in population (...) class='Hi'>axiology introduced by John Broome. The problem for axiological retributivism is that it supports the existence of a range of negative wellbeing levels such that if a deserving person comes into existence at any of these levels, the resulting outcome is neither better nor worse with respect to desert. However, the existence of such a range is inconsistent with a set of very plausible axiological claims. I call this the desert neutrality paradox. After introducing the paradox, I consider several possible responses to it. I suggest that one reasonable response, though perhaps not the only one, is to reject axiological retributivism. (shrink)

Is the overall value of a world just the sum of values contributed by each value-bearing entity in that world? Additively separable axiologies (like total utilitarianism, prioritarianism, and critical level views) say 'yes', but non-additive axiologies (like average utilitarianism, rank-discounted utilitarianism, and variable value views) say 'no'. This distinction is practically important: additive axiologies support 'arguments from astronomical scale' which suggest (among other things) that it is overwhelmingly important for humanity to avoid premature extinction and ensure the existence of a (...) large future population, while non-additive axiologies need not. We show, however, that when there is a large enough 'background population' unaffected by our choices, a wide range of non-additive axiologies converge in their implications with some additive axiology -- for instance, average utilitarianism converges to critical-level utilitarianism and various egalitarian theories converge to prioritiarianism. We further argue that real-world background populations may be large enough to make these limit results practically significant. This means that arguments from astronomical scale, and other arguments in practical ethics that seem to presuppose additive separability, may be truth-preserving in practice whether or not we accept additive separability as a basic axiological principle. (shrink)

Given the deep disagreement surrounding population axiology, one should remain uncertain about which theory is best. However, this uncertainty need not leave one neutral about which acts are better or worse. We show that as the number of lives at stake grows, the Expected Moral Value approach to axiological uncertainty systematically pushes one towards choosing the option preferred by the Total and Critical Level views, even if one’s credence in those theories is low.

Formal arguments have proven that avoiding the Repugnant Conclusion is impossible without rejecting one or more highly plausible population principles. To many, such proofs establish not only a deep challenge for axiology, but also pose an important practical problem of how policymaking can confidently proceed without resolving any of the central questions of population ethics. Here we offer deflationary responses: first to the practical challenge, and then to the more fundamental challenge for axiology. Regarding the practical (...) challenge, we provide an overview of recent literature that explores the implications for public policy of the Repugnant Conclusion and related puzzles within population ethics, and shows that there is more commonality in the implications of different population axiologies than is generally recognized. The upshot is that uncertainty about population ethics presents no important problem for policymaking, and the importance of population ethics to policymaking has been overstated. We then turn to more fundamental issues about axiology, and describe a new series of formal proofs that undermine the idea that any plausible axiology could avoid the Repugnant Conclusion, including those that are assumed to avoid it in the literature. The philosophical upshot is that the Repugnant Conclusion cannot plausibly be avoided, and so it is a mistake to assume as a constraint on a plausible axiology that it must be avoided, as is assumed by most of the literature in population ethics, including by all of the fundamental impossibility theorems. (shrink)

This thesis consists of several independent papers in population ethics. I begin in Chapter 1 by critiquing some well-known 'impossibility theorems', which purport to show there can be no intuitively satisfactory population axiology. I identify axiological vagueness as a promising way to escape or at least mitigate the effects of these theorems. In particular, in Chapter 2, I argue that certain of the impossibility theorems have little more dialectical force than sorites arguments do. From these negative arguments (...) I move to positive ones. In Chapter 3, I justify the use of a 'veil of ignorance', starting from three more basic normative principles. This leads to positive arguments for various kinds of utilitarianism - the best such arguments I know. But in general the implications of the veil depend on how one answers what I call 'the risky existential question': what is the value to an individual of a chance of non-existence? I chart out the main options, and raise some puzzles for non-comparativism, the view that life is incomparable to non-existence. Finally, in Chapter 4, I consider the consequences for population ethics of the idea that what is normatively relevant is not personal identity, but a degreed relation of psychological connectedness. In particular, I pursue a strategy based in population ethics for understanding the controversial 'time-relative interests' account of the badness of death. (shrink)

This thesis consists of a series of papers in population ethics: a subfield of normative ethics concerned with the distinctive issues that arise in cases where our actions can affect the identities or number of people of who ever exist. Each paper can be read independently of the others. In Chapter 1, I present a dilemma for Archimedean views in population axiology: roughly, those views on which adding enough good lives to a population can make that (...) population better than any other. In Chapter 2, I extend Gustaf Arrhenius’s famous impossibility theorems in population axiology into the domain of choices under risk. My risky impossibility theorems dispense with the assumption that welfare levels are finitely fine-grained, and so tell against lexical views in population axiology. In Chapter 3, I present objections to critical-level and critical-range views in population axiology. I then sketch out what I call the ‘Imprecise Exchange Rates View’ and argue that it is an attractive alternative. In Chapter 4, I address critical-level and critical-range views again. This time, I note that they are vulnerable to objections from biographical identity: identity between lives. I suggest that these objections give us reason to reject critical-level and critical-range views and embrace the Total View. In Chapter 5, I argue that objections of the same form – objections from personal identity – tell against person-affecting views in population ethics. In Chapter 6, I draw out some counterintuitive implications of two recent complaints-based theories of the procreation asymmetry. (shrink)

Jan Österberg is one of the pioneers in the field of population ethics. He started thinking about this issue already in the late 60s and he has developed one of the most original and interesting population axiologies.1 I’ve discussed the problems and drawbacks of Österberg’s theory elsewhere, and I don’t think that this is the place and time to discuss them again.2 Rather, I shall show that Österberg’s theory has a feature in common with the population axiologies (...) of such luminaries like Plato, Aristotle, Kant, Nietzsche, Wittgenstein and Heidegger, had they developed such a theory: None of these theories simultaneously satisfy five weak adequacy conditions. We shall show this by proving that no population axiology satisfies these five conditions. As a fringe benefit, this theorem also shows that the on-going project of constructing an acceptable population axiology has very gloomy prospects. 3. (shrink)

The article critically covers the current issues of "value-driven management" and the creative economy. Analyzing the concept of a "fragile and incomprehensible" (BANI) world, the author conclude that the widely proclaimed era of the knowledge economy is nothing more than utopia. A value-based transformation is possible if it is approached in a comprehensive and systemic way, which requires large-scale transformations initiated and supported by the power structures. The author believe that the creative economy is more extensive than the traditional one, (...) and its development potential is rather limited. The paradigm of "commercial creativity", in fact, is aimed at providing employment and meeting the needs of the population of the "golden billion" countries. Статья в критическом ключе освещает актуальные вопросы «ценностного менеджмента» и креативной экономики. Анализируя концепцию «хрупкого и непостижимого» (BANI) мира, автор приходит к выводу, что широко провозглашенная эра экономики знаний — не более чем утопия. Ценностная трансформация возможна, если подход к ней будет комплексным и системным, для чего требуются масштабные преобразования, инициируемые и поддерживаемые властными структурами. Креативная экономика, как полагает автор, в большей степени экстенсивна, чем традиционная, а потенциал ее развития весьма ограничен. Парадигма «коммерческого креатива», по сути, нацелена на обеспечение занятости и удовлетворение потребностей населения стран «золотого миллиарда». (shrink)

A search is under way for a theory that can accommodate our intuitions in population axiology. The object of this search has proved elusive. This is not surprising since, as we shall see, any welfarist axiology that satisfies three reasonable conditions implies at least one of three counter-intuitive conclusions. I shall start by pointing out the failures in three recent attempts to construct an acceptable population axiology. I shall then present an impossibility theorem and conclude (...) with a short discussion of how it might be extended to pluralist axiologies, that is, axiologies that take more values than welfare into account. (shrink)

Population ethics studies the tradeoff between the total number of people who will ever live, and their quality of life. But widely accepted theories in modern cosmology say that spacetime is probably infinite. In this case, its population is also probably infinite, so the quantity/quality tradeoff of population ethics is no longer meaningful. Instead, we face the problem of how to ethically evaluate an infinite population of people dispersed throughout time and space. I argue that axiologies (...) based on _spatiotemporal Cesàro average utility_ are the most appropriate way to make this evaluation, because their unique properties make them superior to other axiologies that have been proposed. (shrink)

Population axiology concerns how to evaluate populations in regard to their goodness, that is, how to order populations by the relations “is better than ” and “is as good as”. This field has been riddled with paradoxes and impossibility results which seem to show that our considered beliefs are inconsistent in cases where the number of people and their welfare varies. All of these results have one thing in common, however. They all involve an adequacy condition that rules (...) out Derek Parfit’s Repugnant Conclusion. Moreover, some theorists have argued that we should accept the Repugnant Conclusion and hence that avoidance of this conclusion is not a convincing adequacy condition for a population axiology. As I shall show in this chapter, however, one can replace avoidance of the Repugnant Conclusion with a logically weaker and intuitively more convincing condition. The resulting theorem involves, to the best of my knowledge, logically weaker and intuitively more compelling conditions than the other theorems presented in the literature. As such, it. (shrink)

Values are incommensurable when they cannot be measured on a single cardinal scale. Many philosophers suggest that incommensurability can help us solve the problems of population ethics. I agree. But some philosophers claim that populations bear incommensurable values merely because they contain different numbers of people, perhaps within some range. I argue that mere differences in how many people exist, even within some range, do not suffice for incommensurability. I argue that the intuitive neutrality of creating happy people is (...) better captured by a version of average utilitarianism. But this view is problematic. So I suggest a version of total utilitarianism that avoids the repugnant conclusion by appealing to incommensurable dimensions of wellbeing. (shrink)

Separability is roughly the principle that, in comparing the value of two outcomes, one can ignore any people whose existence and welfare are unaffected. Separability is both antecedently plausible, at least as a principle of beneficence, and surprisingly powerful; it is the key to some of the best positive arguments in population ethics. This chapter surveys the motivations for and consequences of separability. In particular, it presents an ‘additivity theorem’ which explains how separability leads to total utilitarianism and closely (...) related axiological views. It then examines systematically how this family of views can avoid the Repugnant Conclusion by incorporating lexicality, a critical level, or a neutral range. (shrink)

The multiverse theodicy proposes to reconcile the existence of God and evil by supposing that God created all and only the creation-worthy universes and that some universes like ours are, despite their evils, creation-worthy. Drawing on work in population ethics, this paper develops a novel challenge to the multiverse theodicy. Roughly, the challenge contends that the axiological underpinnings of the multiverse theodicy harbor a ‘mere addition paradox’: the assumption that creating creation-worthy universes would always make the world better turns (...) out to have morally repugnant consequences akin to those of the assumption that adding worthwhile lives to a population would always make the overall welfare of the population better. Further, the challenge leverages this difficulty into an argument against God’s having created all and only the creation-worthy universes, and hence against the multiverse theodicy. Responses to this challenge are considered but found wanting, largely because of commitments of the multiverse theodicy that have no analogs in population ethics. (shrink)

We analyze the role of ethical values in the determination of the social cost of carbon, arguing that the familiar debate about discounting is too narrow. Other ethical issues are equally important to computing the social cost of carbon, and we highlight inequality, risk, and population ethics. Although the usual approach, in the economics of cost-benefit analysis for climate policy, is confined to a utilitarian axiology, the methodology of the social cost of carbon is rather flexible and can (...) be expanded to a broader set of social-welfare approaches. [Open access]. (shrink)

Fred Feldman has proposed a desert-adjusted version of utilitarianism,, as a plausible population axiology. Among other things, he claims that justicism avoids Derek Parfit's. This paper explains the theory and tries to straighten out some of its ambiguities. Moreover, it is shown that it is not clear whether justicism avoids the repugnant conclusion and that it is has other counter-intuitive implications. It is concluded that justicism is not convincing as a population axiology.

This paper examines a dilemma in reproductive and population ethics that can illuminate broader questions in axiology and normative ethics. This dilemma emerges because most people have conflicting intuitions concerning whether the interests of non-existent beings can outweigh the interests of existing beings when those merely potential beings are expected to have overall net-good or overall net-bad lives. The paper claims that the standard approach to this issue, in terms of exemplifying the conflict between Narrow Person-Affecting Views and (...) Impersonal Views, is not correct. It argues that, instead, we can approach the issue through the distinction between Symmetrical and Asymmetrical Views about the relative importance of positive and negative value. The paper also claims that Asymmetrical Views provide the most intuitively satisfactory solution to the dilemma and can in addition be defended independently on further grounds. Keywords: person-affecting views, impersonal views, symmetry, asymmetry. (shrink)

Variable-Value axiologies avoid Parfit’s Repugnant Conclusion while satisfying some weak instances of the Mere Addition principle. We apply calibration methods to two leading members of the family of Variable-Value views conditional upon: first, a very weak instance of Mere Addition and, second, some plausible empirical assumptions about the size and welfare of the intertemporal world population. We find that such facts calibrate these two Variable-Value views to be nearly totalist, and therefore imply conclusions that should seem repugnant to anyone (...) who opposes Total Utilitarianism only due to the Repugnant Conclusion. (shrink)

IntroductionCardiology is characterized by its state-of-the-art biomedical technology and the predominance of Evidence-Based Medicine. This predominance makes it difficult for healthcare professionals to deal with the ethical dilemmas that emerge in this subspecialty. This paper is a first endeavor to empirically investigate the axiological foundations of the healthcare professionals in a cardiology hospital. Our pilot study selected, as the target population, cardiology personnel not only because of their difficult ethical deliberations but also because of the stringent conditions in which (...) they have to make them. Therefore, there is an urgent need to reconsider clinical ethics and Value-Based Medicine. This study proposes a qualitative analysis of the values and the virtues of healthcare professionals in a cardiology hospital in order to establish how the former impact upon the medical and ethical decisions made by the latter.ResultsWe point out the need for strengthening the roles of healthcare personnel as educators and guidance counselors in order to meet the ends of medicine, as well as the need for an ethical discernment that is compatible with our results, namely, that the ethical values developed by healthcare professionals stem from their life history as well as their professional education.ConclusionWe establish the kind of actions, communication skills and empathy that are required to build a stronger patient-healthcare professional relationship, which at the same time improves prognosis, treatment efficiency and therapeutic adhesion. (shrink)

Cardiology is characterized by its state-of-the-art biomedical technology and the predominance of Evidence-Based Medicine. This predominance makes it difficult for healthcare professionals to deal with the ethical dilemmas that emerge in this subspecialty. This paper is a first endeavor to empirically investigate the axiological foundations of the healthcare professionals in a cardiology hospital. Our pilot study selected, as the target population, cardiology personnel not only because of their difficult ethical deliberations but also because of the stringent conditions in which (...) they have to make them. Therefore, there is an urgent need to reconsider clinical ethics and Value-Based Medicine. This study proposes a qualitative analysis of the values and the virtues of healthcare professionals in a cardiology hospital in order to establish how the former impact upon the medical and ethical decisions made by the latter. (shrink)

This paper develops a largely neglected parallel between prudence and population ethics. Prudence is generally understood to be concerned with the balancing of well-being over time. How, precisely, well-being ought to be balanced over time, however, is a fervently debated question. I argue that developing a standard guiding such evaluations is exceedingly challenging. This is due to an often overlooked fact about prudence, namely that it shares a structural similarity with population ethics: In both contexts, we assess the (...) comparative value of populations of personstages/people, which may vary in number and level of well-being. Based on this analogy, I show that the development of an adequate theory of prudence runs into very similar impossibility results as obtain in population ethics. In particular, I prove that Arrhenius’ fifth impossibility theorem can be applied to prudence. I develop and compare four possible answers to this challenge. First, I discuss the possibility of accepting the very repugnant conclusion intrapersonally. Second, I present and further develop Donald Bruckner’s Minimax Regret approach, which gives up Transitivity. Third, I apply Jacob Nebel’s Lexical Threshold View to prudence and critically evaluate it. Lastly, I introduce what I call the Negative Lexicality View, which is based on Lexical Threshold View but overcomes some of its problems. (shrink)

IntroductionCardiology is characterized by its state-of-the-art biomedical technology and the predominance of Evidence-Based Medicine. This predominance makes it difficult for healthcare professionals to deal with the ethical dilemmas that emerge in this subspecialty. This paper is a first endeavor to empirically investigate the axiological foundations of the healthcare professionals in a cardiology hospital. Our pilot study selected, as the target population, cardiology personnel not only because of their difficult ethical deliberations but also because of the stringent conditions in which (...) they have to make them. Therefore, there is an urgent need to reconsider clinical ethics and Value-Based Medicine. This study proposes a qualitative analysis of the values and the virtues of healthcare professionals in a cardiology hospital in order to establish how the former impact upon the medical and ethical decisions made by the latter.ResultsWe point out the need for strengthening the roles of healthcare personnel as educators and guidance counselors in order to meet the ends of medicine, as well as the need for an ethical discernment that is compatible with our results, namely, that the ethical values developed by healthcare professionals stem from their life history as well as their professional education.ConclusionWe establish the kind of actions, communication skills and empathy that are required to build a stronger patient-healthcare professional relationship, which at the same time improves prognosis, treatment efficiency and therapeutic adhesion. (shrink)

In the face of an impossibility result, some assumption must be relaxed. The Mere Addition Paradox is an impossibility result in population ethics. Here, I explore substantially weakening the decision-theoretic assumptions involved. The central finding is that the Mere Addition Paradox persists even in the general framework of choice functions when we assume Path Independence as a minimal decision-theoretic constraint. Choice functions can be thought of either as generalizing the standard axiological assumption of a binary “betterness” relation, or as (...) providing a general framework for a normative (rather than axiological) theory of population ethics. Path Independence, a weaker assumption than typically (implicitly) made in population ethics, expresses the idea that, in making a choice from a set of alternatives, the order in which options are assessed or considered is ethically arbitrary and should not affect the final choice. Since the result establishes a conflict between the relevant ethical principles and even very weak decision-theoretic principles, we have more reason to doubt the ethical principles. (shrink)

A principal aim of the branch of ethics called ‘population theory’ or ‘population ethics’ is to find a plausible welfarist axiology, capable of comparing total outcomes with respect to value. This has proved an exceedingly difficult task. In this paper I shall state and discuss two ‘trilemmas’, or choices between three unappealing alternatives, which the population ethicist must face. The first trilemma is not new. It originates with Derek Parfit's well-known ‘Mere Addition Paradox’, and was first (...) explicitly stated by Yew-Kwang Ng. I shall argue that one horn of this trilemma is less unattractive than Parfit and others have claimed. The second trilemma, which is a kind of mirror image of the first, appears hitherto to have gone unnoticed. Apart from attempting to resolve the two trilemmas, I shall suggest certain features which I believe a plausible welfarist axiology should possess. The details of this projected axiology will, however, be left open. (shrink)

Population axiology concerns how to evaluate populations in regard to their goodness, that is, how to order populations by the relations “is better than” and “is as good as”. This field has been riddled with “paradoxes” which seem to show that our considered beliefs are inconsistent in cases where the number of people and their welfare varies. Already in Derek Parfit’s seminal contribution to the topic, an informal paradox — the Mere Addition Paradox — was presented and later (...) contributions have proved similar results.1 All of these contributions, however, have one thing in common: They all involve an adequacy condition that rules out Parfit’s Repugnant Conclusion: The Repugnant Conclusion: For any perfectly equal population with very high positive welfare, there is a population with very low positive welfare which is better, other things being equal.2 A number of theorists, however, have argued that we should accept the Repugnant Conclusion and hence that avoidance of this conclusion is not a convincing adequacy condition for a population axiology. Torbjörn Tännsjö, for example, argues that the Repugnant Conclusion is not at all repugnant but rather “an unsought, but acceptable, consequence of hedonistic utilitarianism”:3.. (shrink)

As the title of this paper indicates, I’m going to discuss what we ought to do in situations where our actions affect future generations. More specifically, I shall focus on the moral problems raised by cases where our actions affect who’s going to live, their number and their well being. I’ll start, however, with population axiology. Most discussion in population ethics has concentrated on how to evaluate populations in regard to their goodness, that is, how to order (...) populations by the relations “is better than” and “is as good as”. This field has been riddled with “paradoxes” which purport to show that our considered beliefs are inconsistent in cases where the number of people and their welfare varies. Derek Parfit’s Mere Addition Paradox is a case in point. The main question of my paper concerns the implication of such axiological paradoxes for normative theories. Do the axiological paradoxes translate into paradoxes for normative theories or will they, as some believe, disappear if we switch to a normative framework? (shrink)

The passage of Mill’s Utilitarianism that sets out the condition in which one pleasure has a superior quality than another stokes interpretive controversy. According to the Lexical Interpretation, Mill takes one pleasure, P1, to be of a superior quality than another, P2, if, and only if, the smallest quantity of P1 is more valuable than any finite quantity of P2. This paper argues that, while the Lexical Interpretation may be supported with supplementary evidence, the passage itself does not rule out (...) qualitative superiority without lexical dominance, as it only requires P1 to be more valuable than any quantity of P2 that it is possible for someone to experience. Some will object that this concession to opponents of the Lexical Interpretation still renders Mill’s condition for qualitative superiority too demanding to be plausible. However, if Mill’s qualitative rankings apply to higher-order pleasures taken in modes of existence as such rather than to the pleasures of different activities chosen from within these modes, the objection loses much of its force. One upshot is that Mill may have more to contribute to debates in contemporary population axiology than is usually acknowledged. (shrink)

The Repugnant Conclusion served an important purpose in catalyzing and inspiring the pioneering stage of population ethics research. We believe, however, that the Repugnant Conclusion now receives too much focus. Avoiding the Repugnant Conclusion should no longer be the central goal driving population ethics research, despite its importance to the fundamental accomplishments of the existing literature.

This book is a comprehensive and unique text and reference in medical ethics. By far the most inclusive set of primary documents and articles in the field ever published, it contains over 100 selections. Virtually all pieces appear in their entirety, and a significant number would be difficult to obtain elsewhere. The volume draws upon the literature of history, medicine, philosophical and religious ethics, economics, and sociology. A wide range of topics and issues are covered, such as law and medicine, (...) truth-telling by the physician, research, population policy, genetics, abortion, dying, and individual rights in medical care. The selections span the centuries, beginning with material from the works of Hippocrates, continuing through Thomas Percival, John Stuart Mill, and Claude Bernard, down to modern commentators like Henry K. Beecher, Walsh McDermott, David L. Bazelon, Paul Freund, H. L. A. Hart, John Rawls, Paul Ramsey, Richard McCormick, Rashi Fein, and Bernard Barber. The text has eight major divisions, beginning with sections on the ethical dimensions of the physician-patient relationship in history; the moral bases of medical ethics; and regulation, compulsion, and protection of the consumer in clinical medicine and public health. Each of these sections includes key essays that appear for the first time. All of the book's major divisions contain primary documents: codes such as the Hippocratic Oath, Medieval Law for the Regulation of Medicine, and the first as well as the most recent code of the American Medical Association; court decisions, including those on Karen Quinlan and on abortion in the United States and West Germany; government documents such as the statement of the National Commission on the Protection of Human Subjects, the Tuskegee Syphilis Report, the British Parliamentary debate on euthanasia, and the Council of Europe on rights of the sick and dying; and various published guidelines such as the Harvard Medical School brain death criteria, the American Hospital Association on patient's rights, and Pope Pius XII on the prolongation of life. Cases that illustrate moral dilemmas are provided for discussion purposes. Each section is preceded by a succinct editor's introduction. The documents and essays are of practical value for practitioners and students in medicine, law, ethics, and counselling, and for individual patients and groups concerned with medical care. Through encompassing divergent viewpoints, the essays and primary documents were selected to encourage humane practices and deepen understanding of the multiple traditions that shaped and do shape the development of medicine. (shrink)

Many population axiologies avoid the Repugnant Conclusion by endorsing Superiority: some number of great lives is better than any number of mediocre lives. But as Nebel shows, RC follows from the Intrapersonal Repugnant Conclusion: a guaranteed mediocre life is better than a sufficiently small probability of a great life. This result is concerning because IRC is plausible. Recently, Kosonen has argued that IRC can be true while RC is false if small probabilities are discounted to zero. This article details (...) the unique problems created by combining Superiority with discounting. The resultant view, Superiority Discounting, avoids the Repugnant Conclusion only at the cost of the Preposterous Conclusion: near-certain hell for arbitrarily many people is better than near-certain heaven for arbitrarily many people. (shrink)

Population axiology includes two major arguments. The first is the repugnant conclusion, which was originally formulated by Derek Parfit to criticize total utilitarianism. The second is the sadistic conclusion. In this study, I demonstrate that no additively separable principle can avoid both repugnant and sadistic conclusions if individual moral values have no upper bound. This impossibility holds not only for utilitarian principles but also for any population principles that guarantee the separability of people’s well-being. I emphasize the (...) importance of examining non-separable principles in population ethics. (shrink)

Grill (2023) defends the Sum of Averages View (SAV), on which the value of a population is found by summing the average lifetime welfare of each generation or birth cohort. A major advantage of SAV, according to Grill, is that it escapes the Egyptology objection to average utilitarianism. But, we argue, SAV escapes only the most literal understanding of this objection, since it still allows the value of adding a life to depend on facts about other, intuitively irrelevant lives. (...) Moreover, SAV has a decisive drawback not shared with either average or total utilitarianism: it can evaluate an outcome in which every individual is worse off as better overall, even when exactly the same people exist in both outcomes. These problems, we argue, afflict not only Grill’s view but any view that uses a sum of subpopulation averages, apart from the limiting cases of average and total utilitarianism. (shrink)