Health insurance coverage for incarcerated citizens is generally acceptable by Western standards. However, it creates internal tensions with the prevailing justifications for public healthcare. In particular, a conceptualization of medical care as a source of autonomy enhancement does not align with the decreased autonomy of incarceration and the needs-based conceptualization of medical care in cases of imprisonment; and rejecting responsibility as a criterion for assigning medical care conflicts with the use of responsibility as a criterion for assigning punishment. The recent (...) introduction of sofosbuvir in Germany provides a particularly instructive illustration of such tensions. It requires searching for a refined reflective equilibrium regarding the scope, limits, and justifications of publicly guaranteed care. (shrink)
Despite the prevalence of the terms utilitarianism and utilitarian in the health care and health policy literature, anecdotal evidence suggests that authors are often not fully aware of the diversity of utilitarian theories, their principles, and implications. Further, it seems that authors often categorically reject utilitarianism under the assumption that it violates individual rights. The tendency of act utilitarianism to neglect individual rights is attenuated, however, by the diminishing marginal utility of wealth and the disutility of a protest by those (...) who are disadvantaged. In practice, act utilitarians tend to introduce moral rules and preserve traditional rules. At the same time, the tenability of rule utilitarianism is limited because it ultimately collapses into act utilitarianism or a deontological theory. Negative utilitarianism is a viable utilitarian variant only if we accept complete aversion to suffering, ie, if we disregard any forgone opportunities to increase pleasure. Finally, the adoption of preference utilitarianism requires us to accept the subjectivity of individual claims which may be perceived as unfair. (shrink)
Scarce public resources require trade-offs between competing programs indifferent sectors, and the careful allocation of fixed resources within a single sector. This paper argues that a general quality of life instrument encompassing health-related and non-health-related components is suitable for determining the best trade-offs between sectors. Further, this paper suggests that subjective well-being shows the properties crucial to a general quality of life measure and has additional advantages that makes it particularly useful for the allocation of public and health care resources. (...) The paper argues that Western societies are in an unusually prosperous situation today which allows to concentrate efforts not only on reducing harm but also on improving positive states of health. Further, subjective well-being can be evaluated from the patient's perspective and incorporates a valuation of life expectancy. Criteria required for an appropriate questionnaire that measures subjective well-being are presented. (shrink)
The purpose of this paper is to discuss the rational foundation of utilitarianism and the moral motivation to pursue utilitarianism. To this end, the paper discusses a variety of theories including not only utilitarianism and theories of rationality, but also economic theory and evolutionary theories of cooperation.The paper shows that both the rational foundation of utilitarianism and the motivation to pursue utilitarianism are questionable. Agent-relative theories are a recent attempt to attenuate the problem of motivation for utilitarianism. This paper shows, (...) however, that agent-relative theories are also problematic because they require suppression of evolutionary altruistic behavior. (shrink)
The Trends in International Mathematics and Science Study shows that US school students have a lower level of achievement than students from many East Asian countries. Therefore, media, researchers and policy‐makers in the United States have often argued that US competitiveness in mathematics and science will decline. This paper aims at verifying this conclusion by analysing data on medallists at the International Olympiads for high school students. The analysis suggests that US competitiveness may not be endangered.