In this article, I attempt to resuscitate the perennially unfashionable distinctive feeling theory of pleasure (and pain), according to which for an experience to be pleasant (or unpleasant) is just for it to involve or contain a distinctive kind of feeling. I do this in two ways. First, by offering powerful new arguments against its two chief rivals: attitude theories, on the one hand, and the phenomenological theories of Roger Crisp, Shelly Kagan, and Aaron Smuts, on the other. Second, by (...) showing how it can answer two important objections that have been made to it. First, the famous worry that there is no felt similarity to all pleasant (or unpleasant) experiences (sometimes called ‘the heterogeneity objection’). Second, what I call ‘Findlay’s objection’, the claim that it cannot explain the nature of our attraction to pleasure and aversion to pain. (shrink)

What is it for a life to be meaningful? In this article, I defend what I call Consequentialism about Meaning in Life, the view that one's life is meaningful at time t just in case one's surviving at t would be good in some way, and one's life was meaningful considered as a whole just in case the world was made better in some way for one's having existed.

Purposeful infection of healthy volunteers with a microbial pathogen seems at odds with acceptable ethical standards, but is an important contemporary research avenue used to study infectious diseases and their treatments. Generally termed ‘controlled human infection studies’, this research is particularly useful for fast tracking the development of candidate vaccines and may provide unique insight into disease pathogenesis otherwise unavailable. However, scarce bioethical literature is currently available to assist researchers and research ethics committees in negotiating the distinct issues raised by (...) research involving purposefully infecting healthy volunteers. In this article, we present two separate challenge studies and highlight the ethical issues of human challenge studies as seen through a well-constructed framework. Beyond the same stringent ethical standards seen in other areas of medical research, we conclude that human challenge studies should also include: independent expert reviews, including systematic reviews; a publicly available rationale for the research; implementation of measures to protect the public from spread of infection beyond the research setting; and a new system for compensation for harm. We hope these additions may encourage safer and more ethical research practice and help to safeguard public confidence in this vital research alternative in years to come. (shrink)

Strategies to increase influenza vaccination rates have typically targeted healthcare professionals and individuals in various high-risk groups such as the elderly. We argue that they should focus on increasing vaccination rates in children. Because children suffer higher influenza incidence rates than any other demographic group, and are major drivers of seasonal influenza epidemics, we argue that influenza vaccination strategies that serve to increase uptake rates in children are likely to be more effective in reducing influenza-related morbidity and mortality than those (...) targeting HCPs or the elderly. This is true even though influenza-related morbidity and mortality amongst children are low, except in the very young. Further, we argue that there are no decisive reasons to suppose that children-focused strategies are less ethically acceptable than elderly or HCP-focused strategies. (shrink)

Several critics of realist theories of political legitimacy have alleged that it possesses a problematic bias towards the status quo. This bias is thought to be reflected in the way in which these...

Three plausible views—Presentism, Truthmaking, and Independence—form an inconsistent triad. By Presentism, all being is present being. By Truthmaking, all truth supervenes on, and is explained in terms of, being. By Independence, some past truths do not supervene on, or are not explained in terms of, present being. We survey and assess some responses to this.

European Journal of Philosophy, EarlyView.

Some healthcare systems are said to be grounded in solidarity because healthcare is funded as a form of mutual support. This article argues that health care systems that are grounded in solidarity have the right to penalise some users who are responsible for their poor health. This derives from the fact that solidary systems involve both rights and obligations and, in some cases, those who avoidably incur health burdens violate obligations of solidarity. Penalties warranted include direct patient contribution to costs, (...) and lower priority treatment, but not typically full exclusion from the healthcare system. We also note two important restrictions on this argument. First, failures of solidary obligations can only be assumed under conditions that are conducive to sufficiently autonomous choice, which occur when patients are given ‘Golden Opportunities’ to improve their health. Second, because poor health does not occur in a social vacuum, an insistence on solidarity as part of healthcare is legitimate only if all members of society are held to similar standards of solidarity. We cannot insist upon, and penalise failures of, solidarity only for those who are unwell, and who cannot afford to evade the terms of public health. (shrink)

In this paper, I reconstruct Robert Nozick's experience machine objection to hedonism about well-being. I then explain and briefly discuss the most important recent criticisms that have been made of it. Finally, I question the conventional wisdom that the experience machine, while it neatly disposes of hedonism, poses no problem for desire-based theories of well-being.

European Journal of Philosophy, Volume 30, Issue 3, Page 1110-1124, September 2022.

Efforts to promote equitable public policy with algorithms appear to be fundamentally constrained by the “impossibility of fairness” (an incompatibility between mathematical definitions of fairness). This technical limitation raises a central question about algorithmic fairness: How can computer scientists and policymakers support equitable policy reforms with algorithms? In this article, I argue that promoting justice with algorithms requires reforming the methodology of algorithmic fairness. First, I diagnose the problems of the current methodology for algorithmic fairness, which I call “formal algorithmic (...) fairness.” Because formal algorithmic fairness restricts analysis to isolated decision-making procedures, it leads to the impossibility of fairness and to models that exacerbate oppression despite appearing “fair.” Second, I draw on theories of substantive equality from law and philosophy to propose an alternative methodology, which I call “substantive algorithmic fairness.” Because substantive algorithmic fairness takes a more expansive scope of analysis, it enables an escape from the impossibility of fairness and provides a rigorous guide for alleviating injustice with algorithms. In sum, substantive algorithmic fairness presents a new direction for algorithmic fairness: away from formal mathematical models of “fair” decision-making and toward substantive evaluations of whether and how algorithms can promote justice in practice. (shrink)

If musical works are abstract objects, which cannot enter into causal relations, then how can we refer to musical works or know anything about them? Worse, how can any of our musical experiences be experiences of musical works? It would be nice to be able to sidestep these questions altogether. One way to do that would be to take musical works to be concrete objects. In this paper, we defend a theory according to which musical works are concrete objects. In (...) particular, the theory that we defend takes musical works to be fusions of performances. We defend this view from a series of objections, the first two of which are raised by Julian Dodd in a recent paper and the last of which is suggested by some comments of his in an earlier paper. (shrink)

Can a musical work be created? Some say ‘no’. But, we argue, there is no handbook of universally accepted metaphysical truths that they can use to justify their answer. Others say ‘yes’. They have to find abstract objects that can plausibly be identified with musical works, show that abstract objects of this sort can be created, and show that such abstract objects can persist. But, we argue, none of the standard views about what a musical work is allows musical works (...) both to be created and to persist. (shrink)

In this article I defend a new argument against moralist theories of legitimacy and in favour of realist theories. Moralist theories, I argue, are vulnerable to ideological and wishful thinking because they do not connect the demands of legitimacy with the interests of rulers. Realist theories, however, generally do manage to make this connection. This is because satisfying the usual realist criteria for legitimacy – the creation of a stable political order that transcends brute coercion – is usually necessary for (...) rulers to preserve their rule. (shrink)

There is significant controversy over whether patients have a ‘right not to know’ information relevant to their health. Some arguments for limiting such a right appeal to potential burdens on others that a patient’s avoidable ignorance might generate. This paper develops this argument by extending it to cases where refusal of relevant information may generate greater demands on a publicly funded healthcare system. In such cases, patients may have an ‘obligation to know’. However, we cannot infer from the fact that (...) a patient has an obligation to know that she does not also have a right not to know. The right not to know is held against medical professionals at a formal institutional level. We have reason to protect patients’ control over the information that they receive, even if in individual instances patients exercise this control in ways that violate obligations. (shrink)

This article explains and defends a novel idea about how people can be misled by a discussion topic, even if the discussion itself does not explicitly involve the making of false claims. The crucial aspect of this idea is that people are liable to infer, from the fact that a particular topic is being discussed, that this topic is important. As a result, they may then be led to accept certain beliefs about the state of the world they consider necessary (...) for the topic’s importance. What the article calls “importance misrepresentation” occurs when these beliefs about the state of the world are false or otherwise mistaken. The article explores different ways in which importance misrepresentation can occur, and it uses this idea to help clarify and strengthen some well‐known criticisms of the topic choices of academic philosophers. (shrink)

I introduce a distinction between health need and medical need, and raise several questions about their interaction. Health needs are needs that relate directly to our health condition. Medical needs are needs which bear some relation to medical institutions or processes. I suggest that the question of whether medical insurance or public care should cover medical needs, health needs, or only needs which fit both categories is a political question that cannot be resolved definitionally. I also argue against an overly (...) strict definition of medical need on the grounds that this presupposes, wrongly, that medical intervention should always be a last resort. (shrink)

Recent literature on intrinsic value contains a number of disputes about the nature of the concept. On the one hand, there are those who think states of affairs, such as states of pleasure or desire satisfaction, are the bearers of intrinsic value (“Mooreans”); on the other hand, there are those who think concrete objects, like people, are intrinsically valuable (“Kantians”). The contention of this paper is that there is not a single concept of intrinsic value about which Mooreans and Kantians (...) have disagreed, but rather two distinct concepts. I state a number of principles about intrinsic value that have typically (though not universally) been held by Mooreans, all of which are typically denied by Kantians. I show that there are distinct theoretical roles for a concept of intrinsic value to play in a moral framework. When we notice these distinct theoretical roles, we should realize that there is room for two distinct concepts of intrinsic value within a single moral framework: one that accords with some or all of the Moorean principles, and one that does not. (shrink)

In this article I defend a new argument against moralist theories of legitimacy and in favour of realist theories. Moralist theories, I argue, are vulnerable to ideological and wishful thinking because they do not connect the demands of legitimacy with the interests of rulers. Realist theories, however, generally do manage to make this connection. This is because satisfying the usual realist criteria for legitimacy – the creation of a stable political order that transcends brute coercion – is usually necessary for (...) rulers to preserve their rule. (shrink)

In the nineteenth century, astronomers thought that a planet between Mercury and the Sun was causing perturbations in the orbit of Mercury, and they introduced ‘Vulcan’ as a name for such a planet. But they were wrong: there was, and is, no intra-Mercurial planet. Still, these astronomers went around saying things like (2) Vulcan is a planet between Mercury and the Sun. Some philosophers think that, when nineteenth-century astronomers were theorizing about an intra-Mercurial planet, they created a hypothetical planet.

There is an ongoing increase in the use of mobile health technologies that patients can use to monitor health-related outcomes and behaviours. While the dominant narrative around mHealth focuses on patient empowerment, there is potential for mHealth to fit into a growing push for patients to take personal responsibility for their health. I call the first of these uses ‘medical monitoring’, and the second ‘personal health surveillance’. After outlining two problems which the use of mHealth might seem to enable us (...) to overcome—fairness of burdens and reliance on self-reporting—I note that these problems would only really be solved by unacceptably comprehensive forms of personal health surveillance which applies to all of us at all times. A more plausible model is to use personal health surveillance as a last resort for patients who would otherwise independently qualify for responsibility-based penalties. However, I note that there are still a number of ethical and practical problems that such a policy would need to overcome. The prospects of mHealth enabling a fair, genuinely cost-saving policy of patient responsibility are slim. (shrink)

Accoding to G.E. Moore, something''s intrinsic valuedepends solely on its intrinsic nature. Recently Thomas Hurka andShelly Kagan have argued, contra Moore, that something''s intrinsic valuemay depend on its extrinsic properties. Call this view the ConditionalView of intrinsic value. In this paper I demonstrate how a Mooreancan account for purported counterexamples given by Hurka and Kagan. I thenargue that certain organic unities pose difficulties for the ConditionalView.

In this paper, I argue against Millian Descriptivism: that is, the view that, although sentences that contain names express singular propositions, when they use those sentences speakers communicate descriptive propositions. More precisely, I argue that Millian Descriptivism fares no better (or worse) than Fregean Descriptivism: that is, the view that sentences express descriptive propositions. This is bad news for Millian Descriptivists who think that Fregean Descriptivism is dead.

The idea of using responsibility in the allocation of healthcare resources has been criticized for, among other things, too readily abandoning people who are responsible for being very badly off. One response to this problem is that while responsibility can play a role in resource allocation, it cannot do so if it will leave those who are responsible below a “sufficiency” threshold. This paper considers first whether a view can be both distinctively sufficientarian and allow responsibility to play a role (...) even for those who will be left with very poor health. It then draws several further distinctions that may affect the application of responsibility at this level. We conclude that a more plausible version of the sufficientarian view is to allow a role for responsibility where failure to do so will leave someone else who is not responsible below the sufficiency threshold. However, we suggest that individuals must exhibit “sufficient responsibility” in order for this to apply, involving both a sufficient level of control and an avoidable failure to respond adequately to reasons for action. (shrink)

Thanks to David Kaplan (1989a, 1989b), we all know how to handle indexicals like ‘I’. ‘I’ doesn’t refer to an object simpliciter; rather, it refers to an object only relative to a context. In particular, relative to a context C, ‘I’ refers to the agent of C. Since different contexts can have different agents, ‘I’ can refer to different objects relative to different contexts. For example, relative to a context cwhose agent is Gottlob Frege, ‘I’ refers to Frege; relative to (...) a context 0* whose agent is Alexius.. (shrink)

Whole-genome analysis and whole-exome analysis generate many more clinically actionable findings than traditional targeted genetic analysis. These findings may be relevant to research participants themselves as well as for members of their families. Though researchers performing genomic analyses are likely to find medically significant genetic variations for nearly every research participant, what they will find for any given participant is unpredictable. The ubiquity and diversity of these findings complicate questions about disclosing individual genetic test results. We outline an approach for (...) disclosing a select range of genetic results to the relatives of research participants who have died, developed in response to relatives? requests during a pilot study of large-scale medical genetic sequencing. We also argue that studies that disclose individual research results to participants should, at a minimum, passively disclose individual results to deceased participants? relatives. (shrink)

A considerable literature has emerged around the idea of using ‘personal responsibility’ as an allocation criterion in healthcare distribution, where a person's being suitably responsible for their health needs may justify additional conditions on receiving healthcare, and perhaps even limiting access entirely, sometimes known as ‘responsibilisation’. This discussion focuses most prominently, but not exclusively, on ‘luck egalitarianism’, the view that deviations from equality are justified only by suitably free choices. A superficially separate issue in distributive justice concerns the two–way relationship (...) between health and other social goods: deficits in health typically undermine one's abilities to secure advantage in other areas, which in turn often have further negative effects on health. This paper outlines the degree to which this latter relationship between health and other social goods exacerbates an existing problem for proponents of responsibilisation (the ‘harshness objection’) in ways that standard responses to this objection cannot address. Placing significant conditions on healthcare access because of a person's prior responsibility risks trapping them in, or worsening, negative cycles where poor health and associated lack of opportunity reinforce one another, making further poor yet ultimately responsible choices more likely. It ends by considering three possible solutions to this problem. (shrink)

In recent work, Peter Hanks and Scott Soames argue that propositions are types whose tokens are acts, states, or events. Let’s call this view the type view. Hanks and Soames think that one of the virtues of the type view is that it allows them to explain why propositions have semantic properties. But, in this paper, we argue that their explanations aren’t satisfactory. In Section 2, we present the type view. In Section 3, we present one explanation—due to Hanks (2007, (...) 2011) and Soames (2010)—of why propositions have semantic properties. We criticize this first explanation in Section 4. In Section 5, we present another explanation—due to Soames (2104)—of why propositions have semantic properties. We criticize this second explanation in Section 6. (shrink)

Healthcare practitioners have access to a range of ethical guidance. However, the normative role of this guidance in ethical decision-making is underexplored. This paper considers two ways that healthcare practitioners could approach ethics guidance. We first outline the idea of deference to ethics guidance, showing how an attitude of deference raises three key problems: moral value; moral understanding; and moral error. Drawing on philosophical literature, we then advocate an alternative framing of ethics guidance as a form of moral testimony by (...) colleagues and suggest that a more promising attitude to ethics guidance is to approach it in the spirit of ‘critical engagement’ rather than deference. (shrink)

In this critique of longtermism, I attack its Heart, the idea that there is intrinsic value in the addition of each new happy being to the world. I provide new responses to longtermists' two main arguments for the Heart (The Argument from Extinction and The Argument from Miserable Beings). I then sketch an alternative view to longtermism, which I call Future Sentimentalism, a view that does a better job of explaining our future-regarding reasons. Finally, I consider an important objection to (...) my critique. (shrink)

Greg Bognar has recently offered a prioritarian justification for ‘fair innings’ distributive principles that would ration access to healthcare on the basis of patients' age. In this article, I agree that Bognar's principle is among the strongest arguments for age-based rationing. However, I argue that this position is incomplete because of the possibility of ‘time-relative' egalitarian principles that could complement the kind of lifetime egalitarianism that Bognar adopts. After outlining Bognar's position, and explaining the attraction of time-relative egalitarianism, I suggest (...) various ways in which these two kinds of principle could interact. Since various options have very different implications for age-based rationing, proponents of such a rationing scheme must take a position on time-relative egalitarianism to complement a lifetime prioritarian view like Bognar's. (shrink)

Several recent articles have weighed in on the question of whether moral philosophers can be counted as moral experts. One argument denying this has been rejected by both sides of the debate. According to this argument, the extent of disagreement in modern moral philosophy prevents moral philosophers from being classified as moral experts. Call this the Argument From Disagreement. In this article, I defend a version of AD. Insofar as practical issues in moral philosophy are characterized by disagreement between moral (...) philosophers who are more or less equally well credentialed on the issue, non-philosophers have no good reasons to defer to their views. (shrink)

Descriptivists say that every name is synonymous with some definite description, and Descriptivists who are Widescopers say that the definite description that a name is synonymous with must take wide scope with respect to modal adverbs such as “necessarily”. In this paper, I argue against Widescopism. Widescopers should be Super Widescopers: that is, they should say that the definite description that a name is synonymous with must take wide scope with respect to complementizers such as “that”. Super Widescopers should be (...) Super Duper Widescopers: that is, they should say that the definite description that a name is synonymous with must take wide scope with respect to quotation marks. And Super Duper Widescopers should be Ultra Super Duper Widescopers: that is, they should say that, when the definite description that a name is synonymous with itself contains a name, the definite description that that name is synonymous with must take wide scope with respect to modal adverbs, complementizers, and quotation marks. But Descriptivists should not be Ultra Super Duper Widescopers. So Descriptivists should not be Widescopers either. (shrink)

In a series of recent publications, Jeffrey King (The nature and structure of content, 2007; Proc Aristot Soc 109(3):257–277, 2009; Philos Stud, 2012) argues for a view on which propositions are facts. He also argues against views on which propositions are set-theoretical objects, in part because such views face Benacerraf problems. In this paper, we argue that, when it comes to Benacerraf problems, King’s view doesn’t fare any better than its set-theoretical rivals do. Finally, we argue that his view faces (...) a further Benacerraf problem, one that threatens to undercut his explanation of why propositions have truth-conditions. If correct, our arguments undercut King’s main motivation for accepting his view over its rivals. (shrink)

Thanks to David Kaplan, we all know how to handle indexicals like ‘I’. ‘I’ doesn’t refer to an object simpliciter; rather, it refers to an object only relative to a context. In particular, relative to a context C, ‘I’ refers to the agent of C. Since different contexts can have different agents, ‘I’ can refer to different objects relative to different contexts. For example, relative to a context c whose agent is Gottlob Frege, ‘I’ refers to Frege; relative to a (...) context c* whose agent is Alexius Meinong, ‘I’ refers to Meinong. (shrink)

Many political realists reject the idea that the first task for political philosophy is to justify the existence of coercive political institutions. Instead, they say, we should begin with the factual existence of CPIs, and ask how they ought to be structured. In holding this view, they adopt a form of political naturalism that is broadly Aristotelian in character. In this article, I distinguish between two forms that this political naturalism might take - what I call a ‘strong’ form, and (...) a ‘weak’ form - and argue that both ought to be rejected. (shrink)

There is a simple but powerful argument against the human practice of raising and killing animals for food (RKF for short). It goes like this: 1. RKF is extremely bad for animals. 2. RKF is only trivially good for human beings Therefore, 3. RKF should be stopped. While many consider this argument decisive, not everyone is convinced. There have been four main lines of objection to it. In this paper, I provide new responses to these four objections.

British Journal of Aesthetics (forthcoming Jan. 2008).

Research ethics guidelines grew out of several infamous episodes where research subjects were exploited. There is significant international synchronization of guidelines. However, indigenous groups in New Zealand, Canada and Australia have criticized these guidelines as being inadequate for research involving indigenous people and have developed guidelines from their own cultural perspectives. Whilst traditional research ethics guidelines place a lot of emphasis on informed consent, these indigenous guidelines put much greater emphasis on interdependence and trust. This article argues that traditional guidelines (...) are premised on relationships of equal power, and that often the researcher has more power that is not fully equalized by providing information. Where there is a relationship of unequal power, then focusing on interdependence and trust is more likely to achieve ethical safety. We illustrate this thesis by describing the detail of a research project looking at the use of interpreters, where we video-recorded live consultations and then interviewed the patient, interpreter and doctor. We conclude by suggesting that mainstream research ethics guidelines should pay more attention to the development of a trustworthy relationship between subject and researcher, and that, following the lead from clinical medicine, we should develop a culturally competent ethical framework for research on human subjects. (shrink)

We developed this study to examine the issue of parental refusal of treatment, looking at the issue through a cultural competence lens. Recent cases in Canada where courts have declined applications by clinicians for court orders to overrule parental refusal of treatment highlight the dispute in this area. This study analyses the 16 cases of a larger group of 24 cases that were selected by a literature review where cultural or religious beliefs or ethnic identity was described as important reasons (...) behind the refusal. The most significant finding was that nearly all of the cases cited unacceptable side effects as the main reason for declining treatment. We then analysed the detail of the cases and concluded that in the first instance a skilled clinical approach to develop an agreed management plan is by far the best approach. In the event that agreement cannot be reached we recommend engaging a mediator to help the clinician and parents/child to find an agreeable way forward. We argue that the option of se... (shrink)

In this paper, I argue that, when it comes to explaining what can be described as “representational” properties of propositions, Soames’s new conception of propositions—on which the proposition that Seattle is sunny is the act of predicating the property being sunny of Seattle and to entertain that proposition is to perform that act—does not have an advantage over traditional ones.

The non-identity problem is that some actions seem morally wrong even though, by affecting future people’s identities, they are worse for nobody. In this paper, I further develop and defend a lesser-known solution to the problem, one according to which when such actions are wrong, it is not because of what they do or produce, but rather just because of why they were performed. In particular, I argue that the actions in non-identity cases are wrong just when and because they (...) result from, or reflect in those who have performed them, a morally dubious character trait. (shrink)

Pickeringet al’s paper argues that the capacity of the decision-maker is the sole consideration in whether a decision should stand, and that the risk of the decision should not be considered. This argument ignores the existence of the player who is of the view that a decision is not wise. This paper argues that patient autonomy is not the sole determinant of whether a person is able to make an unwise decision, particularly in healthcare where there are always others affected (...) by the patient decision. Rather than asserting that patients have an unfettered autonomous choice on clinical decisions this paper argues that these decisions should be looked at through the lens of quality in health care that has proposed four parameters to be balanced; the patient experience, wise use of resources, the effect on public health and the clinician experience. (shrink)