BackgroundThe state of the world is one with scarce medical resources where longevity is not equally distributed. Given such facts, setting priorities in health entails making difficult yet unavoidable decisions about which lives to save. The business of saving lives works on the assumption that longevity is valuable and that an early death is worse than a late death. There is a vast literature on health priorities and badness of death, separately. Surprisingly, there has been little cross-fertilisation between the academic (...) fields of priority setting and badness of death. Our aim is to connect philosophical discussions on the badness of death to contemporary debates in health priorities.DiscussionTwo questions regarding death are especially relevant to health priorities. The first question is why death is bad. Death is clearly bad for others, such as family, friends and society. Many philosophers also argue that death can be bad for those who die. This distinction is important for health priorities, because it concerns our fundamental reasons for saving lives. The second question is, ‘When is the worst time to die?’ A premature death is commonly considered worse than a late death. Thus, the number of good life years lost seems to matter to the badness of death. Concerning young individuals, some think the death of infants is worse than the death of adolescents, while others have contrary intuitions. Our claim is that to prioritise between age groups, we must consider the question of when it is worst to die.ConclusionsDeprivationism provides a more plausible approach to health priorities than Epicureanism. If Deprivationism is accepted, we will have a firmer basis for claiming that individuals, in addition to having a health loss caused by morbidity, will have a loss of good life years due to mortality. Additionally, Deprivationism highlights the importance of age and values for health priorities. Regarding age, both variants of Deprivationism imply that stillbirths are included in the Global Burden of Disease. Finally, we suggest that the Time-Relative Interest Account may serve as an alternative to the discounting and age weighting previously applied in the Global Burden of Disease. (shrink)

In recent years, it has become commonplace among the Global Burden of Disease study authors to regard the disability-adjusted life year primarily as a descriptive health metric. During the first phase of the GBD, it was widely acknowledged that the DALY had built-in evaluative assumptions. However, from the publication of the 2010 GBD and onwards, two central evaluative practices—time discounting and age-weighting—have been omitted from the DALY model. After this substantial revision, the emerging view now appears to be that the (...) DALY is primarily a descriptive measure. Our aim in this article is to argue that the DALY, despite changes, remains largely evaluative. Our analysis focuses on the understanding of the DALY by comparing the DALY as a measure of disease burden in the two most significant phases of GBD publications, from their beginning to the most recent releases. We identify numerous assumptions underlying the DALY and group them as descriptive or evaluative. We conclude that while the DALY model arguably has become more descriptive, it remains, by necessity, largely evaluative. (shrink)

Death is something we mourn or fear as the worst thing that could happen―whether the deaths of close ones, the deaths of strangers in reported accidents or tragedies, or our own. And yet, being dead is something that no one can experience and live to describe. This simple truth raises a host of difficult philosophical questions about the negativity surrounding our sense of death, and how and for whom exactly it is harmful. The question of whether death is bad has (...) occupied philosophers for centuries, and the debate emerging in philosophical literature is referred to as the "badness of death." Are deaths primarily negative for the survivors, or does death also affect the deceased? What are the differences between death in fetal life, just after birth, or in adolescence? In order to properly evaluate deaths in global health, we must find answers to these questions. -/- In this volume, leading philosophers, medical doctors, and economists discuss different views on how to evaluate death and its relevance for health policy. This includes theories about the harm of death and its connections to population-level bioethics. For example, one of the standard views in global health is that newborn deaths are among the worst types of death, yet stillbirths are neglected. This raises difficult questions about why birth is so significant, and several of the book's authors challenge this standard view. -/- This is the first volume to connect philosophical discussions on the harm of death with discussions on population health, adjusting the ways in which death is evaluated. Changing these evaluations has consequences for how we prioritize different health programs that affect individuals at different ages, as well as how we understand inequality in health. (shrink)

While forgiveness is widely recognised as an example of a supererogatory action, it remains to be explained precisely what makes forgiveness supererogatory, or the circumstances under which it is supererogatory to forgive. Philosophers often claim that forgiveness is supererogatory, but most of the time they do so without offering an adequate explanation for why it is supererogatory to forgive. Accordingly, the literature on forgiveness lacks a sufficiently nuanced account of the supererogatory status of forgiveness. In this paper, I seek to (...) remedy this shortcoming by offering a systematic account of forgiveness as an example of a supererogatory action. In terms of explaining the supererogatory status of forgiveness, I will argue that, to qualify as supererogatory, a forgiving action must fulfil three conditions: (i) it must be permissible; (ii) it must not be obligatory; and (iii) it must be good or praiseworthy, that is, it must have a certain moral value. Moreover, a distinction is drawn between “unconditional” and “conditional” forgiveness. I argue that conditional forgiveness (i.e. forgiveness of repentant wrongdoers) is sometimes a duty and sometimes supererogatory, whereas unconditional forgiveness (i.e. forgiveness of unrepentant wrongdoers) is typically supererogatory or beyond duty. (shrink)

The purpose of this paper is to consider the question of whether we have a duty to forgive those who repent and apologize for the wrong they have done. I shall argue that we have a pro tanto duty to forgive repentant wrongdoers, and I shall propose and consider the norm of forgiveness. This norm states that if a wrongdoer repents and apologizes to a victim, then the victim has a duty to forgive the wrongdoer, other things being equal. That (...) someone has a pro tanto duty to forgive a repentant wrongdoer means that he or she ought to forgive unless other considerations outweigh the norm of forgiveness. Furthermore, a distinction is made between what are termed 'general considerations' and 'case-relative considerations', and it is argued that only after all the relevant considerations have been examined can it be determined whether there is a duty to forgive, all things considered. (shrink)

It is widely recognised in moral philosophy that there is only something to forgive in cases of unexcused and unjustified wrongdoing. I will call this the standard view. According to this view, forgiveness presupposes that the person to be forgiven has done something that warrants blame and resentment. This standard view has not prompted much discussion in the literature on forgiveness. Most writers on forgiveness seem to accept that it only makes sense to speak of forgiveness in those cases where (...) someone is strictly speaking to blame for having done wrong. I think, however, that the literature on forgiveness lacks an adequately nuanced account of the relationship between forgiveness, justifications and excuses. The present paper challenges the standard view among philosophers that we can only make sense of forgiveness in the context of unexcused and unjustified wrongdoing. I will propose and consider an alternative view according to which there is something to forgive in certain types of cases involving limited responsibility, that is, where a person has a justification or an excuse for her action. More precisely, the aim of this paper is twofold: First, to argue that there is something to forgive others for in certain cases where the other person is excused or justified (i.e. interpersonal forgiveness). Secondly, to argue that there is something to forgive oneself for in certain cases where one has an excuse or a justification for one’s action (i.e. self-forgiveness). (shrink)

Ruth Tallman has recently offered a defense of the modified youngest first principle of scarce resource allocation [1]. According to Tallman, this principle calls for prioritizing adolescents and young adults between 15–40 years of age. In this article, I argue that Tallman’s defense of the modified youngest first principle is vulnerable to important objections, and that it is thus unsuitable as a basis for allocating resources. Moreover, Tallman makes claims about the badness of death for individuals at different ages, but (...) she lacks an account of the loss involved in dying to support her claims. To fill this gap in Tallman’s account, I propose a view on the badness of death that I call ‘Deprivationism’. I argue that this view explains why death is bad for those who die, and that it has some advantages over Tallman’s complete lives view in the context of scarce resource allocation. Finally, I consider some objections to the relevance of Deprivationism to resource allocation, and offer my responses. (shrink)

In recent years, multifetal pregnancy reduction (MFPR) has increasingly been the subject of debate in Norway, and the intensity reached a tentative maximum when Legislation Department delivered the interpretative statement § 2 - Interpretation of the Abortion Act in 2016 in response to the Ministry of Health (2014) requesting the Legislation Department to consider whether the Law on abortion allows for MFPR of healthy fetuses in multiple pregnancies. The Legislation Department concluded that current abortion laws allow MFPR within the framework (...) the law otherwise stipulates. The debate has not subsided, and during autumn 2018, it was further intensified in connection with the Christian Democrat "crossroads" and signals from the Conservatives to consider removing §2.3c and to forbid MFPR. -/- Many of the arguments in the MFPR debate appear seemingly similar to arguments pending in the general abortion debate, and an analysis of what sets MFPR apart from other abortions is wanting. The aim of this article is, therefore, to examine whether there is a moral distinction between abortion and MFPR of healthy fetuses. We will cover the typical arguments of the Norwegian debate, and highlight them with scholarly articles from the literature. The most important arguments against MFPR that we have identified we have dubbed the harm argument, slippery-slope argument, intent argument, grief argument, psychological long-term effects for the woman and sorting argument. We conclude that counter-arguments do not measure up in terms of detecting a morally relevant difference between MFPR of healthy fetuses and abortions. Our conclusion is therefore that—despite what several debaters seem to think—there is no morally relevant difference between the two. Therefore, when we allow abortion, we should also allow MFPR. (shrink)

In recent years, multifetal pregnancy reduction has increasingly been a subject of debate in Norway. The intensity of this debate reached a tentative maximum when the Legislation Department delivered their interpretative statement, Section 2 - Interpretation of the Abortion Act, in 2016 in response to a request from the Ministry of Health that the Legislation Department consider whether the Abortion Act allows for MFPR of healthy fetuses in multiple pregnancies. The Legislation Department concluded that the current abortion legislation [as of (...) 2016] allows for MFPR subject to the constraints that the law otherwise stipulates. The debate has not subsided, and during autumn 2018 it was further intensified in connection with the Norwegian Christian Democratic "crossroads" policy and signals from the Conservatives to consider removing section 2.3c and to forbid MFPR. Many of the arguments in the MFPR debate are seemingly similar to arguments put forward in the general abortion debate, and an analysis to ascertain what distinguishes MFPR from other abortions has yet to be conducted. The aim of this article is, therefore, to examine whether there is a moral distinction between abortion and MFPR of healthy fetuses. We will cover the typical arguments emerging in the debate in Norway and exemplify them with scholarly articles from the literature. We have dubbed the most important arguments against MFPR that we have identified the harm argument, the slippery-slope argument, the intention argument, the grief argument, the long-term psychological effects for the woman argument, and the sorting argument. We conclude that these arguments do not measure up in terms of demonstrating a morally relevant difference between MFPR of healthy fetuses and other abortions. Our conclusion is, therefore — despite what several discussants seem to think — that there is no morally relevant difference between the two. Therefore, on the same conditions as we allow for abortions, we should also allow MFPR. Keywords: abortion, ethics, medical ethics, MFPR, selective MFPR. (shrink)

_Systematic public vaccination constitutes a tremendous health success, perhaps the greatest achievement of biomedicine so far. There is, however, room for improvement. Each year, 1.5 million deaths could be avoided with enhanced immunisation coverage. In recent years, many countries have introduced mandatory childhood vaccination programmes in an attempt to avoid deaths. In Norway, however, the vaccination programme has remained voluntary. Our childhood immunisation programme covers protection for twelve infectious diseases, and Norwegian children are systematically immunised from six weeks to sixteen (...) years of age. In this article, we address the question of whether our country, Norway, should make the childhood vaccination programme mandatory. This question has received considerable public attention in the media, yet surprisingly little academic discussion has followed. The aim of the article is to systematically discuss whether it is morally justified to introduce a mandatory childhood vaccination programme in Norway. Our discussion proceeds as follows: We begin by presenting relevant background information on the history of vaccines and the current Norwegian childhood vaccination programme. Next, we discuss what we consider to be the most central arguments against mandatory childhood vaccination: the argument from the standpoints of parental rights, bodily integrity, naturalness, mistrust, and immunisation coverage. After that, we examine the central arguments in favour of mandatory childhood vaccination from the standpoints of harm, herd immunity, and as a precautionary strategy. We conclude that there are convincing moral arguments in favour of adopting a policy of mandatory childhood vaccination in Norway._ _Keywords_: autonomy, harm principle, herd immunity, parental rights, precautionary approach. (shrink)

The practical goal of preventing premature death seems uncontroversial. But the term ‘premature death’ is vague with several, sometimes conflicting definitions. This ambiguity results in several conceptions with which not all will agree. Moreover, the normative rationale behind the goal of preventing premature deaths is masked by the operational definition of existing measures. In this article, we argue that ‘premature death’ should be recognized as a normative concept. We propose that normative theories should be used to justify measures of premature (...) death to provide them with normative validity and public legitimacy. (shrink)

There is no doubt that Spinoza values what he calls living under the guidance of reason, and that he somehow equates such a life with happiness. What is less clear is exactly how he conceives of such a life, and thus how he conceives of human happiness. According to Arne Naess's interpretation of Spinoza, the virtuous and free person will prefer the life of action, and happiness is best realised through living an active life “in the world”. Other scholars, however, (...) have interpreted Spinoza as suggesting that the maximally free person will prefer a life of contemplation “outside the world”. In this paper, I address Naess's relationship with this aspect of Spinoza's practical philosophy, and propose my own interpretation of Spinoza where happiness, or living under the guidance of reason, consists in a combination of activity and contemplation. (shrink)

For this special issue of the Nordic Journal of Applied Ethics, we have selected four papers that address, directly or indirectly, some key issues in family ethics.

What is the best way to approach our environmental problems? Or what kind of environmental ethics or philosophy is best suited to address and possibly solve some of the most serious environmental problems of our time? These questions have been discussed several times over the last decades and various alternative answers have been proposed for how to deal with contemporary environmental problems. One influential approach in the early 1970s was deep ecology, launched by Arne Naess in his article «The Shallow (...) and the Deep, Long-Range Ecology Movement: A Summary». Deep ecology or the deep ecological movement was for a long time a dominant theme in environmental philosophy and it has given rise to numerous articles, books and conferences. Deep ecology flourished in the 1970-80s, but its standing today is severely diminished. Why has deep ecology lost its standing as a leading environmental philosophy and movement? In this paper, I discuss some of the reasons why I think deep ecology has such a limited appeal today. I will argue that the flaw of deep ecology lies in its adherence to ontology rather than ethics. Supporters of deep ecology, such as Naess himself, have tended to attach great importance to our experience of reality as a source of environmental attitudes. But I believe that this focus on environmental ontology has been a recipe for disaster rather than a success for deep ecology and its supporters. I suggest that a proper environmental position should be based on critical thinking and moral principles rather than on ontological assumptions about human experiences of the world. (shrink)

Ethics, Policy & Environment, Volume 14, Issue 3, Page 361-375, October 2011.

In this paper, I discuss some central ethical aspects of self-forgiveness. A first comparison is made between interpersonal forgiveness and self-forgiveness. It would seem that self-forgiveness follows much of the same structure as interpersonal forgiveness, although with some exceptions. One noticeable difference is that with self-forgiveness, the forgiver and forgiven is one and the same person. The main ethical question discussed is when self-forgiveness is morally permissible. I argue that self-forgiveness is only morally permissible when the wrongdoer acknowledges wrongdoing and (...) display genuine repentance. He must also, insofar as possible, ask the victim for forgiveness before contemplating self-forgiveness. (shrink)

It is a useful exercise to reflect, sometimes, on the way philosophy is carried out, and on how we think philosophy should be carried out in the future. We need to accept that academia is undergoing some important changes, which means that academic philosophy is also changing. The aim of this article is to discuss what gives philosophy its legitimacy in Norway. I will argue that the justification for having philosophy in Norway, in one way or the other, must be (...) that it has societal value. In this respect, I believe that teaching and public outreach are philosophy's most important areas of focus. Even though I mainly concentrate on academic philosophy in Norway, much of what I say is relevant for understanding the legitimacy of academic philosophy in other countries. (shrink)

Ethics, Policy & Environment, Volume 14, Issue 3, Page 307-312, October 2011.