There has been a growing concern over establishing norms that ensure the ethically acceptable and scientifically sound conduct of clinical trials. Among the leading norms internationally are the World Medical Association's Declaration of Helsinki, guidelines by the Council for International Organizations of Medical Sciences, the International Conference on Harmonization's standards for industry, and the CONSORT group's reporting norms, in addition to the influential U.S. Federal Common Rule, Food and Drug Administration's body of regulations, and information sheets by the Department of (...) Health and Human Services. There are also many norms published at more local levels by official agencies and professional groups.Any account of international standards should cover both scientific and ethical norms at once – the two are conceptually intertwined. Recent sources recognize that “[s]cientifically unsound research on human subjects is unethical in that it exposes research subjects to risks without possible benefit.”. (shrink)

The Rachels–Temkin spectrum arguments against the transitivity of better than involve good or bad experiences, lives, or outcomes that vary along multiple dimensions—e.g., duration and intensity of pleasure or pain. This paper presents variations on these arguments involving combinations of good and bad experiences, which have even more radical implications than the violation of transitivity. These variations force opponents of transitivity to conclude that something good is worse than something that isn’t good, on pain of rejecting the good altogether. That (...) is impossible, so we must reject the spectrum arguments. (shrink)

Totalism is the view that one distribution of well-being is better than another just in case the one contains a greater sum of well-being than the other. Many philosophers, following Parfit, reject totalism on the grounds that it entails the repugnant conclusion: that, for any number of excellent lives, there is some number of lives that are barely worth living whose existence would be better. This paper develops a theory of welfare aggregation—the lexical-threshold view—that allows totalism to avoid the repugnant (...) conclusion, as well as its analogues involving suffering populations and the lengths of individual lives. The theory is grounded in some independently plausible views about the structure of well-being, identifies a new source of incommensurability in population ethics, and avoids some of the implausibly extreme consequences of other lexical views, without violating the intuitive separability of lives. (shrink)

Is well-being the kind of thing that can be summed across individuals? This paper takes a measurement-theoretic approach to answering this question. To make sense of adding well-being, we would need to identify some natural "concatenation" operation on the bearers of well-being that satisfies the axioms of extensive measurement and can therefore be represented by the arithmetic operation of addition. I explore various proposals along these lines, involving the concatenation of segments within lives over time, of entire lives led alongside (...) one another or in sequence, and of evaluatively basic propositions via conjunction. All of these proposals turn out to carry highly controversial commitments about the good. I do not claim that these commitments are unacceptable. But they suggest that we cannot simply take for granted, as many philosophers do, that there is any such thing as the sum of well-being. (shrink)

This paper presents a new kind of problem in the ethics of distribution. The problem takes the form of several “calibration dilemmas,” in which intuitively reasonable aversion to small-stakes inequalities requires leading theories of distribution to recommend intuitively unreasonable aversion to large-stakes inequalities. We first lay out a series of such dilemmas for prioritarian theories. We then consider a widely endorsed family of egalitarian views and show that they are subject to even more forceful calibration dilemmas than prioritarian theories. Finally, (...) we show that our results challenge common utilitarian accounts of the badness of inequalities in resources. (shrink)

I present a new argument for the repugnant conclusion. The core of the argument is a risky, intrapersonal analogue of the mere addition paradox. The argument is important for three reasons. First, some solutions to Parfit’s original puzzle do not obviously generalize to the intrapersonal puzzle in a plausible way. Second, it raises independently important questions about how to make decisions under uncertainty for the sake of people whose existence might depend on what we do. And, third, it suggests various (...) difficulties for leading views about the value of a person’s life compared to her nonexistence. (shrink)

Matthew Adler's Measuring Social Welfare is an introduction to the social welfare function (SWF) methodology. This essay questions some ideas at the core of the SWF methodology having to do with the relation between the SWF and the measure of well-being. The facts about individual well-being do not single out a particular scale on which well-being must be measured. As with physical quantities, there are multiple scales that can be used to represent the same information about well-being; no one scale (...) is special. Like physical laws, the SWF and its ranking of distributions cannot depend on exactly which of these scales we use. Adler and other theorists in the SWF tradition have used this idea to derive highly restrictive constraints on the shape of the SWF. These constraints rule out seemingly plausible views about distributive justice and population ethics. I argue, however, that these constraints stem from a simple but instructive mistake. The SWF should not be applied to vectors of numbers such as 1 and 2, but rather to vectors of dimensioned quantities such as 1 util and 2 utils. This seemingly pedantic suggestion turns out to have far-reaching consequences. Unlike the orthodox SWF approach, treating welfare levels as dimensioned quantities lets us distinguish between real changes in well-being and mere changes in the unit of measurement. It does this without making the SWF depend on the scale on which welfare is measured, and in a way that avoids the restrictive constraints on the shape of the SWF. (shrink)

This paper is about the role of interpersonal comparisons in Harsanyi's aggregation theorem. Harsanyi interpreted his theorem to show that a broadly utilitarian theory of distribution must be true even if there are no interpersonal comparisons of well-being. How is this possible? The orthodox view is that it is not. Some argue that the interpersonal comparability of well-being is hidden in Harsanyi's premises. Others argue that it is a surprising conclusion of Harsanyi's theorem, which is not presupposed by any one (...) of the premises. I argue instead that Harsanyi was right: his theorem and its weighted-utilitarian conclusion do not require interpersonal comparisons of well-being. The key to making sense of this possibility is to treat Harsanyi's weights as dimensional constants rather than dimensionless numbers. (shrink)

The standard view of "believes" and other propositional attitude verbs is that such verbs express relations between agents and propositions. A sentence of the form “S believes that p” is true just in case S stands in the belief-relation to the proposition that p; this proposition is the referent of the complement clause "that p." On this view, we would expect the clausal complements of propositional attitude verbs to be freely intersubstitutable with their corresponding proposition descriptions—e.g., "the proposition that p"—as (...) they are in the case of "believes." In many cases, however, intersubstitution of that-clauses and proposition descriptions fails to preserve truth value or even grammaticality. These substitution failures lead some philosophers to reject the standard view of propositional attitude reports. Others conclude that propositional attitude verbs are systematically ambiguous. I reject both these views. On my view, the that-clause complements of propositional attitude verbs denote propositions, but proposition descriptions do not. (shrink)

I defend the view that a reason for someone to do something is just a reason why she ought to do it. This simple view has been thought incompatible with the existence of reasons to do things that we may refrain from doing or even ought not to do. For it is widely assumed that there are reasons why we ought to do something only if we ought to do it. I present several counterexamples to this principle and reject some (...) ways of understanding "ought" so that the principle is compatible with my examples. I conclude with a hypothesis for when and why the principle should be expected to fail. (shrink)

How should we choose between uncertain prospects in which different possible people might exist at different levels of wellbeing? Alex Voorhoeve and Marc Fleurbaey offer an egalitarian answer to this question. I give some reasons to reject their answer and then sketch an alternative, which I call person-affecting prioritarianism.

Lara Buchak argues for a version of rank-weighted utilitarianism that assigns greater weight to the interests of the worse off. She argues that our distributive principles should be derived from the preferences of rational individuals behind a veil of ignorance, who ought to be risk averse. I argue that Buchak’s appeal to the veil of ignorance leads to a particular way of extending rank-weighted utilitarianism to the evaluation of uncertain prospects. This method recommends choices that violate the unanimous preferences of (...) rational individuals and choices that guarantee worse distributions. These results, I suggest, undermine Buchak’s argument for rank-weighted utilitarianism. (shrink)

This paper develops and explores a new framework for theorizing about the measurement and aggregation of well-being. It is a qualitative variation on the framework of social welfare functionals developed by Amartya Sen. In Sen’s framework, a social or overall betterness ordering is assigned to each profile of real-valued utility functions. In the qualitative framework developed here, numerical utilities are replaced by the properties they are supposed to represent. This makes it possible to characterize the measurability and interpersonal comparability of (...) well-being directly, without the use of invariance conditions, and to distinguish between real changes in well-being and merely representational changes in the unit of measurement. The qualitative framework is shown to have important implications for a range of issues in axiology and social choice theory, including the characterization of welfarism, axiomatic derivations of utilitarianism, the meaningfulness of prioritarianism, the informational requirements of variable-population ethics, the impossibility theorems of Arrow and others, and the metaphysics of value. (shrink)

Many economists and philosophers assume that status quo bias is necessarily irrational. I argue that, in some cases, status quo bias is fully rational. I discuss the rationality of status quo bias on both subjective and objective theories of the rationality of preferences. I argue that subjective theories cannot plausibly condemn this bias as irrational. I then discuss one kind of objective theory, which holds that a conservative bias toward existing things of value is rational. This account can fruitfully explain (...) some compelling aspects of common sense morality, and it may justify status quo bias. (shrink)

According to asymmetric comparativism, it is worse for a person to exist with a miserable life than not to exist, but it is not better for a person to exist with a happy life than not to exist. My aim in this paper is to explain how asymmetric comparativism could possibly be true. My account of asymmetric comparativism begins with a different asymmetry, regarding the (dis)value of early death. I offer an account of this early death asymmetry, appealing to the (...) idea of conditional goods, and generalize it to explain how asymmetric comparativism could possibly be true. I also address the objection that asymmetric comparativism has unacceptably antinatalist implications. (shrink)

ABSTRACT Sometimes it seems that an existing bearer of value should be preserved even though it could be destroyed and replaced with something of equal or greater value. How can this conservative intuition be explained and justified? This paper distinguishes three answers, which I call existential, attitudinal, and object-affecting conservatism. I raise some problems for existential and attitudinal conservatism, and suggest how they can be solved by object-affecting conservatism.

Substituted judgment has increasingly become the accepted standard for rendering decisions for incapacitated adults in the USA. A broad exception exists with regard to patients with diminished capacity secondary to depressive disorders, as such patients’ previous wishes are generally not honoured when seeking to turn down life-preserving care or pursue aid-in-dying. The result is that physicians often force involuntary treatment on patients with poor medical prognoses and/or low quality of life as a result of their depressive symptoms when similarly situated (...) incapacitated patients without such depressive symptoms would have their previous wishes honoured via substituted judgment. This commentary argues for reconsidering this approach and for using a substituted judgment standard for a subset of EMP/LQL patients seeking death. (shrink)

The public discourse surrounding sex and severe disability over the past 40 years has largely focused on protecting vulnerable populations from abuse. However, health professionals and activists are increasingly recognising the inherent sexuality of disabled persons and attempting to find ways to accommodate their intimacy needs. This essay explores several ethical issues arising from such efforts.

According to the person-affecting restriction, one distribution of welfare can be better than another only if there is someone for whom it is better. Extant problems for the person-affecting restriction involve variable-population cases, such as the nonidentity problem, which are notoriously controversial and difficult to resolve. This paper develops a fixed-population problem for the person-affecting restriction. The problem reveals that, in the presence of incommensurable welfare levels, the person-affecting restriction is incompatible with minimal requirements of impartial beneficence even in fixed-population (...) contexts. (shrink)

Extensive measurement is the standard measurement-theoretic approach for constructing a ratio scale. It involves the comparison of objects that can be concatenated in an additively representable way. This paper studies the implications of extensively measurable welfare for social choice theory. We do this in two frameworks: an Arrovian framework with a fixed population and no interpersonal comparisons, and a generalized framework with variable populations and full interpersonal comparability. In each framework we use extensive measurement to introduce novel domain restrictions, independence (...) conditions, and constraints on social evaluation. We prove a welfarism theorem for these domains and characterize the social welfare functions that satisfy the axioms of extensive measurement at both the individual and social levels. The main results are simple axiomatizations of strong dictatorship in the Arrovian framework and classical utilitarianism in the generalized framework. (shrink)

We argue that all comparative expressions in natural language obey a principle that we call Comparability: if x and y are at least as F as themselves, then either x is at least as F as y or y is at least as F as x. This principle has been widely rejected among philosophers, especially by ethicists, and its falsity has been claimed to have important normative implications. We argue that Comparability is needed to explain the goodness of several patterns (...) of inference that seem manifestly valid, that the purported failures of Comparability would have absurd consequences, and that the influential arguments against Comparability are less compelling than they may have initially seemed. (shrink)

Recent research indicates that compensation structure can be used by firms to discourage their employees from whistleblowing. We extend the ethics literature by examining how compensation structures and financial rewards work together to influence managers’ decisions to blow the whistle. Results from an experiment indicate that compensation with restricted stock, relative to stock payments that lack restrictions, can enhance the likelihood that managers will blow the whistle when large rewards are available. However, restricted stock can also threaten the effectiveness of (...) whistleblowing systems without the presence of large financial rewards for whistleblowing. Thus, the large potential rewards for whistleblowing enacted by the Dodd–Frank Act appear timely as firms are moving toward compensation agreements that include greater proportions of restricted stock. (shrink)

Priority for solid organ transplant generally does not consider the underlying cause of the need for transplantation. This paper argues that a distinctive set of factors justify assigning lower priority to willfully unvaccinated individuals who require transplant as a result of suffering from COVID‐19. These factors include the personal responsibility of the patients for their own condition and the public outrage likely to ensue if willfully unvaccinated patients receive organs at the expense of vaccinated ones. The paper then proposes a (...) three‐prong test for similar deviations from the current allocation standard that incorporates patient responsibility, foreseeability and avoidability, and the frequency of the occurrence. (shrink)

A sample of 460 low-income women completed a mate preference questionnaire and surveys that assessed family background, life history, conscientiousness, sexual motives, self-ratings (e.g., looks), and current circumstances (e.g., income). A cluster analysis revealed two groups of women: women who reported a strong preference for looks and money in a short-term mate and commitment in a long-term mate, and women who reported smaller differences across mating context. Group differences were found in reported educational levels, family background, sexual development, number of (...) children, and motives for having sex. Implications for understanding individual differences in women’s mate-preference trade-offs are discussed. (shrink)

Physicians expressing opinions on medical matters that run contrary to the consensus of experts pose a challenge to licensing bodies and regulatory authorities. While the right to express contrarian views feeds a robust marketplace of ideas that is essential for scientific progress, physicians advocating ineffective or dangerous cures, or actively opposing public health measures, pose a grave threat to societal welfare. Increasingly, a distinction has been made between professional speech that occurs during the physician-patient encounter and public speech that transpires (...) beyond the clinical setting, with physicians being afforded wide latitude to voice empirically false claims outside the context of patient care. This paper argues that such a bifurcated model does not sufficiently address the challenges of an age when mass communications and social media allow dissenting physicians to offer misleading medical advice to the general public on a mass scale. Instead, a three-tiered model that distinguishes between citizen speech, physician speech and clinical speech would best serve authorities when regulating physician expression. (shrink)

The integrity of the patient–physician relationship depends on maintaining professional boundaries. While ethicists and professional organisations have devoted significant consideration to the subject of sexual boundary transgressions, the subject of non-sexual boundaries, especially outside the mental health setting, has been largely neglected. While professional organisations may offer guidance on specific subjects, such as accepting gifts or treating relatives, as well as general guidance on transparency and conflict of interest, what is missing is a principle-based method that providers can use to (...) assess non-sexual interactions with patients that transcend norms of practice. This paper attempts to offer an operational model for such assessment that considers not only the traditional emphasis on beneficence, but also incorporates concerns over entanglement and concordance. (shrink)

The “Goldwater rule,” a policy adopted by the American Psychiatry Association in 1973, prohibits organization members from diagnosing or offering professional opinions regarding the mental health of public figures without both first-hand evaluation and authorization. Initially developed in response to a controversial survey of APA members during the 1964 Presidential election campaign, the ethics rule faced few large scale challenges until the election of Donald Trump in 2016. Since that time, a significant number of psychiatrists have either violated or criticized (...) the rule openly. This paper argues that whatever the initial merits of the rule, the prohibition has since been rendered obsolete by the combined lack of professional consensus supporting the policy, absence of a meaningful enforcement mechanism, and the credible statements of non-APA members in the mental health professions regarding public figures. (shrink)

Since several landmark legal decisions in the 1970s and 1980s, substituted judgment has become widely accepted as an approach to decision‐making for incapacitated patients that incorporates their autonomy and interests. Two notable exceptions have been cases involving minors and those involving cognitively or psychiatrically impaired individuals who never previously possessed the ability to contemplate the medical decisions involved in their care. While a best interest standard may have universal merit in pediatric cases, this paper argues that substituted judgement has been (...) rejected too broadly for “never‐capacitated” patients. It then lays out a three‐condition test for using substituted judgment in these cases. For a subset of “never‐capacitated” patients who belong to distinctive religious or cultural communities with clear medical values and have an appropriate surrogate, these values may prove helpful in vindicating the interests of the never‐capacitated and should not be blanketly dismissed. (shrink)

Several hypotheses on the form and function of sex differences in social behaviors were tested. The results suggest that friendship preferences in both sexes can be understood in terms of perceived reciprocity potential—capacity and willingness to engage in a mutually beneficial relationship. Divergent social styles may in turn reflect trade-offs between behaviors selected to maintain large, functional coalitions in men and intimate, secure relationships in women. The findings are interpreted from a broad socio-relational framework of the types of behaviors that (...) facilitate selective advertisement and investment of reciprocity potential across individuals and within groups of men and women. (shrink)

Tsui and Weymark (Economic Theory, 1997) have shown that the only continuous social welfare orderings on the whole Euclidean space which satisfy the weak Pareto principle and are invariant to individual-specific similarity transformations of utilities are strongly dictatorial. Their proof relies on functional equation arguments which are quite complex. This note provides a simpler proof of their theorem.

The American Journal of Bioethics, Volume 12, Issue 9, Page 9-11, September 2012.

In their analyses of the neural correlates of discrete emotionality, Lindquist et al. do not consider the numerous drawbacks to inferring psychological processes based on currently available cognitive neurometric technology. The authors also disproportionately emphasize the relevance of neuronal activation over deactivation, which, in our opinion, limits the scope and utility of their conclusions.

We disagree with Dixon et al. by maintaining that prejudice is primarily rooted in aversive reactions toward out-group members. However, these reactions are not indicative of negative attributes, such as trait bigotry, but rather normative homophily for peers with similar perceived attributes. Cognitive biases such as stereotype threat perpetuate perceptions of inequipotential and subsequent discrimination, irrespective of individuals' personality characteristics.

Social signaling models predict that subtle variation in climatic temperature induces systematic changes in expressed cognition. An experiment showed that perceived room temperature was associated with variability in self-descriptions, social reactions of others, and desiring differing types of social networks. The findings reflect the tendency to inflate capacity demonstrations in warmer climates as a result of the social networking opportunities they enable.

This essay assesses the degree to which the deaf were regarded as a disabled population in medical, religious, and legal thought during the Renaissance, chronologically identified with the period between approximately 1500 and 1650. The primary geographic focus rests on the German-speaking lands of central Europe. Analysis shows that the idea of deafness as a disability here was composite one, making connections between inability to hear and intellectual impairment, moral deficiency, and disease. This contrasts with recent findings elsewhere in Europe, (...) where intellectuals were more focused on sign languages as a means of integrating the deaf into hearing society. (shrink)