This work argues that philosophy is not just useful, but vital, for thinking coherently about priorities in health policy and public policy.

Democracy establishes relationships of political equality, ones in which citizens equally share authority over what they do together and respect one another as equals. But in today's divided public square, democracy is challenged by political thinkers who disagree about how democratic institutions should be organized, and by antidemocratic politicians who exploit uncertainties about what democracy requires and why it matters. Democratic Equality mounts a bold and persuasive defense of democracy as a way of making collective decisions, showing how equality of (...) authority is essential to relating equally as citizens. James Lindley Wilson explains why the US Senate and Electoral College are urgently in need of reform, why proportional representation is not a universal requirement of democracy, how to identify racial vote dilution and gerrymandering in electoral districting, how to respond to threats to democracy posed by wealth inequality, and how judicial review could be more compatible with the democratic ideal. What emerges is an emphatic call to action to reinvigorate our ailing democracies, and a road map for widespread institutional reform. Democratic Equality highlights the importance of diverse forms of authority in democratic deliberation and electoral and representative processes—and demonstrates how that authority rests equally with each citizen in a democracy. (shrink)

Philosophy & Public Affairs, Volume 50, Issue 2, Page 169-201, Spring 2022.

Research involving human subjects is much more stringently regulated than many other nonresearch activities that appear to be at least as risky. A number of prominent figures now argue that research is overregulated. We argue that the reasons typically offered to justify the present system of research regulation fail to show that research should be subject to more stringent regulation than other equally risky activities. However, there are three often overlooked reasons for thinking that research should be treated as a (...) special case. First, research typically involves the imposition of risk on people who do not benefit from this risk imposition. Second, research depends on public trust. Third, the complexity of the moral decision making required favors ethics committees as a regulative solution for research. (shrink)

This article concerns the nature and limits of individuals’ rights to privacy over information that they have made public. For some, even suggesting that an individual can have a right to privacy over such information may seem paradoxical. First, one has no right to privacy over information that was never private to begin with. Second, insofar as one makes once-private information public – whether intentionally or unintentionally – one waives one’s right to privacy to that information. In this article, however, (...) we suggest the moral situation is more complicated than this. Rather, we argue that there is a class of public information – namely, once-private information that individuals have made public unintentionally – which remains within the scope of an individuals’ right to privacy, even when it has passed into the public domain. Significantly, this class includes any information rights-holders were unaware could be inferred from information they have made public and which they would not otherwise have wanted to be in the public domain. As we show, as well as clarifying several everyday dilemmas with regards to individuals’ privacy rights, this finding has elucidates a number of problems in the ethics of Big Data. (shrink)

Health systems that provide for universal patient access through a scheme of prepayments—whether through taxes, social insurance, or a combination of the two—need to make decisions on the scope of coverage that they secure. Such decisions are inherently controversial, implying, as they do, that some patients will receive less than comprehensive health care, or less than complete protection from the financial consequences of ill-heath, even when there is a clinically effective therapy to which they might have access.Controversial decisions of this (...) sort call for a public justification for covering or not covering a given treatment. Priority-setting agencies play a key role in providing such a justification. A recent... (shrink)

Comprehensive Biomedical Research Centre and Centre for Philosophy, Justice and Health, UCL, First Floor, Charles Bell House, 67–73 Riding House Street, London W1W 7EJ, UK. Tel.: +44 (0)20 7679 9417; Fax: +44 (0)20 7679 9426; Email: james-gs.wilson{at}ucl.ac.uk ' + u + '@' + d + ' '//--> . Abstract This paper aims to shed some light on the difficulties we face in constructing a generally acceptable normative framework for thinking about public health. It argues that there are three factors that (...) combine to make theorising about public health difficult, and which when taken together defeat simplistic top-down and bottom-up approaches to the design of public health policies. The first factor is the problem of complex systems, namely that the distribution of health both affects and is affected by the distribution of other goods. The second is the difficulty of defining the goals of public health: we still need to get clear about what we should mean by health in this context, and what the goals of public health should be. The third is that we stand in need of an account of how important health is relative to the importance of other goods that a just society should be trying to secure for its citizens. The paper argues that these problems should lead us to abandon the search for a ‘one-size fits all’ normative framework for thinking about public health. Rather, different approaches will be appropriate at different levels of abstraction. CiteULike Connotea Del.icio.us What's this? (shrink)

The infant mortality rate in Liberia is 50 times higher than it is in Sweden, whilst a child born in Japan has a life expectancy at birth of more than double that of one born in Zambia. 1 And within countries, we see differences which are nearly as great. For example, if you were in the USA and travelled the short journey from the poorer parts of Washington to Montgomery County Maryland, you would find that ‘for each mile travelled life (...) expectancy rises about a year and a half. There is a twenty-year gap between poor blacks at one end of the journey and rich whites at the other’. (Marmot, 2004, p.2). There are two types of questions which it is important to ask about inequalities in health such as these. The first are social scientific questions about the extent of inequalities in health and the factors which are causally responsible for these inequalities. Examples of social scientific questions to ask might be: how do infant mortality rates in the UK differ according to social class? What is the difference in life expectancy between Japanese who emigrate to the US and those who remain in Japan? Why do civil servants in higher ranked jobs tend to live longer than civil servants in lower ranked jobs? The second type are normative questions about the reasons we have to care about inequalities in health. Important normative questions to answer are: which inequalities in health should we care about (all inequalities or merely some of them)? When is an inequality in health unjust? How should we weigh our concern for equality in health against other factors such as maximising the.. (shrink)

Three main claims are made in this paper. First, it is argued that Onora O’Neill has uncovered a serious problem in the way medical ethicists have thought about both respect for autonomy and informed consent. Medical ethicists have tended to think that autonomous choices are intrinsically worthy of respect, and that informed consent procedures are the best way to respect the autonomous choices of individuals. However, O’Neill convincingly argues that we should abandon both these thoughts. Second, it is argued that (...) O’Neill’s proposed solution to this problem is inadequate. O’Neill’s approach requires that a more modest view of the purpose of informed consent procedures be adopted. In her view, the purpose of informed consent procedures is simply to avoid deception and coercion, and the ethical justification for informed consent derives from a different ethical principle, which she calls principled autonomy. It is argued that contrary to what O’Neill claims, the wrongness of coercion cannot be derived from principled autonomy, and so its credentials as a justification for informed consent procedures is weak. Third, it is argued that we do better to rethink autonomy and informed consent in terms of respecting persons as ends in themselves, and a characteristically liberal commitment to allowing individuals to make certain categories of decisions for themselves. Respect for autonomy is in trouble. In recent work in this journal1 and elsewhere,2 O’Neill has forcefully argued that respect for autonomy, as it has come to be used in medical ethics, is philosophically indefensible. If her arguments are sound, then, contrary to the standard view, respect for autonomy cannot be the source of the ethical requirement to seek informed consent before treating a patient or enrolling a participant in a trial. So her critique goes to the heart of contemporary medical ethics: if O’Neill is right, medical ethicists have systematically misunderstood two of the most fundamental concepts they deal with—respect for autonomy and informed consent. This paper has four sections. Section 1 distinguishes between three different ways of talking about respect for autonomy, and looks in more detail at the one that has come to be central to bioethical writing on informed consent—namely, the idea that we should respect autonomous choices. Section 2 argues, following O’Neill, that it is implausible to think that the purpose of informed consent requirements is to respect autonomous choices. Section 3 argues that O’Neill’s proposed reworking of autonomy and informed consent is inadequate. O’Neill’s approach requires us to adopt a more modest view of the purpose of informed consent procedures. In her view, the purpose of informed consent procedures is simply to avoid deception and coercion, and the ethical justification for informed consent derives from a different ethical principle, which she calls principled autonomy. I argue that contrary to what O’Neill claims, we cannot derive the wrongness of coercion from principled autonomy, and so its credentials as a justification for informed consent procedures is weak. Section 4 argues that we do better to rethink autonomy and informed consent in terms of respecting persons as ends in themselves, and a characteristically liberal commitment to allowing individuals to make certain categories of decisions for themselves. (shrink)

Intellectual property typically involves claims of ownership of types, rather than particulars. In this article I argue that this difference in ontology makes an important moral difference. In particular I argue that there cannot be an intrinsic moral right to own intellectual property. I begin by establishing a necessary condition for the justification of intrinsic moral rights claims, which I call the Rights Justification Principle. Briefly, this holds that if we want to claim that there is an intrinsic moral right (...) to φ, we must be able to show that (a) violating this right would typically result in either a wrongful harm or other significant wrong to the holder of the right, and (b) the wrongful harm or other wrong in question is independent of the existence of the intrinsic right we are trying to justify. I then argue that merely creating a new instance of a type is not the kind of action which can wrongfully harm the creator of that type. Insofar as there do seem to be wrongs involved in copying a published poem or computer program, these wrongs presuppose the existence of an intrinsic right to own intellectual property, and so cannot be used to justify it. I conclude that there cannot be an intrinsic right to own intellectual property. (shrink)

This article examines when deceptive withholding of information is ethically acceptable in research. The first half analyses the concept of deception. We argue that there are two types of accounts of deception: normative and non-normative, and argue that non-normative accounts are preferable. The second half of the article argues that the relevant ethical question which ethics committees should focus on is not whether the person from whom the information is withheld will be deceived, but rather on the reasonableness of withholding (...) the information from the person who is deceived. We further argue that the reasonableness of withholding information is dependent on the context. The last section examines how the context of research should shape our judgements about the circumstances in which withholding information from research participants is ethically acceptable. We argue that some important features of research make it more difficult to justify withholding information in the context of research than elsewhere. (shrink)

The pandemic significantly raised the stakes for the translation of bioethics insights into policy. The novelty, range and sheer quantity of the ethical problems that needed to be addressed urgently within public policy were unprecedented and required high‐bandwidth two‐way transfer of insights between academic bioethics and policy. Countries such as the United Kingdom, which do not have a National Ethics Committee, faced particular challenges in how to facilitate this. This paper takes as a case study the brief career of the (...) Ethics Advisory Board (EAB) for the NHS Covid‐19 App, which shows both the difficulty and the political complexity of policy‐relevant bioethics in a pandemic and how this was exacerbated by the transience and informality of the structures through which ethics advice was delivered. It analyses how and why, after EAB's demise, the Westminster government increasingly sought to either take its ethics advice in private or to evade ethical scrutiny of its policies altogether. In reflecting on EAB, and these later ethics advice contexts, the article provides a novel framework for analysing ethics advice within democracies, defining four idealised stances: the pure ethicist, the advocate, the ethics arbiter and the critical friend. (shrink)

Conservative thinkers such as Francis Fukuyama have produced a battery of objections to the transhumanist project of fundamentally enhancing human capacities. This article examines one of these objections, namely that by allowing some to greatly extend their capacities, we will undermine the fundamental moral equality of human beings. I argue that this objection is groundless: once we understand the basis for human equality, it is clear that anyone who now has sufficient capacities to count as a person from the moral (...) point of view will continue to count as one even if others are fundamentally enhanced; and it is mistaken to think that a creature which had even far greater capacities than an unenhanced human being should count as more than an equal from the moral point of view. (shrink)

Philosophical reflection on intellectual property (IP) is still very young. Whilst much has been written by lawyers on intellectual property, the vast majority of this writing is philosophically unsophisticated. This paper aims to at least partially remedy this philosophical deficit by examining what reflection on the ontology of intellectual property can add to our understanding of how to regulate IP. I argue that ontological reflection should bring us to an important basic fact, namely that ownership of intellectual property involves the (...) ownership of types rather than tokens. This difference in the ontological status of the objects owned makes a normative difference to how we should regulate ownership of intellectual property as compared to tangible property. The argument falls into three main parts. I begin by arguing that the type-token distinction is the best way to account for the ontology of intellectual property. I next argue that the realisation that we are dealing with ownership of types rather than tokens has important normative implications. In particular some of the standard arguments in favour of private ownership of physical property simply do not apply in the case of ownership of types, whilst some other arguments apply only in an attenuated way. The next section examines the limitations of ontology as a guide to the regulation of IP. I argue that whilst thinking through the normative implications of the type-token distinction is a necessary 1 condition for a sound regulatory approach to IP, it is certainly not sufficient. This is because many of the specific questions about the regulation of intellectual property that matter most in practice—such as how long the patent term should be, or how much someone should be able to quote from a book and it count as fair use—are not answerable by ontological reflection. Such questions concern the fair distribution of the burdens and benefits involved in the construction of public goods, rather than questions of ontology.. (shrink)

As health policy-makers around the world seek to make progress towards universal health coverage, they must navigate between two important ethical imperatives: to set national spending priorities fairly and efficiently; and to safeguard the right to health. These imperatives can conflict, leading some to conclude that rights-based approaches present a disruptive influence on health policy, hindering states’ efforts to set priorities fairly and efficiently. Here, we challenge this perception. We argue first that these points of tension stem largely from inadequate (...) interpretations of the aims of priority setting as well as the right to health. We then discuss various ways in which the right to health complements traditional concerns of priority setting and vice versa. Finally, we set out a three-step process by which policy-makers may navigate the ethical and legal considerations at play. (shrink)

In the book Valuing Health, Daniel Hausman sets out a normative framework for assessing social policy, which he calls restricted consequentialism. For the restricted consequentialist, government policy-making not only is, but ought to be, largely siloed in individual government departments. Each department has its own goal linked to a fundamental public value, which it should pursue in a maximizing way. I argue that, first, Hausman’s argument appears to be internally inconsistent: his case for thinking that health policy should default to (...) a form of maximization is plausible only if a much narrower vision of the goals of policy is adopted than Hausman thinks appropriate in the case of education. Secondly, it turns out that none of Hausman’s analysis helps us with the crucial question of how maximization should be constrained by other values—a question that even on Hausman’s account looks to be crucial, and that will be even more important if adopt a broader perspective on the purposes of health policy than Hausman allows. (shrink)

When we talk about intellectual property, it is often implicitly assumed that we are talking about private intellectual property. However, private property and the idea of private ownership do not exhaust the possibilities for accounts of ownership and of property. There are other ways that ownership can operate, such as common property. A resource is common property if its use is ‘governed by rules whose point is to make them available for use by all or any members of the society.’.

This paper develops an account of rigour in the use of thought experiments in ethics. I argue that there are two separate challenges to be faced. The first is internal validity: is the thought experiment designed in a way that allows its readers to make judgements that are confident and free of bias about the hypothesis or point of principle that it aims to test? The second is external validity: to what extent do ethical judgements that are correct of the (...) world of the thought experiment generalize to a wide variety of other contexts, including ethical decision-making in the actual world? Ensuring external validity is the harder and more important problem of rigour, yet it is one that few philosophers have even noticed, let alone begun to solve. (shrink)

Equal Justice: Fair Legal Systems in an Unfair World, by Wilmot-SmithFrederick. Cambridge, MA: Harvard University Press, 2019. Pp. 256.

Drugs are much more expensive whilst they are subject to patent protection than once patents expire: patented drugs make up only 20% of NHS drugs prescriptions, but consume 80% of the total NHS drugs bill. This article argues that, given the relatively uncontroversial assumption that we should save the greater number in cases where all are equally deserving and we cannot save both groups, it is more difficult than is usually thought to justify why publicly funded healthcare systems should pay (...) for patented treatments. The claim to medical treatment of those who will be sick with a given condition once the patent runs out is just as strong as those who are sick with it now, but we will be able to treat more people with the same unit of resource in the future. Hence, when resource constraints entail that both cannot be funded, publicly funded healthcare systems ought to wait until patents expire before approving drugs for general use in the publicly funded system. (shrink)

This paper reflects on the relationship between theory and practice in bioethics, by using various concepts drawn from debates on innovation in healthcare research—in particular debates around how best to connect up blue skies ‘basic’ research with practical innovations that can improve human lives. It argues that it is a mistake to assume that the most difficult and important questions in bioethics are the most abstract ones, and also a mistake to assume that getting clear about abstract cases will automatically (...) be of much help in getting clear about more complex cases. It replaces this implicitly linear model with a more complex one that draws on the idea of translational research in healthcare. On the translational model, there is a continuum of cases from the most simple and abstract to the most concrete and complex. Insights need to travel in both directions along this continuum—from the more abstract to the more concrete and from the more concrete to the more abstract. The paper maps out some difficulties in moving from simpler to more complex cases, and in doing so makes recommendations about the future of bioethics. (shrink)

In this article we aim to assess the ethical desirability of self-test diagnostic kits for influenza, focusing in particular on the potential benefits and challenges posed by a new, mobile phone-based tool currently being developed by i-sense, an interdisciplinary research collaboration based at University College London and funded by the Engineering and Physical Sciences Research Council. Our study adopts an empirical ethics approach, supplementing an initial review into the ethical considerations posed by such technologies with qualitative data from three focus (...) groups. Overall, we map a range of possible considerations both for and against the use of such technologies, synthesizing evidence from a range of secondary literature, as well as identifying several new considerations previously overlooked. We argue that no single consideration marks these technologies as either entirely permissible or impermissible but rather tools which have the potential to incur certain costs and benefits, and that context is important in determining these. In the latter stages of the article, we explain how developers of such technologies might seek to mitigate such costs and reflect on the possible limitations of the empirical ethics method brought out during the study. Not applicable. (shrink)

Jansen and Wall suggest a new way of defending hard paternalism in clinical research. They argue that non-therapeutic research exposing people to more than minimal risk should be banned on egalitarian grounds: in preventing poor decision-makers from making bad decisions, we will promote equality of welfare. We argue that their proposal is flawed for four reasons.First, the idea of poor decision-makers is much more problematic than Jansen and Wall allow. Second, pace Jansen and Wall, it may be practicable for regulators (...) to uncover the values that a potential research participant holds when agreeing to enter a research project, so their claim that we must ban such research projects for all if we are to ban them for poor decision-makers looks to be unmotivated. Third, there seem to be cases where the liberty to enter the sort of research project Jansen and Wall discuss is morally weighty, and arguably should outweigh concerns of egalitarian distribution. Fourth, banning certain types of research, which seem on the face of it to offer an unfavourable risk-benefit ratio, would have unwelcome consequences for all clinical research, which Jansen and Wall do not recognize. (shrink)

Geographic definitions of constituency—the set of voters eligible to vote for a representative—have been criticized by theorists and reformers as undermining democratic values. I argue, in response, that there is no categorical (or even generally applicable) reason sounding in political equality to reject geographic districts. Geographic districting systems are typically flexible enough that, when properly designed, and matched with an appropriate electoral system, they can satisfy the requirements of political equality. More generally, I argue that it is a mistake to (...) evaluate the egalitarian character of constituency definitions in isolation from the political decision-making process as a whole. While it is conceptually important that we can detach constituency definition from other features of electoral systems, when it comes to normative and evaluative judgment, we ought to judge holistically. When we do so, we will rarely find general reasons to prefer one type of constituency definition to another. Geographic districts may offer benefits of logistical convenience and information circulation, even given the existence of advanced information technology. The best reason to reject geographic districts is their liability to anti-democratic abuse. Their defensibility in any given polity thus depends on how feasible it is to protect against such abuses while retaining a geographic districting system. (shrink)

Research data produced in both universities and the NHS are subject to the Freedom of Information Act 2000. This article examines the practical and ethical implications of freedom of information for research data, arguing that increased openness is both here to stay and is ethically justifiable. Researchers need to learn how best to cope with this.

One rationale policy-makers sometimes give for declining to fund a service or intervention is on the grounds that it would be ‘unaffordable’, which is to say, that the total cost of providing the service or intervention for all eligible recipients would exceed the budget limit. But does the mere fact that a service or intervention is unaffordable present a reason not to fund it? Thus far, the philosophical literature has remained largely silent on this issue. However, in this article, we (...) consider this kind of thinking in depth. Albeit with certain important caveats, we argue that the use of affordability criteria in matters of public financing commits what Parfit might have called a ‘mistake in moral mathematics’. First, it fails to abide by what we term a principle of ‘non-perfectionism’ in moral action: the mere fact that it is practically impossible for you to do all the good that you have reason to do does not present a reason not to do whatever good you can do. And second, when used as a means of arbitrating between which services to fund, affordability criteria can lead to a kind of ‘numerical discrimination’. Various attendant issues around fairness and lotteries are also discussed. (shrink)

Verbal autopsy presents the opportunity to understand the disease burden in many low-income countries where vital registration systems are underdeveloped and most deaths occur in the community. Advances in technology have led to the development of software that can provide probable cause of death information in real time, and research considering the ethical implications of these advances is necessary to inform policy. Our research explores these ethical issues in rural Nepal using a public health ethics framework. We considered the burdens (...) and benefits of VA and giving cause of death information to families of the deceased through qualitative research with VA interviewers, community members, national policy stakeholders and international academics. Burdens can be experienced differently, and it is important to balance the emotional burden of VA with utilization of the data to inform planning and increased access to health services. The training, support and supervision of VA interviewers should be prioritized if VA is taken to scale. Initial and ongoing community engagement is recommended in addition to engaging ethical, legal, health and policy personnel in developing protocols and systems. Integrating rigorous research while cautiously moving forward is recommended to ensure systems and responses to concerns are relevant to contexts. (shrink)

DeGrazia argues that post-persons have as much justification in believing that they have higher moral status than persons as persons have in believing that they have higher moral status than animals. DeGrazia's claim presupposes that what Buchanan calls the “moral equality assumption” is false. This article argues that DeGrazia has given us no reason to disbelieve the moral equality assumption. Further, even if DeGrazia's arguments about moral status were sound, it is unclear that his first-order normative claims about how we (...) should weigh human against animal interests would follow. (shrink)

Since the 1960s we have moved rapidly from a “doctor-knows-best” society which in which medical paternalism -- such as withholding information from patients “for their benefit” -- was common, towards a society which celebrates patients’ rights to make informed decisions about their care. In Choosing Life, Choosing Death, Charles Foster mounts a polemic against the current enthusiasm for respect for autonomy in medical ethics and law.

We are all familiar with assertions of rights: we talk of the right to confi dentiality, the right to health care and, more controversially, the right to die. But beneath this surface familiarity lies a heap of diffi culties about what it is to have a right, how we should go about determining which assertions of rights are genuine and what role (if any) rights should play in our broader moral thinking. This chapter aims to offer a guide through these (...) perplexities. (shrink)

Fair allocation of scarce healthcare resources has been much studied within philosophy and bioethics, but analysis has focused on a narrow range of cases. The Covid-19 pandemic provided significant new challenges, making powerfully visible the extent to which health systems can be fragile, and how scarcities within crucial elements of interlinked care pathways can lead to cascading failures. Health system resilience, while previously a key topic in global health, can now be seen to be a vital concern in high-income countries (...) too. Unfortunately, mainstream philosophical approaches to the ethics of rationing and prioritisation provide little guidance for these new problems of scarcity. Indeed, the cascading failures were arguably exacerbated by earlier attempts to make health systems leaner and more efficient. This paper argues that health systems should move from simple and atomistic approaches to measuring effectiveness to approaches that are holistic both in focusing on performance at the level of the health system as a whole, and also in incorporating a wider range of ethical concerns in thinking about what makes a health system good. (shrink)

In this article the basic principles of responsible authorship and peer review are surveyed, with special emphasis on (a) guidelines for refereeing archival journal articles and proposals; and (b) how these guidelines should be taken into account at all stages of writing.

The idea that there is something ethically corrupt or ethically corrupting about Nietzsche’s work is an anathema to Nietzsche scholars today. Although there are some serious moral philosophers, such as Philippa Foot, Jonathan Glover and Martha Nussbaum who write about Nietzsche whilst finding his position ethically deplorable, most Nietzsche scholars tend to focus rather more heavily on his positive aspects. This means that negative ethical assessments of Nietzsche now tend to be relatively few and far between, and given that they (...) tend to be composed by people who know the texts less well than the dedicated Nietzsche scholars, these criticisms can usually be swatted away quite easily. There are two halves to this paper. The first half sets up the problem for the Nietzsche interpreter: the moral equality of human beings is the basic idea through which we (now) think about morality; and Nietzsche’s views on the nature of human ethical life commit him to opposing the moral equality of human beings. The second half of the paper examines Nietzsche’s critique of moral egalitarianism in more detail. Nietzsche’s critique, I suggest, is composed of two parts: a negative and a positive. The negative part (the slave morality thesis) argues that (a) we should make a distinction between moralities of affirmation and moralities of denial; and (b) all moralities which have the equality of human beings as their fundamental value are moralities of denial. The positive part, which, following Nietzsche, I shall call the pathos of distance thesis claims that human greatness requires a feeling of great height from which the great person looks down in lofty contempt on others. I shall argue that it is false to claim that all moralities which have the equality of human beings as their fundamental value are moralities of denial, and that the pathos of distance thesis is either false or question begging or both. Hence there is no reason, even being as generous to Nietzsche as we can be, to think his critique should force us to give up moral egalitarianism. However, even if not all egalitarian moralities are moralities of denial, it is certainly true that some are, which leaves us with a very difficult question: how do we ensure that our belief in the moral equality of human beings forms part of a morality of affirmation rather than one of denial? (shrink)

This paper examines the ethical issues that arise when healthcare providers act as gatekeepers to research involving vulnerable populations. Traumatised refugees serve as an example of this subset of research participants. Highlighting the particular vulnerabilities of this group, we argue that specific ethical considerations are required that go beyond the conventional research approaches. While gatekeeping responds to some of those vulnerabilities, it risks wronging through unwarranted paternalism. Instead, we will propose that a relational ethics of justice and care serves as (...) a more appropriate framework for responding to the challenges of research involving traumatised refugees. Specifically, such a framework allows us to reflect more deeply on the role of the gatekeeper. In conclusion, we recommend that clinicians and researchers collaborate with survivors’ advisory groups in the development of specific research ethical guidelines. (shrink)

In this essay, I make the interpretive claim that we cannot properly understand the Federalist without appreciating the extent to which the papers mount a sustained rejection of extra-constitutional democracy—practices in which people aim to assert authority over the terms of common life in ways that are not sanctioned by existing laws. I survey such practices, which were common in America before and after the Revolution. I argue that there is continuity between Publius’s justification for rejecting extra-constitutional democracy and his (...) justification for his preferred system against constitutional alternatives. Adequate analysis and evaluation of the Federalist’s arguments about faction, representation, and institutional design require attention to the double duty the arguments play against constitutional and extra-constitutional opposition. This interpretive argument supports several analytic and evaluative conclusions. First, we must distinguish a new form of “non-hierarchical dualist” constitutionalism, according to which irregular democratic activity need not be limited to extraordinary “constitutional moments” or revolutions. Second, the politically egalitarian character of procedures depends not on the procedures alone, but how the maintenance of such procedures limits other forms of democratic practice. Third, the argument suggests a novel defense of “uncivil” disobedient politics: one grounded not in contributions to democratic deliberation, but in the entitlements of citizens to direct assertions of authority over common life. (shrink)

This article introduces a symposium on Daniel Hausman’s Valuing Health: Well-Being, Suffering and Freedom. The symposium contains papers by Elselijn Kingma, Adam Oliver, Anna Alexandrova, Erik Nord, Alex Voorhoeve and James Wilson, with replies by Daniel Hausman. In Valuing Health, Hausman argues that, despite apparently measuring health, projects such as the Global Burden of Disease Study in fact measure judgments about the value of health. Once this has been clarified, the key question is how the value of health should be (...) measured. Hausman argues that existing instruments measure the private value of health, that is, health’s ‘contribution to whatever the individual cares about or should care about’, whereas what should be measured for resource allocation purposes is the public value of health, that is, the value health should be accorded from the perspective of the liberal state. Hausman argues that the public value of health should be measured by the extent to which suffering and activity limitations are relieved. Each commentator engages with a different aspect of Hausman’s argument. (shrink)

This thesis is a constructive work in the tradition of morality. The thesis divides into three parts. Part One argues that morality is best considered as a tradition (in MacIntyre’s sense) in ethical thinking which begins with the Stoics, develops in Christian thought and reaches its apotheosis in Kant. This tradition structures ethical thinking around three basic concepts: cosmopolitanism, or universal applicability to human beings as such, the dignity of human beings and reciprocity. It is this tradition in ethical thinking (...) which Nietzsche sets out to destroy. Part One then critiques conceptions of morality which take it that universal and exceptionless rules form the core of morality: it criticises both the possibility of putting forward an adequate set of such rules and the proposed relationship between morality and human life that is implicit in these accounts. Part Two begins with Nietzsche’s challenge: that morality is a system of values rooted in nihilistic resentment at the vitality of other, stronger modes of living. It argues that this challenge must be taken seriously, and that the best way to do this is to make it clear that morality has as its fundamental basis a responsiveness to the value of human life; hence it is Nietzsche’s ethics that should be called nihilistic. The rest of Part Two examines the possibility of answering Nietzsche’s challenge by demonstrating a necessary connection between human selfhood and the acknowledgement of the dignity of human beings. Here I argue that neither Christine Korsgaard’s neo-Kantian arguments nor Charles Taylor’s phenomenologically based approach can provide a convincing reason for thinking that there is such a necessary connection. Part Three turns towards pragmatism, and in so doing gives up on the attempt to show that morality is somehow necessary for all human beings. Nietzsche’s challenge is answered more subtly: an empirically backed theory of human selfhood explains the point of morality in terms of our basic need for recognition. I complete the reconstruction of morality by reinterpreting the dignity of human beings in a naturalistic way and adopting a conception of moral rules that is informed by Jürgen Habermas’ discourse ethics. (shrink)