In this article we argue that the social value of health research should be conceptualized as a function of both the expected benefits of the research and the priority that the beneficiaries deserve. People deserve greater priority the worse off they are. This conception of social value can be applied for at least two important purposes: in health research priority setting when research funders, policy-makers, or researchers decide between alternative research projects; and in evaluating the ethics of proposed research proposals (...) when research ethics committees assess whether the social value of the research is sufficient to justify the risks and burdens to research participants and others. In assessing how far a proposed research project will advance the interests of people who are more disadvantaged, research priority setters and RECs should examine the diseases that the research targets and the type of research. Just as certain diseases impose a greater burden on people who are more disadvantaged, so certain types of intervention and forms of research are more likely to benefit people who are more disadvantaged. We outline which populations are likely to be representative of the global worst off and identify what types of health research, and which disease categories, are priorities for these populations. (shrink)

The available resources for global health assistance are far outstripped by need. In the face of such scarcity, many people endorse a principle according to which highest priority should be given to the worst off. However, in order for this prioritarian principle to be useful for allocation decisions, policy-makers need to know what it means to be badly off. In this article, we outline a conception of disadvantage suitable for identifying the worst off for the purpose of making (...) health resource allocation decisions. According to our total advantage view: the worst off are those who have the greatest total lifetime disadvantage; advantage foregone due to premature death should be treated in the same way as other ways of being disadvantaged at a time; how badly off someone is depends on the actual outcomes that will befall her without intervention, not her prospects at a time; and all significant forms of disadvantage count for determining who is worst off, not just disadvantage relating to health. We conclude by noting two important implications of the total advantage view: first, that those who die young are among the globally worst off, and second, that the epidemiological shift in the global burden of disease from communicable to non-communicable diseases should not lead to a corresponding shift in global health spending priorities. (shrink)

Of all the ethical questions, the one of what we owe our fellow humans seems to be both the most pressing and the one around which there is the least agreement. Plausible-looking answers range from the extremely demanding claim that we are obliged to give to others until giving to them costs us more than it benefits them, to the minimally demanding claim that we are not obliged to give to others at all, but that it would be nice if (...) we did. The minimally demanding view often combines with the view that beneficence is the responsibility of governments rather than individuals, and with the thought that we dispense with our duties by paying our taxes. The minimally demanding view, however, does not deal well with the intuitions that we have about clear cases like Peter Singer's example of our duty to save a baby who is lying face down in a pond when we can do so at little cost to ourselves. There seems, here, to be a duty of beneficence that is not reflected in the claim that it would merely be nice to help the baby; it exists regardless of the taxes we pay. Our thinking about beneficence needs to be sensitive to clear intuitions such as this. This paper is essentially a methodological consideration of the role that intuitions like the above might play in moral reasoning. (shrink)

We shall focus on moral theories that are solely concerned with promoting the benefits (e.g., wellbeing) of individuals and explore the possibility of such theories ascribing some priority to benefits to those who are worse off—without this priority being absolute. Utilitarianism (which evaluates alternatives on the basis of total or average benefits) ascribes no priority to the worse off, and leximin (which evaluates alternatives by giving lexical priority to the worst off, and then the second worst off, and (...) so on) ascribes absolute priority to the worse off (i.e., favors even a very small benefit to a worse off person over very large benefits to large numbers of better off people). Neither extreme view, we assume, is plausible. (shrink)

In any complex human society, distinct persons may have strikingly different standards of living. Those who lead the most undesirable, poorest lives in society can be called the worst off. Given that we almost always do not want to be, but some have to be, the worst off, we may want to find a right way to treat the worst off. In the West, John Rawls has proposed a conception of justice as fairness, and in the East, (...) Confucius and Mencius have developed conceptions of ren and yi partly in order to deal with social injustice in the distribution of benefits and the problem of the worst off. Their conceptions and proposed solutions provide valuable ideas, which through comparison may be better assessed and then employed, or even combined, to address the problem. In this essay, I try to examine and compare their conceptions of distributive justice and the worst off, and then expound their suggested solutions to the problem and propose a provisional answer on the basis of those ideas. (shrink)

This article argues that Rawlsian liberal political institutions are incapable of ensuring that the basic welfare needs of the worst off are met. This argument consists of two steps. First, I show that institutions are incapable of ensuring that the basic needs of the worst off are met without pursuing certain non-taxation-based courses of action that are designed to alter the work choices of citizens. Second, I argue that such actions are not permissible for Rawlsian institutions. It follows (...) that a state governed by a Rawls-type political conception of justice is parasitic on the willingness of citizens to be sufficiently motivated by concern for the worst off, but it cannot require or even encourage them to be so motivated. (shrink)

A central strand in philosophical debate over the just distribution of resources attempts to juggle three competing imperatives: helping those who are worst off, helping those who will benefit the most, and then – beyond this – determining when to aggregate such ‘worst off’ and ‘benefit’ claims, and when instead to treat no such claim as greater than that which any individual by herself can exert. Yet as various philosophers have observed, ‘we have no satisfactory theoretical characterization’ as (...) to how to weigh each of the three imperatives against one another, we find it ‘difficult to state... precise or comprehensive conclusions’, and we do not yet have a ‘metric for integrating the three measures’. In what follows, I offer an approach to weighing the three criteria against one another that yields resolutions – in Hard Cases of the ‘saving one infant's life versus replacing ten elderly people's hips’ sort – that are cardinally definitive, intuitively satisfactory and theoretically justified. (shrink)

Non-communicable diseases now account for the majority of the global burden of disease and an international campaign has emerged to raise their priority on the post-2015 development agenda. We argue, to the contrary, that there remain strong reasons to prioritize maternal and child health. Policy-makers ought to assign highest priority to the health conditions that afflict the worst off. In virtue of how little healthy life they have had, children who die young are among the globally worst off. (...) Moreover, many interventions to deal with the conditions that cause mortality in the young are low-cost and provide great benefits to their recipients. Consistent with the original Millennium Development Goals, the international community should continue to prioritize reductions in communicable diseases, neonatal conditions, and maternal health despite the shifts in the global burden of disease. (shrink)

This introduction to The Journal of Clinical Ethics highlights and expands four articles within this issue that propose somewhat new and radical innovations to help and further the interests of patients and families worst off. One article urges us to enable historically marginalized groups to participate more than they have in research; a second urges us to allocate limited resources that can be divided, such as vaccines and even ventilators, in a different way; a third urges us to help (...) families find greater meaning when their loved ones are dying; and a fourth urges us to treat patients who illegally use drugs as caringly as is possible, though there may be limits to what providers can do. This piece also addresses the importance of providers bonding with patients, recognizing that some providers may be better at eliciting patients’ trust than others, and thus the importance of connecting these patients with these providers since this may be the sole way these patients can optimally respond and do well. Finally, providers taking time away from their patients to oppose and reduce social stigma is considered. (shrink)

In this essay, Johannes Giesinger comments on the current philosophical debate on educational justice. He observes that while authors like Elizabeth Anderson and Debra Satz develop a so-called adequacy view of educational justice, Harry Brighouse and Adam Swift defend an egalitarian principle. Giesinger focuses his analysis on the main objection that is formulated, from an egalitarian perspective, against the adequacy view: that it neglects the problem of securing fair opportunities in the competition for social rewards. Giesinger meets this objection by (...) expressing two basic theses: First, he argues that Brighouse and Swift themselves fail to give an adequate account of fair competition; and, second, he shows that the adequacy view provides the theoretical resources to face this problem. (shrink)

Using a fair allocation approach, this paper identifies and examines important concerns arising from the Philippines’ COVID‐19 response while focusing on difficulties encountered by various sectors in gaining fair access to needed societal resources. The effectiveness of different response measures is anchored on addressing inequities that have permeated Philippine society for a long time. Since most measures that are in place as part of the COVID‐19 response are meant to be temporary, these are unable to resolve the inequities that have (...) led to the magnitude of morbidity and mortality associated with the pandemic. These cannot improve the country’s readiness to deal with pandemics and other emergencies in the future.Transition to a new normal recognizes the possibility that other infectious diseases could come and endanger our health security. Our pandemic experiences are proving that having an egalitarian society will serve the interests not only of disadvantaged sectors but also of everybody else, including the privileged. Response measures should thus take the opportunity to promote equity by giving importance to the concerns of the underprivileged and vulnerable while giving preference to initiatives that can be sustained beyond the period of the current pandemic. (shrink)

Using a fair allocation approach, this paper identifies and examines important concerns arising from the Philippines’ COVID‐19 response while focusing on difficulties encountered by various sectors in gaining fair access to needed societal resources. The effectiveness of different response measures is anchored on addressing inequities that have permeated Philippine society for a long time. Since most measures that are in place as part of the COVID‐19 response are meant to be temporary, these are unable to resolve the inequities that have (...) led to the magnitude of morbidity and mortality associated with the pandemic. These cannot improve the country’s readiness to deal with pandemics and other emergencies in the future. Transition to a new normal recognizes the possibility that other infectious diseases could come and endanger our health security. Our pandemic experiences are proving that having an egalitarian society will serve the interests not only of disadvantaged sectors but also of everybody else, including the privileged. Response measures should thus take the opportunity to promote equity by giving importance to the concerns of the underprivileged and vulnerable while giving preference to initiatives that can be sustained beyond the period of the current pandemic. (shrink)

Developing World Bioethics, Volume 21, Issue 4, Page 153-172, December 2021.

Imagine that two ten year-old children, Adam and Bill, have excellent vision but will soon go totally blind due to natural causes unless a morally motivated stranger, Teresa, intervenes. Teresa can use a resource she rightfully controls to produce and administer only one of the following two medicines to both Adam and Bill.

Summarizes Virilio's speculations about the impact that accidents will have on the planet now that we operate on one-world time. Based upon a 1996 conversation Paul Virilio had with French journalist Phillipe Petit, The Politics of the Very Worst summarizes Virilio's speculations about the impact that accidents will have on the planet now that we operate on one-world time. Virilio argues that accidents have now lost all particularity. Accidents and events can no longer be confined to markers in history (...) like Auschwitz or Hiroshima. Trajectories once had three dimensions: past, present, and future. But now, the hyper-concentration of time into "real time" reduces all trajectories to nothing. Consequently, an accident of time is bound to affect our entire being as well as the entire planet. And this is the hidden face of technical and scientific progress that Virilio is attempting to reveal, shrugging off any illusion we may have left about its alleged benefits.Globalization doesn't make the planet bigger, it signals the beginning of "the great confinement." Speed pollutes the distances of the world. After the "green ecology", we are now experiencing another, more invisible and mental, kind of pollution: the "gray ecology." Soon, Virilio suggests, we are going to experience the end of the world--not the apocalyptic end, but the world as finite. The communication revolution, the attainment of absolute speed, is the reduction of the world to a virtual city in which democracy is no longer possible. This extermination of world-space is a cataclysmic event. For the first time, history has hit a cosmological limit. (shrink)

This chapter argues that rather than viewing transparency as a right, we should regard it as a finite resource whose allocation involves tradeoffs. It then argues that those tradeoffs should be resolved by using a multi-principle approach to distributive justice. The relevant principles include maximizing welfare, maximizing autonomy, and giving priority to the worst off. Finally, it examines some of the implications for law of recognizing the tradeoffs presented by transparency proposals.

Based upon a 1996 conversation Paul Virilio had with French journalist Phillipe Petit, The Politics of the Very Worst summarizes Virilio's speculations about the impact that accidents will have on the planet now that we operate on one-world time. Virilio argues that accidents have now lost all particularity. Accidents and events can no longer be confined to markers in history like Auschwitz or Hiroshima. Trajectories once had three dimensions: past, present, and future. But now, the hyper-concentration of time into (...) "real time" reduces all trajectories to nothing. Consequently, an accident of time is bound to affect our entire being as well as the entire planet. And this is the hidden face of technical and scientific progress that Virilio is attempting to reveal, shrugging off any illusion we may have left about its alleged benefits.Globalization doesn't make the planet bigger, it signals the beginning of "the great confinement." Speed pollutes the distances of the world. After the "green ecology", we are now experiencing another, more invisible and mental, kind of pollution: the "gray ecology." Soon, Virilio suggests, we are going to experience the end of the world -- not the apocalyptic end, but the world as finite. The communication revolution, the attainment of absolute speed, is the reduction of the world to a virtual city in which democracy is no longer possible. This extermination of world-space is a cataclysmic event. For the first time, history has hit a cosmological limit. (shrink)

Egalitarian theories of justice hold that equality should be promoted. Typically, perfect equality will not be achievable, and it will be necessary to determine which of various unequal distributions is the most equal. All plausible conceptions of equality hold that, where perfect equality does not obtain, (1) any benefit (no matter how small) to a worst-off person that leaves him/her still a worst-off person has priority (with respect to equality promotion) over any benefit (no matter how large) to (...) a best-off person, and (2) any benefit to a worse-off person (even if not a worst-off person) has priority over a benefit of the same size to a better off person (even if not a best-off person). Beyond that there is much disagreement. (shrink)

Summary 1. Ecologists and conservation biologists consider many issues when designing a field study, such as the expected value of the data, the interests of the study species, the welfare of individual organisms and the cost of the project. These different issues or values often conflict; however, neither animal ethics nor environmental ethics provides practical guidance on how to assess trade-offs between them. -/- 2. We developed a decision framework for considering trade-offs between values in ecological research, drawing on the (...) field of ecological ethics. We used a case study of the population genetics of three frog species, in which a researcher must choose between four methods of sampling DNA from the study animals. We measured species welfare as the reduction in population growth rate following sampling, and assessed individual welfare using two different definitions: (i) the level of suffering experienced by an animal, and (ii) the level of suffering combined with loss of future life. -/- 3. Tipping the tails of tadpoles ranked as the best sampling method for species welfare, while collecting whole tadpoles and buccal swabbing of adult frogs ranked best for the first and second definitions of individual welfare, respectively. Toe clipping of adult frogs ranked as the worst sampling method for species welfare and the first definition of individual welfare, and equal worst for the second definition of individual welfare. -/- 4. When considering species and individual welfare simultaneously, toe clipping was clearly inferior to the other sampling methods, but no single sampling method was clearly superior to the other three. Buccal swabbing, collecting tadpoles and tail tipping were all preferred options, depending on the definition of individual welfare and the level of precision with which we assessed species welfare. -/- 5.Synthesis and applications. The decision framework we present can be used by ecologists to assess ethical and other trade-offs when planning field studies. A formal decision analysis makes transparent how a researcher might negotiate competing ethical, financial and practical objectives. Defining the components of the decision in this way can help avoid errors associated with human judgement and linguistic uncertainty. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Roadmap Needed:How to Help Parents Navigate the Worst Day of Their LivesCheryl KilpatrickOn January 14, 2010, our 3–year–old daughter, Maggie, was rushed to an emergency room at a satellite medical center. I am an occupational therapist and was actually scheduled to work at a hospital that day. I was wearing my purple scrubs. Maggie had been showing “strange” symptoms all week that I thought might be a sign (...) that she was getting a cold or the flu. She had been extremely tired, having morning headaches and ataxia (balance problems). When I dropped Maggie off at preschool the morning of January 14, 2010 she began to have trouble using her left arm. The teacher noticed that her smile was crooked. I did a quick neurological assessment and saw that her [End Page E9] left arm was much weaker than her right arm. I thought to myself, “My kid looks as if she is having a stroke. But she is only 3–years–old. This doesn’t make any sense.” The teacher gave me a look as if to say, “Are you going to take Maggie to the hospital or am I going to have to do it?” I just stood there. I suppose I was in the first stages of shock. I turned to the teacher and said, “We are going to the hospital.”As we walked toward the ER admissions desk I was surprised to see that we were the only people in the waiting area. It didn’t take long before we were called into the examination room. The ER doctor did a neurological assessment on Maggie like I had done only 30 minutes earlier and said that a CAT scan was needed. He thought that we would most likely be transferred to a local children’s hospital. The CAT scan revealed that Maggie had a large mass in her thalamus. I just looked at the ER doctor and said, “Just tell me what I need to do and I will do it.” No tears, no screams, no emotion. I just went into “mommy mode” and made sure that my child felt safe every step of the way. My husband was on his way home from a business trip when I called to tell him the news. He had no idea what he would find when he finally got to us.As expected, we were transported by ambulance to the local children’s hospital. I remember sitting in the front seat with the driver and feeling like this was all a dream. It was all very surreal. Maggie calmly chatted with the EMS personnel in the back of the ambulance as if nothing was happening. I had no idea how our lives would change once we reached the hospital. This ride to the hospital began our journey into uncharted territory. Nothing in my life had prepared me for what was about to happen.We arrived at the children’s hospital around 11:00 a.m. As we walked into ER department, I could feel the eyes of the ER staff following us. I turned to look at them and they smiled. The look on their faces told me that something was very wrong with my daughter. I felt like we were a sideshow at the carnival. I hated those looks. I didn’t want their smiles. I wanted to know what was happening. I wanted information.My husband arrived about an hour after our arrival. He walked into the room and found his little girl looking very spacey and unable to walk to him without falling. When Maggie and I stepped out into the hallway to find the restroom, I turned to look back into the room and saw my husband with his face in his hands. He was crying. I was not. I was still in “mommy mode” or just plain shock. I knew that my daughter was not well. But then again, neither was I. I was not crying. I was not screaming. I was numb. What I needed was someone to take my “emotional pulse.”We waited patiently in that small room watching the hours pass by as each doctor came... (shrink)

This essay is based on a talk the author gave at the By the Book conference in Florence in June 2019. It examines the power dynamics in the Italian publishing world from the perspective of a fiction writer. Writing and publishing are two completely different worlds that can be differently approached. What’s the point of writing? Should writers write about what they know, or about what they do not know? Can publishing be put off? What’s the role of literary agents (...) in the publishing process? The author’s answers to these questions are based on her personal experience. (shrink)

The paper starts by exploring the negative contingencies that are associated with the core institution of capitalist societies, the labour contract: unemployment, poverty, and denial of autonomy. It argues that these are the three conditions that basic income schemes can help prevent. Next, the three major normative arguments are discussed that are raised by opponents of basic income proposals: the idle should not be rewarded, the prosperous don’t need it, and there are so many things waiting to be done in (...) the world. After demonstrating that proponents of basic income stand in no way empty-handed when facing these objections, a third part considers basic income in functional terms: would its introduction help to resolve problems of social and economic order that are unlikely to be resolved in more conventional ways? (shrink)

Climate change is already a major global threat, but many of its worst impacts are still decades away. Many people who will eventually be affected by it still have opportunities to mitigate harm. When considering the avoidable burdens of climate change, it seems plausible victims will often share some responsibility for putting themselves into harm’s way. This fact should be incorporated into our thinking about the ethical significance of climate-induced harms, particularly to emphasize the importance of differential abilities to (...) get and stay out of harm’s way. Currently, many people face serious obstacles to reducing their vulnerability to climate change, such as poverty, lack of education, and political or legal obstacles to mobility. Climate policy discussions should do more to emphasize the alleviation of these sources of difficulties, thereby empowering people to choose what risks they will bear in a warming world. (shrink)

Contradictions of the Welfare State is the first collection of Offe's essays to appear in a single volume in English, and it contains a selection of his most important recent work on the breakdown of the post-war settlement.

Should the Western democracies, contrary to their prevailing self-image as "planned" and "managed," be seen as highly disorganized systems of social power and political authority? If so, what are the symptoms, consequences of, and possible remedies for these disorganizing tendencies?In these ten essays, Claus Offe seeks to answer such questions. Moving beyond the boundaries of both Marxism and established forms of political sociology, he focuses on the growth of serious divisions within the work force, the importance of the "informal" sector, (...) the severe difficulties faced by trade unions in coping with the present economic crisis, the vulnerability of neocorporatist mechanisms, and the failures of state policymaking based on either majority rule or bureaucratic administration.In examining these and other fundamental problems of advanced capitalist democracies, Offe also contests some widely held assumptions of contemporary social science. He calls into question the neutrality of liberal democratic mechanisms of participation and representation, the centrality of the category of work and the division between labor and capital, and the feasibility and desirability of full employment.Claus Offe is the author of numerous books and essays, including Contradictions of the Welfare State. He is currently Professor of Political Science and Sociology in the Faculty of Sociology, University of Bielefeld, West Germany. John Keane is Senior Lecturer in Political Theory and Sociology at the Polytechnic of Central London. Disorganized Capitalism is included in the series, Studies in Contemporary German Social Thought, edited by Thomas McCarthy. (shrink)

Modernity and the State, a dozen essays written over thelast decade, develops his earlier lines of interest and extends them to the new societies emergingin Central-Eastern Europe.Offe frames the essays by suggesting that the key question ...

Reference to the common good has increased in recent political discourse, not only on the right but also on the left. This development partly reflects genuine limitations in the liberal model of politics, and thus should not be dismissed as mere rhetoric. However, appeals to the common good face four difficulties: its social referent; its temporal horizon; its substantive content; and its authoritative identification. The article concludes with a modest suggestion for understanding the common good in complex societies.

Im vierten Band der Ausgewählten Schriften von Claus Offe sind demokratietheoretische Aufsätze aus fünf Dekaden zusammengestellt, die sich mit dem Spannungsverhältnis zwischen den organisierten Konfliktgruppen kapitalistischer Gesellschaften und den Institutionen der liberalen Demokratie befassen. Dabei geht es um die strategischen Akteure und ihre Interessen und Identitäten, die auf der "Eingabeseite" demokratischer Politik deren Tagesordnung wie ihre Verhandlungs- und Entscheidungsergebnisse bestimmen. Ebenso geht es um das politische Beteiligungsverhalten von Bürgern und die Symptome einer prekären Legitimität, die sich trotz des vermeintlichen Universalismus (...) von Gleichheit politischer Rechte und Mehrheitsprinzip unverkennbar abzeichnen. In einem abschließenden Teil des Bandes erörtert der Verfasser verzerrende Formen der Bildung und Messung des "Volkswillens" sowie Möglichkeiten, ihn durch deliberative Verfahren und Institutionen zu rationalisieren. (shrink)

In this article I explore some ancient issues of political theory in the light of some contemporary social and cultural issues. After developing a check list of the virtues and vulnerabilities of constitutional democracy (Section I), I go on to discuss some types and symptoms of difference, conflict, fragmentation and heterogeneity (Section II). I then proceed to a critical review of a particular set of strategies and institutional solutions—political group rights—that are often thought promising devices for strengthening the virtues and (...) overcoming the vulnerabilities of the constitutional democratic form of regime (Section III). Much of the contemporary philosophical and political discussion of these issues is enchanted by the post‐modern spirit of “multiculturalism,”“diversity” and “identity.” It tends to neglect issues of citizenship and social justice. It also tends to fixate on North American examples, neglecting some of the less benign West European and, in particular, Central East European varieties of identity politics. The discussion here, while mostly raising questions rather than claiming to provide definitive answers, nevertheless tries to overcome some of these biases. (shrink)

The nine essays in this volume explore such topics as the characteristics and shortcomings of state socialist societies and of democratic capitalism, the role of ethnic politics in East European transitions, issues of retribution and ...

Resentment is not so much based upon the diversity of cultural and other identities but often rooted in grievances, complaints, and memories of historical conflicts that groups hold against other groups. Using examples from Central and Eastern Europe, this article argues that the viability of liberal democratic welfare states in Europe depends upon a minimum of toleration, trust, and solidarity among citizens. It is these cultural underpinnings of democracy which are threatened by historically rooted and (often strategically activated) feelings of (...) resentment. (shrink)

In a loose analogy to the history of the autonomous movement, the article pleads for the elaboration of a post-autonomous concept of literature in literary studies – which must also include a revision of the scholars’ criteria of aesthetic evaluation. »Post-autonomous« should be understood here as the reflected expression of some of the paradoxes of the autonomous itself.