Medical Research Council, Capetown, South Africa Nasheen Naidoo Medical Research Council, Capetown, South Africa Shamagonam James Medical Research Council, Durban, South Africa Priscilla Reddy Medical Research Council, Capetown, South Africa * Corresponding author: 306 Arnold House, School of Public Health & Health Sciences, University of Massachusetts, Amherst, MA 01003, USA. Tel.: (413) 545 1005; Email: Buchanan{at}schoolph.umass.edu ' + u + '@' + d + ' '//--> . Abstract The analysis presented here lays out the ethical warrants for requiring community (...) oversight of health research conducted in international settings. It reviews the inadequacies with the current standards of individual informed consent and research ethics committee review, and then, shows how a broader population-based public health perspective raises new demands on justice involving due consideration of the rights, harms and benefits to the community as a whole. As developed here, an ethical standard that requires community oversight of health research is justified on three principled grounds: respect for community autonomy and their right to self-determination; due consideration of the consequences of the research for the community as a whole; and, a more complete understanding of human autonomy. The paper concludes with practical recommendations regarding the composition of Community Advisory Boards to ensure that they have legitimate decision-making authority in diverse socio-cultural contexts. CiteULike Connotea Del.icio.us What's this? (shrink)

Our society has long sanctioned, at least tacitly, a degree of conflict of interest in medical practice and clinical research as an unavoidable consequence of the different interests of the physician or clinical investigator, the patient or clinical research subject, third party payers or research sponsors, the government, and society as a whole, to name a few. In the past, resolution of these conflicts has been left to the conscience of the individual physician or clinical investigator and to professional organizations. (...) The public is no longer willing to allow health care providers to wholly govern their own conflicts of interest for several reasons. These include: new forms of health care financing and delivery that provide innovative and lucrative opportunities for physician or insurer enrichment at patient expense; the increased importance of commercial research support as peer-reviewed governmental research support has decreased; evidence that physicians and clinical investigators too frequently resolve conflicts of interest in their own favor; and a general societal mistrust of authority. This volume represents a multidisciplinary effort, drawing from philosophy, medicine, law, economics and public policy to identify and categorize conflicts of interest in medical practice and clinical research, and, where possible, to offer a mechanism for resolving them. Part I addresses conflicts of interest from a theoretical perspective, offering basic concepts and analytical frameworks. The second part discusses two topics prominent in current health care policy debates--self-referral and financial incentives to limit care. Part III examines conflicts of interest generated by pharmaceutical industry involvement in clinical practice and research. The final section deals with conflicts of interest in clinical research in several contexts, including institutional reviews boards, clinical trials, Cooperative Research and Development Agreements between government and private researchers, brokerage of research subjects by Contract Research Organizations, and cost-effectiveness studies. (shrink)

: Recent controversial decisions to terminate several large clinical trials have called attention to the need for developing a sound ethical framework to determine when trials should be stopped in light of emerging efficacy data. Currently, the fundamental rationale for stopping trials early is based on the principle that equipoise has been disturbed. We present an analysis of the ethical and practical problems with the "equipoise disturbed" position and describe an alternative ethical framework based on the principle of nonexploitation. This (...) framework acknowledges the need for balancing the dual ethical obligations of clinical research, the protection of human subjects and the generation of new medical knowledge. Based on this framework, we put forward a proposal to make early stopping guidelines more stringent under specified conditions. The temporary withholding of apparent benefits in certain circumstances is justified by achieving a fair contract with the research participants, one that protects them from undue harm and exploitation while reducing the many uncertainties surrounding new investigational treatments that arise when trials are stopped prematurely. (shrink)

The analysis presented here lays out the ethical warrants for requiring community oversight of health research conducted in international settings. It reviews the inadequacies with the current standards of individual informed consent and research ethics committee review, and then, shows how a broader population-based public health perspective raises new demands on justice involving due consideration of the rights, harms and benefits to the community as a whole. As developed here, an ethical standard that requires community oversight of health research is (...) justified on three principled grounds: respect for community autonomy and their right to self-determination; due consideration of the consequences of the research for the community as a whole; and, a more complete understanding of human autonomy. The paper concludes with practical recommendations regarding the composition of Community Advisory Boards to ensure that they have legitimate decision-making authority in diverse socio-cultural contexts. (shrink)

Patients with persistent pain who lack adetectable underlying disease challenge thetheories supporting much of biomedicalbody-mind discourse. In this context,diagnostic labeling is as inherently vulnerableto the same pitfalls of uncertainty that besetany other interpretative endeavour. The endpoint is often no more than a name ratherthan the discovered essence of a pre-existentmedical condition. In 1990 a Committee of theAmerican College of Rheumatology (ACR)formulated the construct of Fibromyalgia in anattempt to rectify a situation of diagnosticconfusion faced by patients presenting withwidespread pain. It was (...) proposed thatFibromyalgia existed as a ``specific entity'',separable from but curiously able to co-existwith any other painful condition. Epistemological and semiotic analyses ofFibromyalgia have failed to find any sign,clinical or linguistic, which coulddifferentiate it from other diffusemusculoskeletal pain states. The construct ofFibromyalgia sought to define a discernablereality outside the play of language and topass it off as a natural phenomenon. However,because it has failed both clinically andsemiotically, the construct also fails the testof medical utility for the subject inpersistent pain. (shrink)

Public policies to reduce the extent of obesity in the United States have generated considerable public controversy. The paper examines the implications of proposed policies for the principles of justice and autonomy and key assumptions underlying the major contending positions with respect to the relative weight that should be assigned to them in balancing their respective claims. The analysis traces the crux of the debate regarding the ethical warrant for policies to restrict access to calorie-dense foodstuffs to two key issues: (...) the appeal to different and conflicting theories of justice, and the conflation of autonomy with negative liberty in public debates. After clarifying the ethically relevant characteristics of autonomy that merit defense, the paper concludes with a description of how the capabilities approach to justice may offer a more coherent ethical framework for developing and evaluating policies to address the current obesity epidemic. (shrink)

Cancer chemoprevention trials test the efficacy of pharmaceutical agents in preventing cancer in at-risk research subjects who are neither patients diagnosed with the disease nor typical healthy volunteers. Such trials present unique challenges to investigators and IRB reviewers when evaluating risks and benefits, assessing informed consent, and compensating subjects. Investigators and IRBs should pay particular attention to the criteria used to define at-risk subjects and carefully assess the strength of the evidence supporting them, as this is critical to evaluating the (...) risk-benefit ratio. (shrink)

The prelims comprise: Introduction Historical Background The Role of Health Research in Promoting Social Justice Justice in Setting Research Priorities Justice Concerns within the Research Context Case Study: The Investigation of Alternative Lead Abatement Procedures by the Kennedy Krieger Institute Conclusion Note References.

Monetary policy prior to, during, and following the 1990?1991 recession was the tightest and most restrictive in over 30 years. Some have suggested that this policy was explicitly designed by the monetary hawks on the Federal Reserve to wring out the residues of inflationary expectations; others, that the central bank could not offset the real, and powerful, negative shocks buffeting the American economy. But a better explanation is that the monetary authorities were passive because they failed to appreciate the treacherous (...) financial weather caused by new capital requirements and the massive bailout of insolvent institutions. (shrink)

As necessary austerity measures make major inroads into western health services, this paper investigates the philology of austerity and finds that there are two subtly similar yet importantly different derivations from the Latin and the Greek. The Latin austerus is an abstract term meaning dry, harsh, sour; whereas the Greek austeros has a more embodied and literal meaning of making the tongue dry. What seems an initially subtle difference between the metaphorical and the metonymic plays out as involving seriously different (...) outcomes between harsh economic measures and the literal effects on the people suffering under measures that actually make the tongue dry. The paper argues that between the trope and the literal that which Wittgenstein described as ‘a language game’ ensues wherein the metaphorical through a sleight of grammar is passed off as being real while, the literal effects on real people is downplayed as metaphorical ‘collateral damage’. The paper further argues that within this grammar that forces itself upon us, the game of capital is played out through what the author terms an austerity bargain that is levelled by the financial elites: healthy capitalism equals a healthy society. The paper then examines the six elements of the social determinants of health and what actually contributes to a healthy society. Rather than being under an individual threat of exclusion from what Marx termed a superabundance, the paper considers the irreducible differences between the game of capital's individualism, and, the social determinants of health's social inclusion, legitimization and that which Habermas termed public authentication. The paper concludes that not only do necessary austerity measures need to be critiqued but that they radically undermine what determines a healthy society. It follows also that the social determinants of health, radically undermine the bargain inherent for the privileged few within the game of capital. (shrink)

Involuntary civil commitment to treatment for opioid use disorder prevents imminent overdose, but also restricts autonomy and raises other ethical concerns. Using the Kass Public Health Ethics Framework, we identified ICC benefits and harms. Benefits include: protection of vulnerable, underserved patients; reduced legal consequences; resources for families; and “on-demand” treatment access. Harms include: stigmatizing and punitive experiences; heightened family conflict and social isolation; eroded patient self-determination; limited or no provision of OUD medications; and long-term overdose risk. To use ICC ethically, (...) it should be recognized as comprising vulnerable patients worthy of added protections; be a last resort option; utilize consensual, humanizing processes; provide medications and other evidence-based-treatment; integrate with existing healthcare systems; and demonstrate effective outcomes before diffusion. ICC to OUD treatment carries significant potential harms that, if unaddressed, may outweigh its benefits. Findings can inform innovations for ensuring that ICC is used in an ethically responsible way. (shrink)

David Lewis (1974, 1994/1999) proposed to reduce the facts about mental representation to facts about sensory evidence, dispositions to act, and rationality. Recently, Robert Williams (2020) and Adam Pautz (2021) have taken up and developed Lewis’s project in sophisticated and novel ways. In this paper, we aim to present, clarify, and ultimately object to the core thesis that they all build their own views around. The different sophisticated developments and defenses notwithstanding, we think the core thesis is vulnerable. We (...) pose a dilemma by considering the two sides of a current epistemological controversy over the relation between evidence and rational belief: permissivism vs. uniqueness. As we argue, the prospects for the Lewisian project look dim when either supposition is clearly made. (shrink)

I take it as my assignment to criticize the Gauthier enterprise. At the outset, however, I should express my general agreement with David Gauthier's normative vision of a liberal social order, including the place that individual principles of morality hold in such an order. Whether the enterprise is, ultimately, judged to have succeeded or to have failed depends on the standards applied. Considered as a coherent grounding of such a social order in the rational choice behavior of persons, the (...) enterprise fails. Considered as an extended argument implying that persons should adopt the moral stance embodied in the Gauthier structure, the enterprise is, I dunk, largely successful. Considered as a set of empirically falsifiable propositions suggesting that persons do, indeed, choose as the Gauthier precepts dictate, the enterprise offers Humean hope rather than Hobbesian despair. (shrink)

David DeGrazia's article provides a careful and fair rendition of my position on the possibility of post-persons. However, I am unconvinced that he has shown that such beings are possible. My view is based on two assumptions: (1) the concept of moral status is a threshold concept; and (2) the most plausible understanding of moral status as a threshold concept is a Kantian respect-based view, according to which all and only those beings who have the capacity to be accountable (...) for reasons have the high status we associate with persons. I argue that the superior beings DeGrazia describes would be more morally admirable than us, but would not have a higher moral status. I also argue that, contrary to DeGrazia, even the most intelligent of canines do not have the capacity for accountability for reasons, even in an attenuated form. I then argue that DeGrazia faces a painful dilemma: either he must give up the assumption that moral status (so far as persons are concerned) is a threshold concept and say that for any two beings with the capacity for accountability for reasons, the one with the greater capacity has a higher moral status; or he must retain the view that moral status is a threshold concept but concede that he has not account of where the threshold lies. (shrink)

According to Millian Descriptivism, while the semantic content of a linguistically simple proper name is just its referent, we often use sentences containing such expressions “to make assertions…that are, in part, descriptive” (Soames 2008). Against this view, I show, following Ted Sider and David Braun (2006), that simple sentences containing names are never used to assert descriptively enriched propositions. In addition, I offer a diagnosis as to where the argument for Millian Descriptivism goes wrong. Once we appreciate the distinctive (...) way in which this account fails, we can better appreciate the very modest role that associated descriptive information plays in the pragmatics of proper names. (shrink)

Nancy MacLean’s book, Democracy in Chains, raised questions about James M. Buchanan’s commitment to democracy. This paper investigates the relationship of classical liberalism in general and of Buchanan in particular to democratic theory. Contrary to the simplistic classical liberal juxtaposition of “coercion vs. consent,” there have been from Antiquity onwards voluntary contractarian defenses of non-democratic government and even slavery—all little noticed by classical liberal scholars who prefer to think of democracy as just “government by the consent of the (...) governed” and slavery as being inherently coercive. Historically, democratic theory had to go beyond that simplistic notion of democracy to develop a critique of consent-based non-democratic government, e.g., the Hobbesian pactum subjectionis. That critique was based firstly on the distinction between contracts or constitutions of alienation (translatio) versus delegation (concessio). Then the contracts of alienation were ruled out based on the theory of inalienable rights that descends from the Reformation doctrine of inalienability of conscience down through the Enlightenment to modern times in the abolitionist and democratic movements. While he developed no theory of inalienability, the mature Buchanan explicitly allowed only a constitution of delegation, contrary to many modern classical liberals or libertarians who consider the choice between consent-based democratic or non-democratic governments (e.g., private cities or shareholder states) to be a pragmatic one. But Buchanan seems to not even realize that his at-most-delegation dictum would also rule out the employer-employee or human rental contract which is a contract of alienation “within the scope of the employment.”. (shrink)

Responding to several leading ideas from a paper by Allen Buchanan, the present essay explores the implications of genetic enhancement for moral status. Contrary to doubts expressed by Buchanan, I argue that genetic enhancement could lead to the existence of beings so superior to contemporary human beings that we might aptly describe them as post-persons. If such post-persons emerged, how should we understand their moral status in relation to ours? The answer depends in part on which of two (...) general models of moral status—one based on respect and one based on interests—is more adequate. Buchanan tentatively argues that a respect-based model is preferable. I challenge Buchanan's view, along these lines: If we embrace a respect-based model of moral status featuring a threshold that divides persons, who are thought to have full and equal moral status, from sentient nonpersons, thought to have less moral status, then we should acknowledge a second threshold and a level of moral status higher than ours. A better option, I tentatively suggest, is to drop the idea of levels of moral status, accept that all sentient beings have moral status, and allow that some differences in interests and capacities justify some significant differences in how we should treat beings of different kinds. (shrink)

James Buchanan often argued that fairness is an obligation toward our equals. If Adam Smith is our equal, then we are under obligation to try to understand him. We see this in Buchanan’s attempts to reformat political economy on the basis of natural equals, a world in which Smith’s street porter does indeed have the same capacity as the philosopher. This shows in Buchanan’s excitement over increasing returns models as well as John Rawls’ Theory of Justice both (...) of which he saw a way to make this view operational. (shrink)

Some types of solar radiation management (SRM) research are ethically problematic because they expose persons, animals, and ecosystems to significant risks. In our earlier work, we argued for ethical norms for SRM research based on norms for biomedical research. Biomedical researchers may not conduct research on persons without their consent, but universal consent is impractical for SRM research. We argue that instead of requiring universal consent, ethical norms for SRM research require only political legitimacy in decision-making about global SRM trials. (...) Using Allen Buchanan & Robert Keohane's model of global political legitimacy, we examine several existing global institutions as possible analogues for a politically legitimate SRM decision-making body. (shrink)

Current discussion of the normative issues surrounding secession is both helped and hindered by the existence of but one philosophic treatment of these issues sufficiently systematic and comprehensive to qualify as a theory of secession - Allen Buchanan’s. He provides the unique focal point, and so simplifies the task of those who seek to begin from the present state of the art. But in providing the unique focal point, Buchanan complicates the task of those who view, or think (...) they view, secession rather differently than he does. He defends ’a moral right to secede’ but a very qualified right, focusing on state-perpetrated injustice, the preservation of group culture and, in extreme cases, the literal survival of group members. And Buchanan further insists that where preservation of group culture is at stake, ’Neither the state nor any third party has a valid claim to the seceding territory’ -or such a claim is waived so that ’secession in order to preserve a culture is permissible if both parties consent to it’- a condition that he thinks may come to apply to the situation of Quebec. (shrink)

During the later 16th and 17th centuries, Scotland's elite, divided by the Reformation and afflicted by political upheaval, found consolation, and sometimes inspiration, in the teachings of ancient philosophy. The neo-Stoicism with which they especially engaged was a versatile and cosmopolitan body of thought which had developed in response to chronic instability across Europe. Influenced by its ideas about public and private life, which were discussed in poetry and drama as well as in letters, meditations and extended scholarly treatises, they (...) learned how to follow Stoic example - to prepare themselves for political duties, to confront the turbulence of their own world, and even to cultivate a justifiable retirement in the face of its irrational and uncontrollable furies. Examining figures as diverse as Buchanan, Drummond of Hawthornden, Hume of Godscroft, Gordon of Gordonstoun, the Marquis of Montrose, Alexander Ross, Robert Leighton and Sir George Mackenzie, this study traces the attempt made to educate Scots to transpose Roman morality onto early-modern society, providig at the same time an insight into the mental outlook and cultural horizons of the later Stuart elite. (shrink)

There is a fault line running through classical liberalism as to whether or not democratic self-governance is a necessary part of a liberal social order. The democratic and non-democratic strains of classical liberalism are both present today—particularly in America. Many contemporary libertarians and neo-Austrian economists represent the non-democratic strain in their promotion of non-democratic sovereign city-states (startup cities or charter cities). We will take the late James M. Buchanan as a representative of the democratic strain of classical liberalism. Since (...) the fundamental norm of classical liberalism is consent, we must start with the intellectual history of the voluntary slavery contract, the coverture marriage contract, and the voluntary non-democratic constitution (or pactum subjectionis). Next we recover the theory of inalienable rights that descends from the Reformation doctrine of the inalienability of conscience through the Enlightenment (e.g., Spinoza and Hutcheson) in the abolitionist and democratic movements. Consent-based governments divide into those based on the subjects' alienation of power to a sovereign and those based on the citizens' delegation of power to representatives. Inalienable rights theory rules out that alienation in favor of delegation, so the citizens remain the ultimate principals and the form of government is democratic. Thus the argument concludes in agreement with Buchanan that the classical liberal endorsement of sovereign individuals acting in the marketplace generalizes to the joint action of individuals as the principals in their own organizations. (shrink)

Explores how Deleuze's philosophy can help us to understand our digital and biotechnological futuresIn a world where our lives are increasingly mediated by technologies, we need to pay more attention to Deleuze's often explicit focus onour reliance on the machine and the technological. These essays are a collective and determined effort to explore the usefulness Deleuze in thinking about our present and future relianceon technology. At the same time, they take seriously a style of thinking that negotiates between philosophy, science (...) and art.ContributorsWilliam Bogard, Abigail Bray, Ian Buchanan, Verena Conley, Ian Cook, Tauel Harper, Timothy Murray, Saul Newman, Luciana Parisi, Patricia Pisters, Mark Poster, Horst Ruthrof, David Savat, Bent Meier Sorensen and Eugene Thacker.". (shrink)

Samuel Scheffler says, “none of the most prominent contemporary versions of philosophical liberalism assigns a significant role to desert at the level of fundamental principle.” To the extent that this is true, the most prominent contemporary versions of philosophical liberalism are mistaken. In particular, there is an aspect of what we do to make ourselves deserving that, although it has not been discussed in the literature, plays a central role in everyday moral life, and for good reason. As with desert, (...) reciprocity inspires skepticism. What Allen Buchanan calls justice as reciprocity implies that duties of justice obtain only among those who can do each other favors. So characterized, justice as reciprocity is at best only a part of justice – a part that is silent on duties between people who have no favors to offer each other. Still, the more modest root idea of reciprocity – the idea that returning favors is at very least a good thing – remains compelling. What can we say on behalf of this root idea? This article is part of a larger work on the elements of justice. Both parts of it begin with and build on James Rachels’ seminal paper “What People Deserve.”. (shrink)

In this paper, I analyze the ethical implications of genetic enhancement within the specific framework of the “child’s right to an open future” argument (CROF). Whilst there is a broad ethical consensus that genetic modifications for eradicating diseases or disabilities are in line with – or do not violate – CROF, there is huge disagreement about how to ethically understand genetic enhancement. Here, I analyze this disagreement and I provide a revised formulation of the argument in the specific field of (...) genetic enhancement. First, I argue that CROF is not in contrast with every kind of enhancement. I subsequently discuss whether CROF requires some moral obligations to enhance progeny. My argument is that parents do not have the moral obligation to open as many options as possible for their children. Rather, they should provide them with a reasonable range of opportunities. Finally, I contend that the moral obligations required by CROF are directly dependent on what Allen Buchanan calls the ‘dominant cooperative framework’ in a given society. I conclude by claiming that, at present, parents are not morally obliged to genetically enhance their children since a non-enhanced person already might have access to a reasonable range of opportunities. However, the moral obligation to enhance progeny might arise if a structural modification of the dominant cooperative framework occurs. (shrink)

In order responsibly to decide whether there ought to be an international legal right of secession, I believe we need an account of the morality of secession. I propose that territorial and political societies have a moral right to secede, and on that basis I propose a regime designed to give such groups an international legal right to secede. This regime would create a procedure that could be followed by groups desiring to secede or by states desiring to resolve the (...) issue of secession. It would give territorial political societies a legally recognized liberty to conduct a plebiscite on secession, and, assuming such a plebiscite is won by the secessionist side, a qualified right in international law to create a state without interference. Alan Buchanan has argued that proposals of this sort would create perverse incentives. I argue that there is no good reason to believe this. The point is to allow the legal regulation of secession in cases where there are active secessionist movements with legitimate moral claims, and to attempt to dampen the desire for secession in cases where secessionist sentiment is not well grounded in social and geographic reality. (shrink)

Classical liberalism is skeptical about governmental organizations "doing good" for people. Instead governments should create the conditions so that people individually (Adam Smith) and in associations (Tocqueville) are empowered to do good for themselves. The market implications of classical liberalism are well-known, but the implications for organizations are controversial. We will take James Buchanan as our guide (with assists from Mill and Dewey). Unpacking the implications of classical liberalism for the "science of associations" (Tocqueville) requires a tour through the (...) intellectual history of the voluntary slavery contract and the voluntary non-democratic constitution. The argument concludes that the classical liberal endorsement of sovereign individuals acting in the marketplace generalizes to the joint action of individuals as the principals in their own organizations and associations. (shrink)

In a recent paper Allen Buchanan makes a basic distinction between two types of ethical problems which arise in business: “genuine ethical dilemmas, in which the problem is to discover what one ought to do, when two or more valid ethical duties (or values orprinciples) conflict, and compliance problems, which occur when one knows what one’s moral obligations are, but experiences difficulty in fulfilling them due to pressures of self-interest or loyalty to group or organization.” Buchanan argues that (...) most business ethicists believe that this simple dichotomy is exhaustive. He claims it is not and argues that there is a third area of concern that involves perfecting imperfect duties, or coming to “have definite ethical duties, where before there were at best vague ethical goals.” However, I wish to argue that there is a further area of concern in business ethics and this area does not involve deciding between competing moral principles, values etc, attempting to comply with known principles, or imparting determinate content to vague, non-specific imperfect principles of obligation (the subject of Buchanan’s recent paper). This sort of problem occurs frequently in the third world in circumstances in which the agent entirely fails to recognize the normative structure that underpins the considered options. (shrink)

In a recent paper Allen Buchanan makes a basic distinction between two types of ethical problems which arise in business: “genuine ethical dilemmas, in which the problem is to discover what one ought to do, when two or more valid ethical duties (or values orprinciples) conflict, and compliance problems, which occur when one knows what one’s moral obligations are, but experiences difficulty in fulfilling them due to pressures of self-interest or loyalty to group or organization.” Buchanan argues that (...) most business ethicists believe that this simple dichotomy is exhaustive. He claims it is not and argues that there is a third area of concern that involves perfecting imperfect duties, or coming to “have definite ethical duties, where before there were at best vague ethical goals.” However, I wish to argue that there is a further area of concern in business ethics and this area does not involve deciding between competing moral principles, values etc, attempting to comply with known principles, or imparting determinate content to vague, non-specific imperfect principles of obligation (the subject of Buchanan’s recent paper). This sort of problem occurs frequently in the third world in circumstances in which the agent entirely fails to recognize the normative structure that underpins the considered options. (shrink)

A letter to the editor from Howard Brody, David Buchanan, and Franklin G. Miller in response to the recent article by Erik Malmqvist Understanding Exploitation," March-April 2011).

It is widely held that the proper role of criminal punishment is to ensure in a cost-efficient manner that criminal laws will be obeyed. As James Buchanan puts it,the reason we have courts is not that we want people to be convicted of crimes but that we want people not to commit them. The whole procedure of the law is one, essentially, of threatening people with unpleasant consequences if they do things which are regarded as objectionable.According to the deterrence (...) theory of punishment, which I will here accept without argument in order to tease out some of its implications, legislators must be aware of opportunities to maximize the threat value of criminal prohibitions. By maximizing deterrence, we minimize the cost of crime. On the other hand, creating these threats, and carrying them out, is also costly. So we also wish to minimize the cost of avoiding crime. An efficient deterrent, therefore, will be one which minimizes the sum of the costs of crime and crime avoidance, where ‘cost’ is to be broadly construed. (shrink)

This is Volume 9 of Oxford Studies in Political Philosophy. It contains papers on democracy, the law, political liberalism, voting, social experimentation, state neutrality, equality and incentives, self-ownership, drugs and prostitution, and Lincoln. Chapters include: “Challenging Democratic Commitments: On Liberal Arguments for Instrumentalism About Democracy” (Daniel Viehoff); “Emotional Abuse and the Law” (Elizabeth Brake); “Practical Political Liberalism” (Caleb Perl); “Beyond the Voting Debate” (Brookes Brown); “Social Experimentation in an Unjust World” (Jacob Barrett and Allen Buchanan); “State Neutrality and the (...) Dismantling of the Gendered Division of Labour” (Anca Gheaus); “If It’s Not Your Talent, How Come You’re Getting an Incentive?” (Peter Dietsch); “(Owning) our Bodies, (Owning) our Selves?” (Sean Aas); “Self-Sovereignty, Drugs, and Prostitution” (Peter de Marneffe); “Lincoln as Political Philosopher” (William A. Edmundson). (shrink)

As Allen Buchanan and Russell Powell have observed, de-moralization—the retreat of normative regulation from specific areas of human life—represents an under-theorized component of the study of moral change. However, Buchanan and Powell, like Philip Kitcher, focus exclusively on instances of de-moralization that they regard as morally progressive. Indeed, the existing literature on moral change is almost silent on the matter of moral regression, and doubly so on the matter of regressive de-moralization. This paper attempts to define and defend (...) a particular, contractualist account of regressive de-moralization as both historically well-documented and a matter of contemporary concern. (shrink)

In today’s America the persistence of crushing poverty in the midst of staggering affluence no longer incites the righteous jeremiads it once did. Resigned acceptance of this paradox is fueled by a sense that poverty lies beyond the moral and technical scope of government remediation. The failure of experts to reach agreement on the causes of poverty merely exacerbates our despair. Are the causes internal to the poor – reflecting their more or less voluntary choices? Or do they emanate from (...) structures beyond their control? If both of these explanations are true, poverty experts will need to shift their focus to a hitherto under-theorized concept: coercion. I defend this claim by appealing to distinct areas of philosophical inquiry: social epistemology and moral theory. Poverty knowledge is directly related to both of these inquiries. The aim of poverty knowledge is clearly moral: to reduce suffering and to empower the weak. While the former aim is grounded in utilitarian thinking, the latter aim is grounded in the social contractarian insight that poverty is unjustly coercive, imposing excessive limits on the opportunities and choices of the poor that render them vulnerable to domination by others. Equally obvious is the social nature of poverty knowledge. All knowledge depends on the reliable testimony of others. Poverty knowledge not only ostensibly offers us the most reliable, scientific beliefs about the causes and effects of poverty, thereby determining how we morally judge the poor and their poverty, but it reciprocally bases its understanding of poverty on what the poor themselves have to say about it. What unites both social epistemology and moral theory – at least the social contract variants I will be examining here – is concern about the limits and possibilities of rational choice. As poverty knowledge came of age in the fifties and sixties, it absorbed the language of rational choice prevalent in economics, especially the Keynesian economics whose moral underpinnings can be found in Rawlsian social contract theory. Echoing a different economic theory supported by a different, more libertarian, brand of social contract theory, poverty expertise in the eighties continued to use an abstract model of rational choice. I submit that, in both early and later epochs of poverty expertise, reliance on rational choice reasoning prevented poverty experts from appreciating the coercive impact of poverty on the poor. Social epistemology explains this failure by demonstrating the poverty of rational choice thinking and its mistaken reliance on inflated commonsense expectations about the capacity of individuals to calculate their long-term interests, free from the distortions of social bias. Social epistemology not only exhibits the dangers of not relying on expert testimony, but it also exhibits the dangers of relying on an unreliable source of expert testimony that has removed itself from its human subject matter. In order for poverty experts to become more reliable educators about poverty’s coercive impact on the poor they must return to their discipline’s social epistemological roots. Only a more descriptive and explanatory sociology can narrate a comprehensive story about how the lived experience of poverty relates to the larger social system. The social contractarian model best suited to underwriting this kind of poverty knowledge, I submit, is the discourse theoretic model that has been championed by Jürgen Habermas. When applied as a pedagogical method of dialog and not as a social contractarian model of rational normative consent, discourse theory highlights the unique epistemological advantages of empathetic understanding that are so essential to dispelling stereotypes about the poor. Dispelling these stereotypes is the first step toward respecting the poor as free agents who are nonetheless forced to make suboptimal choices. My defense of these claims proceeds as follows: Part One argues that poverty expertise rightly deserves the opprobrium critics have heaped on it. The charge – leveled by progressives and conservatives alike - that such expertise is ideological is true to the extent that poverty knowledge has all-too-easily accommodated the political aims of the agency that has funded it: the federal government. The shift from the war on poverty to the war on the poor – and the resulting shift from blaming poverty on economic structures to blaming it on the culture of poverty – would not have been possible without an increased emphasis on data gathering aimed at measuring poverty rather than describing it. Part Two assesses the consequences of turning away from qualitative research to statistical analysis: the coercive nature of poverty becomes invisible beneath the surface of aggregate individual choices. The failure to grasp how voluntary choices, ostensibly based on rational, self-interested calculations, can be coerced by social structures - and thereby lead to sub-optimizing behavior – invites the conclusion that the poor have only themselves to blame for their misery. Part Three suggests that this pathologization of the poor directly controverts the major aim of poverty research: to empower the poor as free and equal parties to the social contract. I argue that the different varieties of social contract theory that have justified poverty expertise over the last forty years – the welfarist model pioneered by Rawls and the market-based model defended by Nozick – embrace the same rational choice models favored by poverty experts and so conspire with the latter in neglecting important dimensions of poverty-related coercion. While the welfarist model conceals the coercive nature of bureaucratically administered entitlement programs and top-down urban renewal policies, the market-based model conceals the coercive nature of economic class structures. The discourse-theoretic alternative proposed by Habermas endorses a populist, democratic response to the overly abstract rational choice assumptions embedded in these other models. Despite this advance over its counterparts, the chief advantage of discourse theory for poverty knowledge, I submit, resides less in its proposed procedure of rational collective choice than in its heuristic as a dialogical method of social learning. I demonstrate this claim in Part Four, where I turn to the social epistemological insights of Allen Buchanan. Social epistemology offers a much needed corrective to theories of knowledge that rely on the reasoning capacities of isolated individuals. By stressing the connection between moral response and social belief, on one hand, and the dependence of social belief on epistemic authorities, on the other, social epistemologists suggest ways in which we can learn to distinguish reliable from unreliable authorities and become aware of our own error-prone cognitive proclivities. Their insights need to be supplemented by moral epistemologists who stress the affective dimension of knowledge, above all, the role that empathy plays in understanding the plight of others. Drawing from victim narratives, Diana Meyers shows that switching between first-person experiences of one's own and third-person reconstructions of others' experiences is essential to appreciating the gravity of human rights violations and the seriousness of human rights claims. It goes without saying that such empathy is just as essential to understanding the plight of the poor. Meyers mainly has in mind empathetic understanding that has been facilitated by third-person observation and literary encounter, but the importance of visceral and corporeal representation suggests that face-to-face dialog may sometimes be a more effective way to facilitate empathetic understanding. (shrink)

Three prominent economists born early in the twentieth century—James Buchanan, Jack Hirshleifer, and Simon Rottenberg—switched from a belief in socialism in their twenties or thirties to strong support for free markets. Interviews show that for all three, and especially for Buchanan and Rottenberg, what changed them is what they learned in their economics classes. For Hirshleifer, another major influence was the pact between Hitler and Stalin, which caused him to be more skeptical about leftist ideas and made him (...) more open to intellectual criticisms of socialism. (shrink)

The Virginia School's economics of natural equals makes consent critical for policy. Democracy is understood as government by discussion, not majority rule. The claim of efficiency unsupported by consent, as common in orthodox economics, appeals to social hierarchy. Politics becomes an act of exchange among equals where the economist is only entitled to offer advice to citizens, not to dictators. The foundation of natural equality and consent explains the common themes of James Buchanan and John Rawls as well as (...) Ronald Coase and the Fabian socialists. What orthodox economics treats as efficient racial discrimination violates the fair chance entitlement to which people consent in a market economy. The importance of replication stressed by Gordon Tullock, developing themes from Karl Popper, is another expression of natural equality since the foresight of replication induces care into research. The publication of previously unpublished correspondence and documentation allows the reader to judge recent controversy. (shrink)

In this paper, I discuss an example from Buchanan of active voluntary euthanasia (AVE). I first refute objections to the intuitive permissibility of the killing described in the example. After explaining why the killing is intentional, I evaluate Buchanan's solution to the ‘problem of intending death’. According to Buchanan, what justifies a physician in intentionally bringing about a patient's death by AVE is a principle that embodies the values of patient self-determination and well-being. I argue that these (...) two considerations are not sufficient for justifying AVE. The motive of the physician matters, but it is his desire rather than his intention that is relevant. An ethical physician may bring about intentionally the death of his patient if in forming his intention, he began with an appropriate desire to keep the patient alive as well as a legitimate desire to prevent prolonged suffering, with the latter outweighing the former. The ethical physician also desires to respect the choice of his patient wherever possible. On my account, the physician should be guided by the virtues and goals of his profession rather than by strict ‘all-or-nothing’ principles. I defend my account by describing the advantages of my account, and dismissing possible objections. (shrink)

Allen Buchanan and Daniel Brock, in a widely influential account, Deciding for Others (1990), advocate a sliding scale approach to the determination of whether a patient is competent to make a decision regarding his/her health care. An analysis of two critiques of their position (Beauchamp and Childress (1994), Wicclair (1991 a,b)) reveals a tacit presumption by all of these authors that the greater cognitive challenge often posed by high risk therapies constitutes grounds for an elevated standard of competence. This (...) presumption cannot be consistently maintained in cases where the patient's decision involves experimental therapies. It implies either that informed consent can never take place in such situations, or, perhaps even more counter-intuitively, that a lower standard of competency should be used than when the patient is asked to choose only among standard therapies. (shrink)