Screening for unsuspected disease has both possible benefits and harms for those who participate. Historically the benefits of participation have been emphasized to maximize uptake reflecting a public health approach to policy; currently policy is moving towards an informed choice approach involving giving information about both benefits and harms of participation. However, no research has been conducted to evaluate the impact on health of an informed choice policy. Using psychological models, the first aim of this study was to describe an (...) explanatory framework for variation in screening uptake and to apply this framework to assess the impact of informed choices in screening. The second aim was to evaluate ethically that impact. Data from a general population survey of beliefs and attitudes towards participation in diabetes screening indicated that greater orientation to the present is associated with greater social deprivation and lower expectation of participation in screening. The results inform an explanatory framework of social patterning of screening in which greater orientation to the present focuses attention on the disadvantages of screening, which tend to be immediate, thereby reducing participation. This framework suggests that an informed choice policy, by increasing the salience of possible harms of screening, might reduce uptake of screening more in those who are more deprived and orientated to the present. This possibility gives rise to an apparent dilemma where an ethical decision must be made between greater choice and avoiding health inequality. Philosophical perspectives on choice and inequality are used to point to some of the complexities in assessing whether there really is such a dilemma and if so how it should be resolved. The paper concludes with a discussion of the ethics of paternalism. (shrink)

We have found that a sparse version of the claim that alienated labor is a bad thing can inform a political morality without turning that morality into one which makes more comment on people's ends than the liberal can accept. We have also seen that a modification of the ideas of alienation from our species being can play a limited role in a liberal political morality, but that the rational kernel of the critique from species alienation is already a familiar (...) part of the liberal tradition. However, the substantive view of the good life - as one which essentially involves engagement in communal ties and satisfying labor - cannot play the role which certainly many Marxists would like it to play in their critique of capitalism, at least if their critique is to be recognizably liberal. Why should it matter so much that Marxists be able to accommodate central liberal insights? It is not because a political morality has to be liberal in order to be successful in the real world: history and the contemporary world are full of examples of political views which command wide assent despite (or because of) their illiberality. But the foreseeable stages of a socialist society will be plagued by the circumstances of justice as they have been classically conceived. A socialism which is sufficiently better than capitalism to be worth the significant risk and sacrifice it is likely to require must be liberal in the sense that it can be regarded as defensible to each person who is actually subject to it. This does not require that it accommodate the greed of the greedy or the injustice of the unjust. But it does require that it not presume the unworthiness of the moral commitments of its reasonable citizens. 47. (shrink)

In this paper the nature and the role of Rawls's idea of a “free public reason” are examined with an emphasis on the divide between the private and the public spheres, a divide which is the hallmark of a liberal democracy. Criticisms from both the so-called Continental tradition and the Communitarian opponents to liberalism insist on the ineffectiveness of such a conception, on its inability to establish a political consensus on democracy. But it would be a mistake to see a (...) contractarian theory of justice, such as Rawls's justice as fairness, as grounding the social contract in a public use of reason. Such a contract would indeed be susceptible to endless conflicts and renegotiations and would never achieve consensus. Therefore, a distinction must be made between the values of justice that are present in and through the “original” contractual position and the that regulate the public sphere and guarantee its stability. (shrink)

In their recently published book Nudge (2008) Richard H. Thaler and Cass R. Sunstein (T&S) defend a position labelled as ‘libertarian paternalism’. Their thinking appeals to both the right and the left of the political spectrum, as evidenced by the bedfellows they keep on either side of the Atlantic. In the US, they have advised Barack Obama, while, in the UK, they were welcomed with open arms by the David Cameron's camp (Chakrabortty 2008). I will consider the following questions. What (...) is Nudge? How is it different from social advertisement? Does Nudge induce genuine preference change? Does Nudge build moral character? Is there a moral difference between the use of Nudge as opposed to subliminal images to reach policy objectives? And what are the moral constraints on Nudge? (shrink)

Changing preferencesis a phenomenonoften invoked but rarely properlyaccounted for. Throughout the history of the social sciences, researchers have come against the possibility that their subjects’ preferenceswere affected by the phenomenato be explainedor by otherfactorsnot taken into accountin the explanation.Sporadically, attempts have been made to systematically investigate these in uences, but none of these seems to have had a lasting impact. Today we are still not much further with respect to preference change than we were at the middle of the last (...) century. This anthology hopes to provide a new impulse for research into this important subject. In particular, we have chosen two routes to amplify this impulse. First, we stress the use of modellingtechniquesfamiliar from economicsand decision theory. Instead of constructing complex, all-encompassing theories of preference change, the authors of this volume start with very simple, formal accounts of some possible and hopefully plausible mechanism of preference change. Eventually, these models may nd their way into larger, empirically adequate theories, but at this stage, we think that the most importantwork lies in building structure.Secondly,we stress the importance of interdisciplinary exchange. Only by drawing together experts from different elds can the complex empirical and theoretical issues in the modelling of preference change be adequately investigated. (shrink)

This article reexamines the rational choice or economic approach to human studies. Its adherents claim that its extension beyond its original domain to all human behavior can finally lead to integration of the human studies, especially social theory, and thus their elevation from what they see as a chaotic state. Specifically, they propose grounding human studies on the premise that humans are rational egoists or self-interested utility maximizers. Although this premise has been the conceptual foundation of orthodox economic theory, it (...) has been questioned, and even in part discredited in its heterodox versions. This reexamination casts serious doubts on such claims. (shrink)

One-third of all human lives end in early death from poverty-related causes. Most of these premature deaths are avoidable through global institutional reforms that would eradicate extreme poverty. Many are also avoidable through global health-system reform that would make medical knowledge freely available as a global public good. The rules should be redesigned so that the development of any new drug is rewarded in proportion to its impact on the global disease burden (not through monopoly rents). This reform would bring (...) drug prices down worldwide close to their marginal cost of production and would powerfully stimulate pharmaceutical research into currently neglected diseases concentrated among the poor. Its feasibility shows that the existing medical-patent regime (trade-related aspects of intellectual property rights—TRIPS—as supplemented by bilateral agreements) is severely unjust—and its imposition a human-rights violation on account of the avoidable mortality and morbidity it foreseeably produces. (shrink)

Which individuals should count in a welfare-consequentialist analysis of public policy? Some answers to this question are parochial, and others are more inclusive. The most inclusive possible answer is ‘everybody to count for one.’ In other words, all individuals who are capable of having welfare – including foreigners, the unborn, and non-human animals – should be weighed equally. This article argues that ‘who should count’ is a question that requires a two-level answer. On the first level, a specification of welfare-consequentialism (...) serves as an ethical ideal, a claim about the attributes that the ideal policy would have. ‘Everybody to count for one’ might succeed on this level. However, on the second level is the welfare-consequentialist analysis procedure used by human analysts to give advice on real policy questions. For epistemic reasons, the analysis procedure should be more parochial than ‘everybody to count for one.’. (shrink)

Cost-benefit analysis is commonly understood to be intimately connected with utilitarianism and incompatible with other moral theories, particularly those that focus on deontological concepts such as rights. We reject this claim and argue that cost-benefit analysis can take moral rights as well as other non-utilitarian moral considerations into account in a systematic manner. We discuss three ways of doing this, and claim that two of them (output filters and input filters) can account for a wide range of rights-based moral theories, (...) including the absolute notions of moral rights proposed by Hayek, Mayo, Nozick, and Shue. We also discuss whether the use of output filters and input filters can be generalized to cover other non-utilitarian theories, such as Kantian duty ethics and virtue ethics. (shrink)

Center for Humans and Nature, 109 West 77th Street, Suite 2, New York, NY 10024, USA. Tel.: 212 362 7170; Fax: 212 362 9592; Email: brucejennings{at}humansandnature.org ' + u + '@' + d + ' '//--> . Abstract A fundamental question for the ethical foundations of public health concerns the moral justification for limiting or overriding individual liberty. What might justify overriding the individual moral claim to non-interference or to self-realization? This paper argues that the libertarian justification for limiting individual (...) liberty known as the ‘harm principle’ or the ‘Millian paradigm’ is inadequate as a basis of public health ethics and policy. But simply pitting some collectivist value or utilitarian criterion over against individual liberty is not theoretically satisfactory, either. John Stuart Mill himself was not a Millian, in this sense, and his utilitarianism does not pit itself against individual liberty as a situation of balancing conflicting values. A reconsideration of Mill, particularly in light of the later work of Berlin on liberty, points toward a conception of relational liberty that is crucial for public health ethics because it contains within itself the basis for its own moral limitation. CiteULike Connotea Del.icio.us What's this? (shrink)

In this paper, we review two seemingly unrelated debates. In business ethics, the argument is about values: are they universal or emergent? In entrepreneurship, it is about opportunities – are they discovered or constructed? In reality, these debates are similar as they both overlook contingency. We draw insight from pragmatism to define contingency as possibility without necessity. We analyze real-life narratives and show how entrepreneurship and ethics emerge from our discussion as parallel streams of thought.

Behaviour norms are considered for decision trees which allow both objective probabilities and uncertain states of the world with unknown probabilities. Terminal nodes have consequences in a given domain. Behaviour is required to be consistent in subtrees. Consequentialist behaviour, by definition, reveals a consequence choice function independent of the structure of the decision tree. It implies that behaviour reveals a revealed preference ordering satisfying both the independence axiom and a novel form of sure-thing principle. Continuous consequentialist behaviour must be expected (...) utility maximizing. Other plausible assumptions then imply additive utilities, subjective probabilities, and Bayes' rule. (shrink)

This essay explores the two main objectives of Bishop’s book, which he analyzes in the context of the care for the dying: the medical metaphysics underlying medical science and biopolitics as governance of the human body. This essay discusses Bishop’s claims in view of newer developments in medicine, especially the turn to the construction of life, and confronts the concept of the patient’s sovereignty with an alternative model of vulnerable agency. In order to overcome the impasses of contemporary bioethics, the (...) essay argues that practical reason requires a two-fold ethics: first, it must develop a new hermeneutics of illness and disease, and second, in order to protect the individuals in the process of dying, moral claims concerning death must be based on the concept of human rights. (shrink)

This paper critically reviews Ken Binmore’s non- utilitarian and game theoretic solution to the Arrow problem. Binmore’s solution belongs to the same family as Rawls’ maximin criterion and requires the use of Nash bargaining theory, empathetic preferences, and results in evolutionary game theory. Harsanyi has earlier presented a solution that relies on utilitarianism, which requires some exogenous valuation criterion and is therefore incompatible with liberalism. Binmore’s rigorous demonstration of the maximin principle for the first time presents a real alternative to (...) a utilitarian solution. (shrink)

Over the last two decades, the capabilities approach has become an increasingly influential theory of development. It conceptualises human wellbeing in terms of an individual's ability to achieve functionings we have reason to value. In contrast, the African ethic of ubuntu views human flourishing as the propensity to pursue relations of fellowship with others, such that relationships have fundamental value. These two theoretical perspectives seem to be in tension with each other; while the capabilities approach focuses on individuals as the (...) locus of ethical value, an ubuntu ethic concentrates on the relations between individuals. In this article, we ask: to what extent is the capabilities approach compatible with this African ethical theory? We argue that, on reflection, relations play a much stronger role in the capabilities approach than often assumed. There is good reason to believe that relationality is part of the concept of a capability itself, where such relationality has intrinsic ethical value. This understanding of the ethical centrality of relations grounds new normative perspectives on the capabilities approach, and offers a more comprehensive grasp of the relevance of relationships to empirical enquiry. (shrink)

In this paper I would like to make a contribution to the debate on rights-talk and duties-talk relationship and priority by addressing the problem from a peculiar angle: that of moral conflicts and dilemma. My working hypothesis is that it should be possible to identify some basic and relevant normative features of rights-talk and duties-talk by observing how they modify the description of moral conflicts. I will try to show that both rights and duties posses original and irreducible normative features, (...) and that these latter can be employed in a general assessment of their pro and con. I will first show the conceptual relationship between rights and duties, analyzing in the process a deflationary argument for rights. Second, I will define the general features of moral conflict and dilemma. I will then analyze the different readings that can be given, taking rights or duties as standpoints, of two kinds of moral conflicts: «asymmetric» and «symmetric» conflicts. (shrink)