This book addresses a range of relevant theoretical issues, including the possibility of an interpersonally comparable measure of well-being, or “utility” metric; the moral value of equality, and how that bears on the form of the social welfare function; social choice under uncertainty; and the possibility of integrating considerations of individual choice and responsibility into the social-welfare-function framework. This book also deals with issues of implementation, and explores how survey data and other sources of evidence might be used to calibrate (...) both a utility metric and a social welfare function, and whether distributive goals are ever best pursued through regulation rather than the tax system. In working through this range of theoretical and practical issues, the book draws from a wide variety of literatures, including philosophical scholarship on equality, responsibility, the nature of well-being, and personal identity over time; the social choice literature within economics; applied economic literatures concerning the measurement of inequality and poverty; legal and policy-analysis scholarship on cost-benefit analysis, environmental justice, and the choice between regulation and taxation; and the burgeoning field of “happiness studies”. (shrink)

This research proposes a modified metaheuristic optimization algorithm, named as improved stochastic fractal search, which is formed based on the integration of the quasiopposition-based learning and chaotic local search schemes into the original SFS algorithm for solving the optimal capacitor placement in radial distribution networks. The test problem involves the determination of the optimal number, location, and size of fixed and switched capacitors at different loading conditions so that the network total yearly cost is minimized with simultaneous fulfillment (...) of operating constraints. Also, the hourly on/off scheduling plans of switched shunt capacitors considering a modified cost objective function are obtained. The proposed ISFS algorithm has been tested on two IEEE 69-bus and 119-bus RDNs and a practical 152-bus RDN. For clarifying the effectiveness and validation of the ISFS, the simulated results have been compared with those of other previously utilized solution approaches in the literature as well as the original SFS. From result comparison, the proposed ISFS outperforms other previous approaches regarding solution quality and statistical performance for the compared cases, especially in the complex and large-scale networks. Notably, compared with the original SFS, the proposed ISFS shows a significantly better performance in all the tested cases. (shrink)

The purpose of this paper is to describe the nature of dental practice and to identify some recent innovations which have effect on cost containment in dentistry. The first of these innovations is dental insurance or prepaid dental services. Dental insurance has only recently emerged as a significant economic factor. The chronic and prevalent nature of dental disease mandates that the management of these programs incorporate insurance devices which limit demand and utilization. These devices amount to cost containment (...) measures. The second factor to be discussed is advertising. Advertising has been foisted on the dental profession by recent rulings of the Federal Trade Commission in an effort to promote competition. The Reagan administration, despite a market oriented approach to health care, had attempted to blunt some of the FTC actions. Advertising, nevertheless, has the potential to stimulate competition and restrain price escalation. The third factor includes a discussion of alternative delivery systems. These commercially oriented dental enterprises have the potential to compete with established practices as well as increase the demand for services. (shrink)

Individuals often face administrative hurdles in attempting to access health care, public programmes, and other legal statuses and entitlements. These ordeals are the products, directly or indirectly, of institutional and policy design choices. I argue that evaluating whether such ordeals are justifiable or desirable instruments of social policy depends on assessing, beyond their targeting effects, the process-related burdens they impose on those attempting to navigate them and these burdens’ distributive effects. I here examine specifically how ordeals that levy time costs (...) reduce and constrain individuals’ free time, and how such time-cost ordeals may thereby create, deepen and compound disadvantages. (shrink)

Originally published in 1950, this book is one of a series of studies regarding the structure of the British economy which were produced by the National Institute of Economic and Social Research after the Second World War. It was produced in collaboration with a group of leading businessmen, all of whom were concerned in one way or another with the distribution of consumer goods and dissatisfied with the existing state of knowledge about distribution. The study represented a substantial (...) advance in the knowledge of distribution and an important contribution to structural economics. It will remain of value to anyone with an interest in the development of the British economy. (shrink)

Two answers to the question ‘how can we allocate health care resources fairly?’ are introduced and discussed. Both utilitarian and egalitarian approaches are found relevant, but both exhibit considerable theoretical and practical difficulties. Neither seems capable of solving the problem on its own. It is suggested that, for practical purposes, a version of Rawls' famous thought experiment might provide at least some enlightenment about which theoretical approach should be used to address the question.

While there is an extensive literature on how the precautionary principle should be interpreted and when precautions should be taken, relatively little discussion exists about the fair distribution of costs of taking precautions. We address this issue by proposing a general framework for deciding how costs of precautions should be shared, which consists of a series of default principles that are triggered according to desert, rights, and ability to pay. The framework is developed with close attention to the pragmatics (...) of how distributions will affect actual behaviours. It is intended to help decision-makers think more systematically about distributional consequences of taking precautionary measures, thereby to improve decision-making. Two case studies—one about a ban on turtle fishing in Costa Rica, and one about a deep-sea mining project in Papua New Guinea—are given to show how the framework can be applied. (shrink)

Usually a relational approach, such as one appealing to care or love, is contrasted with an account of justice. In this chapter, however, I argue that distributive justice is well conceived as itself a matter of honouring people in virtue of their capacity to love and to be loved. After spelling out a familiar conception of love, I explain how treating people with respect in light of this capacity provides a plausible basis for human rights, one that rivals influential individualist (...) foundations such as Kantian respect for autonomy and Catholic honor of human life. I also articulate an egalitarian conception of how to allocate wealth that I argue is also a function of treating people's ability to love as special and that can compete against views salient in Anglo-American political philosophy such as cost-benefit analysis and John Rawls’ difference principle. (shrink)

Book Reviews Daniel M. Hausman, Economics and Philosophy, FirstView Article.

Book Reviews Daniel M. Hausman, Economics and Philosophy, FirstView Article.

With the human genome mapped, and with the mapping of more than one hundred animal genomes in progress, the amount of genetic data available is increasing exponentially. This exponential increase in data is having an immediate impact on the process of drug development. By using techniques of information technology to manipulate data regarding the genes, proteins, and biochemical pathways associated with various diseases, scientists are beginning to be able to design drugs in a systematic fashion. In the context of any (...) given disease, scientists look to see whether a gene, a protein for which the gene codes, or another protein in the relevant biochemical pathway could be the “target” biological molecule, the “knocking out” of which would halt or slow the disease's progression. Once a target molecule has been identified and characterized structurally, drug therapies that would be likely to knock out this target can be identified and tested systematically. The merger of information technology and genetic technology has changed the process of pharmaceutical development so much that a new term—bioinformatics—has been coined to describe this new approach to such development. (shrink)

Cost-benefit analysis is a widely used governmental evaluation tool, though academics remain skeptical. This volume gathers prominent contributors from law, economics, and philosophy for discussion of cost-benefit analysis, specifically its moral foundations, applications and limitations. This new scholarly debate includes not only economists, but also contributors from philosophy, cognitive psychology, legal studies, and public policy who can further illuminate the justification and moral implications of this method and specify alternative measures. These articles originally appeared in the Journal of (...) Legal Studies. Contributors: - Matthew D. Adler - Gary S. Becker - John Broome - Robert H. Frank - Robert W. Hahn - Lewis A. Kornhauser - Martha C. Nussbaum - Eric A. Posner - Richard A. Posner - Henry S. Richardson - Amartya Sen - Cass R. Sunstein - W. Kip Viscusi. (shrink)

This book is a comprehensive account of what it means to try to quantify health in distributing resources for health care. It examines the concept of QALYs which supposedly makes it more accurate to talk about life in terms of both quality and quantity of years lived when referring to health care policy. It offers an elegant new approach to comparing the costs and benefits of medical interventions. Cost-Utility Analysis is a method designed by economists to aid decision makers (...) distribute scarce resources to areas of health care where they will yield the greatest benefits. Erik Nord questions the feasibility of measuring patients' quality of life meaningfully in numerical terms, as CUA presupposes. He presents an alternative approach called cost-value analysis in which representative samples of the general public express preferences between different health-care programs. In this approach, subjects are allowed to include concerns for fairness that go beyond concerns for efficiency of conventional health economics. (shrink)

Many ethical theorists believe that a given distribution of healthcare is morally justified only if (1) it is cost-effective and (2) it does not discriminate against older adults and disabled people. However, if (3) cost-effectiveness involves maximizing the number of quality-adjusted life-years (QALYs) added by a given unit of healthcare resource, or cost, it seems the pursuit of cost-effectiveness will inevitably discriminate against older adults and disabled patients. I show why this trilemma is harder to (...) escape than some theorists think. We cannot avoid it by using age- or disability-weighted QALY scores, for example. I then explain why there is no sense of “discrimination” on which discrimination isbothunjust, and thus something healthcare rationing must avoid,andsomething cost-effective healthcare rationing inevitably involves. I go on to argue that many of the reasons we have for not favoring rationing that maximizes QALYs outside the healthcare context apply in healthcare as well. Thus, claim (1) above is dubious. (shrink)

In this extended book review, I summarize Adler's views and critically analyze his key arguments on the measurement of well-being and the foundations of prioritarianism.

Household debt has been widely discussed among social scientists, policy makers, and activists. Many have questioned the levels of debt households are required to take on, and have made various proposals for assisting households in debt. Yet theorists of distributive justice have left household debt underexamined. This article offers a normative examination of the distributive justice issues presented by proposals to relieve household debt or protect households from overindebtedness. I examine two goals at which debt relief proposals aim: remedying disadvantage (...) and stabilizing expectations. I then examine strategies for relieving existing debts such as debt abolition, forgiveness, bankruptcy, and mitigation, as well as strategies that aim to prevent future indebtedness, such as public provision or financing of costly goods and credit or interest rate regulations. (shrink)

This book is a comprehensive account of what it means to try to quantify health in distributing resources for health care. It examines the concept of QALYs which supposedly makes it more accurate to talk about life in terms of both quality and quantity of years lived when referring to health care policy. It offers an elegant new approach to comparing the costs and benefits of medical interventions. Cost-Utility Analysis is a method designed by economists to aid decision makers (...) distribute scarce resources to areas of health care where they will yield the greatest benefits. Erik Nord questions the feasibility of measuring patients' quality of life meaningfully in numerical terms, as CUA presupposes. He presents an alternative approach called cost-value analysis in which representative samples of the general public express preferences between different health-care programs. In this approach, subjects are allowed to include concerns for fairness that go beyond concerns for efficiency of conventional health economics. (shrink)

Placing our trust wisely is both difficult and important. The challenge of knowing who to trust inheres at least partially in the fact that coinciding interests cannot be taken for granted, and that language, as the principal medium through which would-be interactants make their interests known, doesn’t discriminate between true and feigned proclamations of good intent. Because our patterns of trust partition the world into reliable and unreliable sources, trust is also important: it determines how we distribute our social and (...) epistemic dependencies, which in turn informs much of what we believe and do. The fact that our interactions with the world and each other are increasingly mediated by digital communication technologies affects both these elements of trust: though unabated access to the internet invites us to distribute our dependencies more broadly, the kinds of information environments that we encounter online make misplaced trust a more common occurrence. I argue that a large part of the problem, as well as one possible set of solutions, resides in a deceptively simple dictum: the internet makes talk cheap, and cheap talk can’t be trusted. (shrink)

The compensatory desert argument is an argument that purports to justify inequalities in (some) incomes generated by a free labour market. It holds, first, that the principle of compensation is a principle of desert; second, that a distribution justified by a principle of desert is just; and third, that (some) rewards people reap on a free labour market are compensation for costs they incur. It concludes that therefore, a distribution of (some) rewards generated by a free labour market (...) is just. In this chapter I criticise the first two premises of this argument. I argue that the principle of compensation is not a principle of desert (sections 3 and 4), and that a distribution of deserved compensatory payments may be unjust (sections 5 and 6). Before developing my critique of the compensatory desert argument, I start by illustrating further that argument in the version of it which has been defended by Julian Lamont (section 1), and to dispel two objections that have been moved against the view that compensation is a principle of desert. (shrink)

In order for states to fulfil (many of) their moral obligations, costs must be passed to individuals. This paper asks how these costs should be distributed. I advocate the common-sense answer: the distribution of costs should, insofar as possible, track the reasons behind the state’s duty. This answer faces a number of problems, which I attempt to solve.

Recent years have seen a surge of interest in applying mechanistic thinking to computational accounts of implementation and individuation. One recent extension of this work involves so-called ‘wide’ approaches to computation, the view that computational processes spread out beyond the boundaries of the individual. These ‘mechanistic accounts of wide computation’ maintain that computational processes are wide in virtue of being part of mechanisms that extend beyond the boundary of the individual. This paper aims to further develop the mechanistic account of (...) wide computationalism by responding to two outstanding worries, what are called the parsimony and testability challenges. The first is based on considerations about wide computation’s ontological cost; the second the view’s experimental testability. The argument is that wide mechanistic computationalism can gain the necessary conceptual resources to address the challenges by embracing two further aspects of the mechanistic approach: i) the structural aspect of mechanistic explanation and ii) the notion of constitutive relevance. (shrink)

In order for states to fulfil their moral duties, costs must be passed to individual citizens. This paper asks how these costs should be distributed. I advocate the common-sense answer: the distribution of costs should, insofar as possible, track the reasons behind the state’s duty. This answer faces a number of problems, which I attempt to solve.

The new Hungarian Labour Code allows informal payments to be accepted, subject only to the prior permission of the employer. In Hungary, the area most affected is Health Care, where informal payments to medical staff are common. The article assesses the practice on ethical terms, focusing on organisational justice. It includes an analysis of distributional injustice, that is, of non-equitable payments to professionals, on the distribution of payments depending on the specialisation and status of the doctor, on his or (...) her rights to allocate Health Care resources and/or on how assertive he or she is. We show, by means of a content analysis of internet postings and of interviews with physicians, the feelings and attitudes of both patients and doctors—thus enabling us to trace interactional and procedural injustice and portray the main driving forces of informal payment with causal loops. We use a new approach (a system dynamics computer simulation) to demonstrate how informal payments influence therapy procedures. The example of treating the common skin disease of psoriasis examines the specific behaviour of doctors in their everyday practice and estimates the extent to which the prescription of unnecessary or more expensive therapy increases the costs. With this multi-method approach, we demonstrate that the legislation allowing informal payment represents bad ethics, since it enforces organisational injustice, creates mistrust between physicians and patients, decreases performance and increases the total costs paid both by society and the Health Insurance Fund. Informal payments distort the allocation of resources, enforce discrimination based solely on money, violate the concept of solidarity and limit Human Rights in terms of health. (shrink)

It is evident that the problem of global climate change is closely bound up with questions of distributional justice, both intra- and intergenerational. Questions of justice are raised by two kinds of burdens: reductions in the emission of greenhouse gases, and the financial and knowledge transfers necessary to enable the poorest countries to compensate the harms suffered by the ongoing process. Both burdens involve considerable costs and opportunity costs. On the backdrop of a prioritarian version of utilitarianism, it is argued (...) that the answer should be a split strategy. While reduction of emissions should be based on the polluter-pays principle, obligations of compensation should be based on the criteria of overall economic strength. (shrink)

This article examines how the existence of unpredictability should influence the quest to promote distributive justice in education. First, the article briefly discusses resource allocation in education finance policy and its relationships with existing philosophical theories of distributive justice. It then explains why unpredictability comes into play in education and how this endangers the achievements of distributive justice. It is argued that unpredictability poses a real challenge to enhancing educational justice. Second, the article examines the common policy conception that educational (...) justice can best be promoted by reducing unpredictability through means of increased control. It is maintained that the costs of this solution exceed its benefits. Finally, the article offers alternative routes for dealing with unpredictability in educational resource allocations. It is argued that we have good reasons, both normative and practical, to embrace a new approach for furthering distributive justice in education that takes into account the complexity of the educational system. (shrink)

The concept of 'sustainable development' as used by the Brundtland Commission was meant to separate environmental policy from distributional conflicts. Increases in income sometimes are beneficial for the environment, but higher incomes have meant higher emissions of greenhouse gases, and higher rates of genetic erosion. In the aftermath of the Rio conference of June 1992, this article analyses some unavoidable links between distributional conflicts and environmental policy. Often, environmental movements have tried to keep environmental resources and services outside the market, (...) but there are now attempts to establish property rights on, and to give money values to environmental resources and services, such as agricultural genetic resources and the CO2 absorption facility provided by the oceans and new vegetation. European 'green' proposals to impose an 'eco-tax', and proposals from India to create a world market for CO2 emission permits are considered. The issue raised by the growing Third World agroecology movement, of payment of 'farmers' rights' for in situ agricultural biodiversity is discussed. The article includes a short discussion of the North American free trade agreement between Mexico and the USA, in so far as it involves so-called 'ecological dumping', i.e. trading at values which do not include environmental costs. In the last sections, the article asks how prices in ecologically-extended markets would be formed, how much such prices will depend on distribution, and how much such payments would change distribution of income. Environmental movements of the Poor are faced with the dilemma of keeping environmental resources and services out of the market, or else asking for property rights to be placed on them. (shrink)

Antimicrobial resistance is a major and increasing problem globally. Economics has engaged with this issue increasingly over the last 20 years. Much of this concerns assessments of the cost of various forms of resistance, but it also includes economic analyses of interventions and policies designed to contain resistance. Analysis has, however, thus far largely neglected possible distributional issues associated with such interventions and analysis. The article explores three normative bases for the conduct of economic analysis: welfarism; extra-welfarism focused on (...) health gain; and extra-welfarism focused on capability assessment. It then considers issues intrinsic to antimicrobial resistance in terms of the distributional implications and how these might be handled within economic analyses from each of the normative perspectives, before considering the actual focus of empirical studies on these distributional issues. The article concludes that the different normative starting points for economic analysis will affect how distributional issues are incorporated into analysis, but suggests that all analyses could benefit from greater discussion of these issues. (shrink)

It is commonly thought that when democratic states act wrongly, they should bear the costs of the harm they cause. However, since states are collective agents, their financial burdens pass on to their individual citizens. This fact raises important questions about the proper distribution of the state’s collective responsibility for its unjust policies. This article identifies two opposing models for sharing this collective responsibility in democracies: first, in proportion to citizens’ personal association with the unjust policy; second, by giving (...) each citizen an equal share of the costs. Proportional distribution is compatible with the principle of fairness. And yet, both in the literature and in political praxis we find many supporters for the equal sharing of the costs of unjust policies in democracies. How can equal distribution be defended on normative grounds? This article develops a defense that is grounded in citizens’ associative obligations. I argue that, at least in some democracies, one of the intrinsic values of the civic bond revolves around the joint formation and execution of worthy political goals. This social good generates the political associative obligation to accept an equal distribution of the costs of unjust policies. (shrink)

Definition of the problem: Even after the new German legislation about organ donors and transplantation (“information solution”), the question of criteria for distributing the organs is still not solved. The various alternatives to solve this problem face different social acceptance and economic efficiency.Arguments: Medical criteria (e.g. HLA compatibility) and non-medical criteria (e.g. willingness to pay of the patients) are valued on the basis of generally accepted objectives (e.g. equal access to health services or low costs). As an innovative form of (...) organ distribution systems the club solution is introduced. It allows the donor to realise preferences regarding use of the organs.Conclusion: Scoring systems may help to increase the transparency of organ allocation. From an economic point of view medical criteria have to be weighted more than non-medical criteria. (shrink)

Cost-benefit analysis (CBA) is inappropriate as an aid to Covid policy-making because the plural, incommensurable values at stake are not all amenable to monetary measurement. CBA for Covid policy is also undermined by pervasive uncertainty and ignorance, and has some troubling distributional implications. However, non-consequentialist alternatives to CBA tend towards implausibly absolutist prohibitions on risk imposition. Arguments for setting aside consequentialism for special circumstances (the precautionary principle, or a medical rule of rescue) are also problematic when applied to Covid (...) policy. A broad consequentialist approach to policy guidance is defended, one which does not demand commensuration on a common monetary scale. Despite the absence of commensuration, policy guidance is still possible. (shrink)

Public goods are goods that are non-rival and non-excludable. One person enjoying the benefits of a public good will not reduce the value of the good for others. And nobody within a particular population can be excluded from enjoying those benefits. While we often think of the relevant population being co-citizens of a state - national defence is taken to be the archetypal public good - in recent years the importance of public goods that benefit individuals across different countries has (...) increasingly been recognised. We can refer to these as "global public goods". When global public goods are supplied, various costs and benefits are generated, and these costs and benefits can be shared among countries in different ways. This thesis explores how justice requires us to share them; I develop a theory of distributive justice for global public goods. I begin by developing two principles for assigning the costs and benefits of supplying public goods within a state, and then argue that these should, for the most part, also govern the distribution of costs and benefits arising from global public good production. Finally, I assess how certain private goods that the supply of public goods make possible should be shared among states. The fact that these goods rely for their production on the supply of global public goods, I argue, will affect the principles of distributive justice that should govern these. (shrink)

When deciding what disorders to screen newborns for, we should be guided by evidence of real effectiveness, take opportunity cost into account, distribute costs and benefits fairly, and respect human rights. Current newborn screening policy does not meet these requirements.

The facts of global poverty are staggering. Consider, for instance, how 1.5 billion people subsist below the international poverty line, which means about a quarter of the world's current population lives in poverty. There is much talk about how freer markets will help the situation of these people, in particular how it will help the worst off. So far the evidence for this claim is fairly unclear. ‘At any rate, on several accounts, alleviating the worst aspects of poverty would impose (...) fairly small costs on us in more affluent countries, yet we continue to do very little about alleviating this situation. For instance, a 1 per cent tax on world product would make enormous inroads in lifting people out of poverty. Alternatively, simply a shift in priorities could do this without any added taxes: a 1 per cent decrease in military spending in the developed world and a 10 per cent decrease in military spending in the developing world could have the same effect. (shrink)

Noniterative approaches to the sorites paradox accept single steps of soritical reasoning, but deny that these can be combined into valid chains of soritical reasoning. The distributed sorites is a puzzle designed to undermine noniterative approaches to the sorites paradox, by deriving an inconsistent conclusion using only single steps, but not chains, of soritical reasoning. This paper shows how a dialetheist version of the noniterative approach, the strict-tolerant approach, also solves the distributed sorites paradox, at no further cost, by (...) accepting the inconsistent conclusion. (shrink)

ABSTRACTIn light of the large recent inflow of refugees to the EU and the Commission’s efforts to relocate them, I raise the question of what a fair distribution of refugees between EU countries would look like. More specifically, I consider what concerns such a distributive scheme should be sensitive to. First, I put forward some arguments for why states are obligated to admit refugees and outline how I believe the EU should respond to the refugee crisis. This involves, among (...) other things, resettling a proportion of refugees from countries neighbouring Syria in the EU. Second, I consider how the intake into the EU should be distributed between member states, that is, the shares different countries can be expected to admit. I discuss the relevance of a number of different factors that may be claimed to affect such shares, including population size, GDP, number of refugees admitted so far, unemployment rate, country-specific costs and cultural ‘closeness’. Third, I consider whether the distributive scheme should be restricted to reflect specific states’ responsibility for creating refugees in the first place, levels of racism and xenophobia, and whether other states are required to pick up the slack if some refuse to admit their fair share. (shrink)

Democratic societies find it difficult to reach consensus concerning principles for healthcare distribution in the face of resource constraints. At the same time the need for legitimacy of allocation decisions has been recognised. Against this background, the National Institute for Health and Clinical Excellence (NICE) aspires to meet the principles of procedural justice, specifically the conditions of accountability for reasonableness as espoused by Daniels and Sabin, that is, publicity, relevance, revisions and appeal, and enforcement. Although NICE has adopted a (...) highly standardised approach and continuously publishes key documents on its website, its technology appraisal programme does not fulfil the publicity condition of accountability for reasonableness. Economic models are not made sufficiently transparent to enable public scrutiny, and decision criteria other than cost-effectiveness remain enigmatic. NICE’s reliance on cost-utility analysis and “plausible” cost-per-quality-adjusted life year (QALY) benchmarks further raises serious issues with regard to the relevance condition of accountability for reasonableness. This is illustrated by counterintuitive cost-per-QALY rankings that are difficult to justify using reflective equilibrium methods, and by the current debate surrounding expensive therapies for rare diseases (“orphan” treatments). In addition, an excessive focus on QALYs may stand in the way of exploiting the best available effectiveness evidence. The NICE mechanism for revision and appeals is also more restrictive than provided in accountability for reasonableness. As to the enforcement condition, no effective quality assurance processes are in place for technology assessments, and implementation of guidance remains imperfect. NICE, despite impressive efforts, appears to have a long way to go before meeting the conditions of accountability for reasonableness. (shrink)

The Canadian province of Quebec recently amended its Health Insurance Act to cover the costs of In Vitro Fertilization . The province of Ontario recently de-insured IVF. Both provinces cited cost-effectiveness as their grounds, but the question as to whether a public health insurance system ought to cover IVF raises the deeper question of how we should understand reproduction at the social level, and whether its costs should be a matter of individual or collective responsibility. In this article I (...) examine three strategies for justifying collective provisions in a liberal society and assess whether public reproductive assistance can be defended on any of these accounts. I begin by considering, and rejecting, rights-based and needs-based approaches. I go on to argue that instead we ought to address assisted reproduction from the perspective of the contractarian insurance-based model for public health coverage, according to which we select items for inclusion based on their unpredictability in nature and cost. I argue that infertility qualifies as an unpredictable incident against which rational agents would choose to insure under ideal conditions and that assisted reproduction is thereby a matter of collective responsibility, but only in cases of medical necessity or inability to pay. The policy I endorse by appeal to this approach is a means-tested system of coverage resembling neither Ontario nor Quebec's, and I conclude that it constitutes a promising alternative worthy of serious consideration by bioethicists, political philosophers, and policy-makers alike. (shrink)

What is the proper role of cost-benefit analysis in understanding the tort concept of negligence or reasonable care? A straightforward question, you might think. But it is a question that manages to elicit groans of exasperation from those on both sides of the controversy. For most utilitarians and adherents to law and economics, the answer is obvious: to say that people should not be negligent is to say that they should minimize the sum of the costs of accidents and (...) the costs of preventing accidents. Under the economic formulation of the famous Learned Hand test, they should take a precaution if but only if the marginal costs (or burden, B) of that precaution are less than its marginal benefits (in the form of reduced risks of injury, measured by multiplying the probability (P) of the injury times the magnitude (L) of the injury if it occurs). If B>PxL, it would be absurd to require the greater expenditure, B. For many advocates of a fairness, corrective justice, rights-based, or contractualist perspective, the opposite answer is equally obvious. Permitting a person to impose risks of harm on others merely because he would thereby obtain a benefit (or would otherwise incur a burden) greater than the discounted value of the harm he might inflict, amounts to authorizing him to dump the costs of his risky activities on innocent victims. To permit this type of sacrifice of individuals on the altar of aggregate social welfare is morally abhorrent. Both sets of criticism have important elements of truth. Neither an unqualified cost-benefit analysis nor an unqualified rights-based rejection of tradeoffs is defensible - either as a description of tort doctrine and practice or as a normative prescription. However, a qualified (sensitive) consequentialist approach can accommodate legitimate criticisms of cost-benefit analysis: the consequentialist can launder preferences, and can consider the distribution of risk both in the social welfare calculus and in determining whether to compensate. At the same time, a qualified (tough-minded) deontological approach can accommodate the legitimate need to recognize tradeoffs: the deontologist can permit intrapersonal but not interpersonal aggregation of risks and benefits, can apply the concept of threshold deontology to risky activity, and can consider individual rather than population risk. I conclude that the formulation of the Learned Hand test found in the Restatement Third of Torts is broad enough to encompass each of these qualified approaches. (shrink)