Totalism is the view that one distribution of well-being is better than another just in case the one contains a greater sum of well-being than the other. Many philosophers, following Parfit, reject totalism on the grounds that it entails the repugnant conclusion: that, for any number of excellent lives, there is some number of lives that are barely worth living whose existence would be better. This paper develops a theory of welfare aggregation—the lexical-threshold view—that allows totalism to avoid the repugnant (...) conclusion, as well as its analogues involving suffering populations and the lengths of individual lives. The theory is grounded in some independently plausible views about the structure of well-being, identifies a new source of incommensurability in population ethics, and avoids some of the implausibly extreme consequences of other lexical views, without violating the intuitive separability of lives. (shrink)

We argue that all comparative expressions in natural language obey a principle that we call Comparability: if x and y are at least as F as themselves, then either x is at least as F as y or y is at least as F as x. This principle has been widely rejected among philosophers, especially by ethicists, and its falsity has been claimed to have important normative implications. We argue that Comparability is needed to explain the goodness of several patterns (...) of inference that seem manifestly valid, that the purported failures of Comparability would have absurd consequences, and that the influential arguments against Comparability are less compelling than they may have initially seemed. (shrink)

Many economists and philosophers assume that status quo bias is necessarily irrational. I argue that, in some cases, status quo bias is fully rational. I discuss the rationality of status quo bias on both subjective and objective theories of the rationality of preferences. I argue that subjective theories cannot plausibly condemn this bias as irrational. I then discuss one kind of objective theory, which holds that a conservative bias toward existing things of value is rational. This account can fruitfully explain (...) some compelling aspects of common sense morality, and it may justify status quo bias. (shrink)

The Rachels–Temkin spectrum arguments against the transitivity of better than involve good or bad experiences, lives, or outcomes that vary along multiple dimensions—e.g., duration and intensity of pleasure or pain. This paper presents variations on these arguments involving combinations of good and bad experiences, which have even more radical implications than the violation of transitivity. These variations force opponents of transitivity to conclude that something good is worse than something that isn’t good, on pain of rejecting the good altogether. That (...) is impossible, so we must reject the spectrum arguments. (shrink)

Is well-being the kind of thing that can be summed across individuals? This paper takes a measurement-theoretic approach to answering this question. To make sense of adding well-being, we would need to identify some natural "concatenation" operation on the bearers of well-being that satisfies the axioms of extensive measurement and can therefore be represented by the arithmetic operation of addition. I explore various proposals along these lines, involving the concatenation of segments within lives over time, of entire lives led alongside (...) one another or in sequence, and of evaluatively basic propositions via conjunction. All of these proposals turn out to carry highly controversial commitments about the good. I do not claim that these commitments are unacceptable. But they suggest that we cannot simply take for granted, as many philosophers do, that there is any such thing as the sum of well-being. (shrink)

This paper presents a new kind of problem in the ethics of distribution. The problem takes the form of several “calibration dilemmas,” in which intuitively reasonable aversion to small-stakes inequalities requires leading theories of distribution to recommend intuitively unreasonable aversion to large-stakes inequalities. We first lay out a series of such dilemmas for prioritarian theories. We then consider a widely endorsed family of egalitarian views and show that they are subject to even more forceful calibration dilemmas than prioritarian theories. Finally, (...) we show that our results challenge common utilitarian accounts of the badness of inequalities in resources. (shrink)

I present a new argument for the repugnant conclusion. The core of the argument is a risky, intrapersonal analogue of the mere addition paradox. The argument is important for three reasons. First, some solutions to Parfit’s original puzzle do not obviously generalize to the intrapersonal puzzle in a plausible way. Second, it raises independently important questions about how to make decisions under uncertainty for the sake of people whose existence might depend on what we do. And, third, it suggests various (...) difficulties for leading views about the value of a person’s life compared to her nonexistence. (shrink)

Matthew Adler's Measuring Social Welfare is an introduction to the social welfare function (SWF) methodology. This essay questions some ideas at the core of the SWF methodology having to do with the relation between the SWF and the measure of well-being. The facts about individual well-being do not single out a particular scale on which well-being must be measured. As with physical quantities, there are multiple scales that can be used to represent the same information about well-being; no one scale (...) is special. Like physical laws, the SWF and its ranking of distributions cannot depend on exactly which of these scales we use. Adler and other theorists in the SWF tradition have used this idea to derive highly restrictive constraints on the shape of the SWF. These constraints rule out seemingly plausible views about distributive justice and population ethics. I argue, however, that these constraints stem from a simple but instructive mistake. The SWF should not be applied to vectors of numbers such as 1 and 2, but rather to vectors of dimensioned quantities such as 1 util and 2 utils. This seemingly pedantic suggestion turns out to have far-reaching consequences. Unlike the orthodox SWF approach, treating welfare levels as dimensioned quantities lets us distinguish between real changes in well-being and mere changes in the unit of measurement. It does this without making the SWF depend on the scale on which welfare is measured, and in a way that avoids the restrictive constraints on the shape of the SWF. (shrink)

This paper is about the role of interpersonal comparisons in Harsanyi's aggregation theorem. Harsanyi interpreted his theorem to show that a broadly utilitarian theory of distribution must be true even if there are no interpersonal comparisons of well-being. How is this possible? The orthodox view is that it is not. Some argue that the interpersonal comparability of well-being is hidden in Harsanyi's premises. Others argue that it is a surprising conclusion of Harsanyi's theorem, which is not presupposed by any one (...) of the premises. I argue instead that Harsanyi was right: his theorem and its weighted-utilitarian conclusion do not require interpersonal comparisons of well-being. The key to making sense of this possibility is to treat Harsanyi's weights as dimensional constants rather than dimensionless numbers. (shrink)

The standard view of "believes" and other propositional attitude verbs is that such verbs express relations between agents and propositions. A sentence of the form “S believes that p” is true just in case S stands in the belief-relation to the proposition that p; this proposition is the referent of the complement clause "that p." On this view, we would expect the clausal complements of propositional attitude verbs to be freely intersubstitutable with their corresponding proposition descriptions—e.g., "the proposition that p"—as (...) they are in the case of "believes." In many cases, however, intersubstitution of that-clauses and proposition descriptions fails to preserve truth value or even grammaticality. These substitution failures lead some philosophers to reject the standard view of propositional attitude reports. Others conclude that propositional attitude verbs are systematically ambiguous. I reject both these views. On my view, the that-clause complements of propositional attitude verbs denote propositions, but proposition descriptions do not. (shrink)

I defend the view that a reason for someone to do something is just a reason why she ought to do it. This simple view has been thought incompatible with the existence of reasons to do things that we may refrain from doing or even ought not to do. For it is widely assumed that there are reasons why we ought to do something only if we ought to do it. I present several counterexamples to this principle and reject some (...) ways of understanding "ought" so that the principle is compatible with my examples. I conclude with a hypothesis for when and why the principle should be expected to fail. (shrink)

Lara Buchak argues for a version of rank-weighted utilitarianism that assigns greater weight to the interests of the worse off. She argues that our distributive principles should be derived from the preferences of rational individuals behind a veil of ignorance, who ought to be risk averse. I argue that Buchak’s appeal to the veil of ignorance leads to a particular way of extending rank-weighted utilitarianism to the evaluation of uncertain prospects. This method recommends choices that violate the unanimous preferences of (...) rational individuals and choices that guarantee worse distributions. These results, I suggest, undermine Buchak’s argument for rank-weighted utilitarianism. (shrink)

This paper develops and explores a new framework for theorizing about the measurement and aggregation of well-being. It is a qualitative variation on the framework of social welfare functionals developed by Amartya Sen. In Sen’s framework, a social or overall betterness ordering is assigned to each profile of real-valued utility functions. In the qualitative framework developed here, numerical utilities are replaced by the properties they are supposed to represent. This makes it possible to characterize the measurability and interpersonal comparability of (...) well-being directly, without the use of invariance conditions, and to distinguish between real changes in well-being and merely representational changes in the unit of measurement. The qualitative framework is shown to have important implications for a range of issues in axiology and social choice theory, including the characterization of welfarism, axiomatic derivations of utilitarianism, the meaningfulness of prioritarianism, the informational requirements of variable-population ethics, the impossibility theorems of Arrow and others, and the metaphysics of value. (shrink)

How should we choose between uncertain prospects in which different possible people might exist at different levels of wellbeing? Alex Voorhoeve and Marc Fleurbaey offer an egalitarian answer to this question. I give some reasons to reject their answer and then sketch an alternative, which I call person-affecting prioritarianism.

According to asymmetric comparativism, it is worse for a person to exist with a miserable life than not to exist, but it is not better for a person to exist with a happy life than not to exist. My aim in this paper is to explain how asymmetric comparativism could possibly be true. My account of asymmetric comparativism begins with a different asymmetry, regarding the (dis)value of early death. I offer an account of this early death asymmetry, appealing to the (...) idea of conditional goods, and generalize it to explain how asymmetric comparativism could possibly be true. I also address the objection that asymmetric comparativism has unacceptably antinatalist implications. (shrink)

ABSTRACT Sometimes it seems that an existing bearer of value should be preserved even though it could be destroyed and replaced with something of equal or greater value. How can this conservative intuition be explained and justified? This paper distinguishes three answers, which I call existential, attitudinal, and object-affecting conservatism. I raise some problems for existential and attitudinal conservatism, and suggest how they can be solved by object-affecting conservatism.

Multidimensional concepts are everywhere, and they are important. Examples include moral value, welfare, scientific confirmation, democracy, and biodiversity. How, if at all, can we aggregate the underlying dimensions of a multidimensional concept F to yield verdicts about which things are Fer than which overall? Social choice theory can be used to model and investigate this aggregation problem. Here, we focus on a particularly thorny problem made salient by this social choice-theoretic framework: the underlying dimensions of a given concept might be (...) measurable on different types of scales—e.g., some ordinal and some cardinal. An underappreciated impossibility theorem due to Anna Khmelnitskaya shows that seemingly plausible constraints on aggregation across scale types are inconsistent. This impossibility threatens to render the notion of overall Fness incoherent. We attempt to defuse this threat, arguing that the impossibility depends on an overly restrictive conception of measurement and of how measurement constrains aggregation. Adopting a more flexible—and, we think, more perspicuous—conception of measurement opens an array of possibilities for aggregation across disparate scale types. (shrink)

Extensive measurement is the standard measurement-theoretic approach for constructing a ratio scale. It involves the comparison of objects that can be concatenated in an additively representable way. This paper studies the implications of extensively measurable welfare for social choice theory. We do this in two frameworks: an Arrovian framework with a fixed population and no interpersonal comparisons, and a generalized framework with variable populations and full interpersonal comparability. In each framework we use extensive measurement to introduce novel domain restrictions, independence (...) conditions, and constraints on social evaluation. We prove a welfarism theorem for these domains and characterize the social welfare functions that satisfy the axioms of extensive measurement at both the individual and social levels. The main results are simple axiomatizations of strong dictatorship in the Arrovian framework and classical utilitarianism in the generalized framework. (shrink)

According to the person-affecting restriction, one distribution of welfare can be better than another only if there is someone for whom it is better. Extant problems for the person-affecting restriction involve variable-population cases, such as the nonidentity problem, which are notoriously controversial and difficult to resolve. This paper develops a fixed-population problem for the person-affecting restriction. The problem reveals that, in the presence of incommensurable welfare levels, the person-affecting restriction is incompatible with minimal requirements of impartial beneficence even in fixed-population (...) contexts. (shrink)

Values are incommensurable when they cannot be measured on a single cardinal scale. Many philosophers suggest that incommensurability can help us solve the problems of population ethics. I agree. But some philosophers claim that populations bear incommensurable values merely because they contain different numbers of people, perhaps within some range. I argue that mere differences in how many people exist, even within some range, do not suffice for incommensurability. I argue that the intuitive neutrality of creating happy people is better (...) captured by a version of average utilitarianism. But this view is problematic. So I suggest a version of total utilitarianism that avoids the repugnant conclusion by appealing to incommensurable dimensions of wellbeing. (shrink)

We defend three controversial claims about preference, credence, and choice. First, all agents (not just rational ones) have complete preferences. Second, all agents (again, not just rational ones) have real-valued credences in every proposition in which they are confident to any degree. Third, there is almost always some unique thing we ought to do, want, or believe.

Derek Parfit argues that everyone ought to follow the principles whose universal acceptance would make things go best. I present a counterexample: a world in which no one's moral beliefs have any motivating force. I explain how Parfit's metaethical commitments imply that such a world is possible, and why this possibility is a problem for Parfit's project of reconciling Kantianism, contractualism, and consequentialism. I consider two of Parfit's responses to my counterexample.

Tsui and Weymark (Economic Theory, 1997) have shown that the only continuous social welfare orderings on the whole Euclidean space which satisfy the weak Pareto principle and are invariant to individual-specific similarity transformations of utilities are strongly dictatorial. Their proof relies on functional equation arguments which are quite complex. This note provides a simpler proof of their theorem.

This paper is about teaching philosophy to high school students through Lincoln-Douglas (LD) debate. LD, also known as “values debate,” includes topics from ethics and political philosophy. Thousands of high school students across the U.S. debate these topics in class, after school, and at weekend tournaments. We argue that LD is a particularly effective tool for teaching philosophy, but also that LD today falls short of its potential. We argue that the problems with LD are not inevitable, and we offer (...) strategic recommendations for improving LD as a tool for teaching philosophy. Ultimately, our aim is to create a dialogue between LD and academic philosophy, with the hope that such dialogue will improve LD’s capacity to teach students how to do philosophy. (shrink)

This paper develops a largely neglected parallel between prudence and population ethics. Prudence is generally understood to be concerned with the balancing of well-being over time. How, precisely, well-being ought to be balanced over time, however, is a fervently debated question. I argue that developing a standard guiding such evaluations is exceedingly challenging. This is due to an often overlooked fact about prudence, namely that it shares a structural similarity with population ethics: In both contexts, we assess the comparative value (...) of populations of personstages/people, which may vary in number and level of well-being. Based on this analogy, I show that the development of an adequate theory of prudence runs into very similar impossibility results as obtain in population ethics. In particular, I prove that Arrhenius’ fifth impossibility theorem can be applied to prudence. I develop and compare four possible answers to this challenge. First, I discuss the possibility of accepting the very repugnant conclusion intrapersonally. Second, I present and further develop Donald Bruckner’s Minimax Regret approach, which gives up Transitivity. Third, I apply Jacob Nebel’s Lexical Threshold View to prudence and critically evaluate it. Lastly, I introduce what I call the Negative Lexicality View, which is based on Lexical Threshold View but overcomes some of its problems. (shrink)

In “An Intrapersonal Addition Paradox,” Jacob Nebel provides a novel intrapersonal argument for the Repugnant Conclusion. The most controversial premise of Nebel’s argument is the “Probable Addition Principle,” on which it is better for individuals to receive additional chances of existence with a life worth living. I provide an alternative intrapersonal argument for the Repugnant Conclusion which does not assume the Probable Addition Principle. I also show that Pareto principles alone, when conjoined with very minimal principles of (...) prudence, imply a version of the Repugnant Conclusion. (shrink)

Measuring the effectiveness of medical interventions faces three epistemological challenges: the choice of good measuring instruments, the use of appropriate analytic measures, and the use of a reliable method of extrapolating measures from an experimental context to a more general context. In practice each of these challenges contributes to overestimating the effectiveness of medical interventions. These challenges suggest the need for corrective normative principles. The instruments employed in clinical research should measure patient-relevant and disease-specific parameters, and should not be sensitive (...) to parameters that are only indirectly relevant. Effectiveness always should be measured and reported in absolute terms (using measures such as 'absolute risk reduction'), and only sometimes should effectiveness also be measured and reported in relative terms (using measures such as 'relative risk reduction')-employment of relative measures promotes an informal fallacy akin to the base-rate fallacy, which can be exploited to exaggerate claims of effectiveness. Finally, extrapolating from research settings to clinical settings should more rigorously take into account possible ways in which the intervention in question can fail to be effective in a target population. (shrink)

Robustness arguments hold that hypotheses are more likely to be true when they are confirmed by diverse kinds of evidence. Robustness arguments require the confirming evidence to be independent. We identify two kinds of independence appealed to in robustness arguments: ontic independence —when the multiple lines of evidence depend on different materials, assumptions, or theories—and probabilistic independence. Many assume that OI is sufficient for a robustness argument to be warranted. However, we argue that, as typically construed, OI is not a (...) sufficient independence condition for warranting robustness arguments. We show that OI evidence can collectively confirm a hypothesis to a lower degree than individual lines of evidence, contrary to the standard assumption undergirding usual robustness arguments. We employ Bayesian networks to represent the ideal empirical scenario for a robustness argument and a variety of ways in which empirical scenarios can fall short of this ideal. (shrink)

Evidence hierarchies are widely used to assess evidence in systematic reviews of medical studies. I give several arguments against the use of evidence hierarchies. The problems with evidence hierarchies are numerous, and include methodological shortcomings, philosophical problems, and formal constraints. I argue that medical science should not employ evidence hierarchies, including even the latest and most-sophisticated of such hierarchies.

The value-free ideal for science holds that values should not influence the core features of scientific reasoning. We defend the difference-to-inference model of value-permeation, which holds that value-permeation in science is problematic when values make a difference to the inferences made about a hypothesis. This view of value-permeation is superior to existing views, and it suggests a corresponding maxim—namely, that scientists should strive to eliminate differences to inference. This maxim is the basis of a novel value-free ideal for science. -/- (...) . (shrink)

A platitude that took hold with Kuhn is that there can be several equally good ways of balancing theoretical virtues for theory choice. Okasha recently modelled theory choice using technical apparatus from the domain of social choice: famously, Arrow showed that no method of social choice can jointly satisfy four desiderata, and each of the desiderata in social choice has an analogue in theory choice. Okasha suggested that one can avoid the Arrow analogue for theory choice by employing a strategy (...) used by Sen in social choice, namely, to enhance the information made available to the choice algorithms. I argue here that, despite Okasha’s claims to the contrary, the information-enhancing strategy is not compelling in the domain of theory choice. (shrink)

The Meno, one of the most widely read of the Platonic dialogues, is seen afresh in this original interpretation that explores the dialogue as a theatrical presentation. Just as Socrates's listeners would have questioned and examined their own thinking in response to the presentation, so, Klein shows, should modern readers become involved in the drama of the dialogue. Klein offers a line-by-line commentary on the text of the Meno itself that animates the characters and conversation and carefully probes each significant (...) turn of the argument. "A major addition to the literature on the Meno and necessary reading for every student of the dialogue."--Alexander Seasonske, Philosophical Review "There exists no other commentary on Meno which is so thorough, sound, and enlightening."-- Choice Jacob Klein was a student of Martin Heidegger and a tutor at St. John's College from 1937 until his death. His other works include Plato's Trilogy: Theaetetus, the Sophist, and the Statesman, also published by the University of Chicago Press. (shrink)

Medicalisation is a social phenomenon in which conditions that were once under legal, religious, personal or other jurisdictions are brought into the domain of medical authority. Low sexual desire in females has been medicalised, pathologised as a disease, and intervened upon with a range of pharmaceuticals. There are two polarised positions on the medicalisation of low female sexual desire: I call these the mainstream view and the critical view. I assess the central arguments for both positions. Dividing the two positions (...) are opposing models of the aetiology of low female sexual desire. I conclude by suggesting that the balance of arguments supports a modest defence of the critical view regarding the medicalisation of low female sexual desire. (shrink)

Harms of medical interventions are systematically underestimated in clinical research. Numerous factors—conceptual, methodological, and social—contribute to this underestimation. I articulate the depth of such underestimation by describing these factors at the various stages of clinical research. Before any evidence is gathered, the ways harms are operationalized in clinical research contributes to their underestimation. Medical interventions are first tested in phase 1 ‘first in human’ trials, but evidence from these trials is rarely published, despite the fact that such trials provide the (...) foundation for assessing the harm profile of medical interventions. If a medical intervention is deemed safe in a phase 1 trial, it is tested in larger phase 2 and 3 clinical trials. One way to think about the problem of underestimating harms is in terms of the statistical ‘power’ of a clinical trial—the ability of a trial to detect a difference of a certain effect size between the experimental group and the control group. Power is normally thought to be pertinent to detecting benefits of medical interventions. It is important, though, to distinguish between the ability of a trial to detect benefits and the ability of a trial to detect harms. I refer to the former as power-B and the latter as power-H. I identify several factors that maximize power-B by sacrificing powerH in phase 3 clinical trials. If a medical intervention is approved for general use, it is evaluated by phase 4 post-market surveillance. Phase 4 surveillance of harms further contributes to underestimating the harm profile of medical interventions. At every stage of clinical research the hunt for harms is shrouded in secrecy, which further contributes to the underestimation of the harm profiles of medical interventions. (shrink)

The phenomenon of disagreement has recently been brought into focus by the debate between contextualists and relativist invariantists about epistemic expressions such as ‘might’, ‘probably’, indicative conditionals, and the deontic ‘ought’. Against the orthodox contextualist view, it has been argued that an invariantist account can better explain apparent disagreements across contexts by appeal to the incompatibility of the propositions expressed in those contexts. This paper introduces an important and underappreciated phenomenon associated with epistemic expressions — a phenomenon that we call (...) reversibility. We argue that the invariantist account of disagreement is incompatible with reversibility, and we go on to show that reversible sentences cast doubt on the putative data about disagreement, even without assuming invariantism. Our argument therefore undermines much of the motivation for invariantism, and provides a new source for constraints on the proper explanation of purported data about disagreement. (shrink)

Panpsychism is a solution to the mind-body problem that presumes that consciousness is a fundamental aspect of reality instead of a product or consequence of physical processes (i.e., brain activity). Panpsychism is an elegant solution to the mind-body problem: it effectively rids itself of the explanatory gap materialist theories of consciousness suffer from. However, many theorists and experimentalists doubt panpsychism can ever be successful as a scientific theory, as it cannot be empirically verified or falsified. In this paper, I present (...) a panpsychist model based on the controversial idea that consciousness may be a so called higher physical dimension. Although this notion seems outrageous, I show that the idea has surprising explanatory power, even though the model (as most models) is most likely wrong. Most importantly, though, it results in a panpsychist model that yields predictions that can be empirically verified or falsified. As such, the model's main purpose is to serve as an example how a metaphysical model of consciousness can be specified in such a way that they can be tested in a scientifically rigorous way. (shrink)

One of the perennial challenges of ethical theory has been to provide an answer to a number of views that appear to undermine the importance of ethical questions. We may refer to such views collectively as “deflationary ethical theories.” These include theories, such as nihilism, according to which no action is better than any other, as well as relativistic theories according to which no ethical theory is better than any other. In this article I present a new response to such (...) deflationary ethical views. Drawing a distinction between acceptance and rejection, on the one hand, and belief and disbelief, on the other, I argue that we have strong reason to reject these theories, even if we do not have reason to disbelieve them. In Section I, I clarify the question of what ethical theory we should accept, and I argue for the central importance of this question. In Section II, I discuss what I call “absolutely deflationary” ethical theories. These are theories according to which it matters not at all what we do or not at all what ethical theory we accept. I argue that it is generally rational to reject any theory of this kind. In Section III, I discuss what I call “relatively deflationary” ethical theories. These are theories according to which it matters little what we do or what ethical theory we accept. I argue that we have strong pro tanto reason to reject theories of this kind. And then, in Sections IV and V, I reply to some common objections to my arguments. Throughout, I will be arguing not that deflationary ethical theories are false but only that we should reject them from the practical point of view as a basis for guiding our actions. (shrink)

The animal agriculture industry causes animals a tremendous amount of pain and suffering. Many ethical vegans argue that we therefore have an obligation to abstain from animal products in order to reduce this suffering. But this argument faces a challenge: thanks to the size and structure of the animal agriculture industry, any individual’s dietary choices are overwhelmingly unlikely to make a difference. In this paper, we criticize common replies to this challenge and develop an alternative argument for ethical veganism. Specifically, (...) we argue that individuals should abstain from animal products because vegans, as a group, successfully reduce animal suffering, and individuals are obligated to participate in, rather than free ride on, this collective endeavor. Or, at the very least, individuals have strong reasons to purchase fewer inhumanely raised animal products—even if they are not obligated to go vegan per se. (shrink)

Consensus conferences are social techniques which involve bringing together a group of scientific experts, and sometimes also non-experts, in order to increase the public role in science and related policy, to amalgamate diverse and often contradictory evidence for a hypothesis of interest, and to achieve scientific consensus or at least the appearance of consensus among scientists. For consensus conferences that set out to amalgamate evidence, I propose three desiderata: Inclusivity, Constraint, and Evidential Complexity. Two examples suggest that consensus conferences can (...) readily satisfy Inclusivity and Evidential Complexity, but consensus conferences do not as easily satisfy Constraint. I end by discussing the relation between social inclusivity and the three desiderata. (shrink)

Drug regulation is fraught with inductive risk. Regulators must make a prediction about whether or not an experimental pharmaceutical will be effective and relatively safe when used by typical patients, and such predictions are based on a complex, indeterminate, and incomplete evidential basis. Such inductive risk has important practical consequences. If regulators reject an experimental drug when it in fact has a favourable benefit/harm profile, then a valuable intervention is denied to the public and a company’s material interests are needlessly (...) thwarted. Conversely, if regulators approve an experimental drug when it in fact has an unfavourable benefit/harm profile, then resources are wasted, people are needlessly harmed, and other potentially more effective treatments are underutilized. Given that such regulatory decisions have these practical consequences, non-epistemic values about the relative importance of these consequences impact the way such regulatory decisions are made (similar to the analysis of laboratory studies on the toxic effects of dioxins presented in Douglas [2000]). To balance the competing demands of the pertinent non-epistemic values, regulators must perform what I call an “inductive risk calculus.” At least in the American context this inductive risk calculus is not well-managed. (shrink)

If scientists violate principles and practices of routine science to quickly develop interventions against catastrophic threats, they are engaged in what I call fast science. The magnitude, imminence, and plausibility of a threat justify engaging in and acting on fast science. Yet, that justification is incomplete. I defend two principles to assess fast science, which say: fast science should satisfy as much as possible the reliability-enhancing features of routine science, and the fast science developing an intervention against a threat should (...) not depend on the same problematic assumptions as the fast science which estimates the magnitude, imminence, and plausibility of the threat. (shrink)

I defend a novel account of scientific progress centred around justification. Science progresses, on this account, where there is a change in justification. I consider three options for explicating this notion of change in justification. This account of scientific progress dispels with a condition for scientific progress that requires accumulation of truth or truthlikeness, and it emphasises the social nature of scientific justification.

Medical scientists employ ‘quality assessment tools’ (QATs) to measure the quality of evidence from clinical studies, especially randomized controlled trials (RCTs). These tools are designed to take into account various methodological details of clinical studies, including randomization, blinding, and other features of studies deemed relevant to minimizing bias and error. There are now dozens available. The various QATs on offer differ widely from each other, and second-order empirical studies show that QATs have low inter-rater reliability and low inter-tool reliability. This (...) is an instance of a more general problem I call the underdetermination of evidential significance. Disagreements about the strength of a particular piece of evidence can be due to different—but in principle equally good—weightings of the fine-grained methodological features which constitute QATs. (shrink)

This article argues that Epictetus employs the terms orexis and hormê in the same manner as the older Stoics. It then shows, on the basis of this claim, that the older Stoics recognized a distinction between dispositional and occurrent forms of motivation. On this account of Stoic theory, intentional action is in each instance the product of two forms of cognition: a value ascription that attributes goodness or badness to some object, conceiving of its possession as beneficial or harmful to (...) the agent, together with a situational judgment about appropriate action. The resulting interpretation suggests that the Stoic theory of motivation as a whole — and not merely the Stoic analysis of the pathê — has the basic shape of a practical syllogism, with more psychological depth than commentators have recognized. (shrink)

The purpose of this chapter is to describe what we see as several important new directions for philosophy of medicine. This recent work (i) takes existing discussions in important and promising new directions, (ii) identifies areas that have not received sufficient and deserved attention to date, and/or (iii) brings together philosophy of medicine with other areas of philosophy (including bioethics, philosophy of psychiatry, and social epistemology). To this end, the next part focuses on what we call the “epistemological turn” in (...) recent work in the philosophy of medicine; the third part addresses new developments in medical research that raise interesting questions for philosophy of medicine; the fourth part is a discussion of philosophical issues within the practice of diagnosis; the fifth part focuses on the recent developments in psychiatric classification and scientific and ethical issues therein, and the final part focuses on the objectivity of medical research. (shrink)

Ideal theorists aim to describe the ideally just society. Problem solvers aim to identify concrete changes to actual societies that would make them more just. The relation between these two sorts of theorizing is highly contested. According to the benchmark view, ideal theory is prior to problem solving because a conception of the ideally just society serves as an indispensable benchmark for evaluating societies in terms of how far they deviate from it. In this paper, I clarify the benchmark view, (...) argue that existing criticisms of it are unsuccessful, and develop a novel redundancy objection to the benchmark view and the claim of priority it allegedly entails. I then consider the extent to which ideal theory might facilitate problem solving without being prior to it and argue that it can only play a modest role in this regard. The upshot is that ideal theory is neither required for nor especially relevant to problem solving—but it is not completely irrelevant either. It facilitates problem solving to some limited degree, but no more, say, than theorizing about dystopia. (shrink)

Reasons transmit. If one has a reason to attain an end, then one has a reason to effect means for that end: reasons are transmitted from end to means. I argue that the likelihood ratio (LR) is a compelling measure of reason transmission from ends to means. The LR measure is superior to other measures, can be used to construct a condition specifying precisely when reasons transmit, and satisfies intuitions regarding end-means reason transmission in a broad array of cases.

Substituted judgment has increasingly become the accepted standard for rendering decisions for incapacitated adults in the USA. A broad exception exists with regard to patients with diminished capacity secondary to depressive disorders, as such patients’ previous wishes are generally not honoured when seeking to turn down life-preserving care or pursue aid-in-dying. The result is that physicians often force involuntary treatment on patients with poor medical prognoses and/or low quality of life as a result of their depressive symptoms when similarly situated (...) incapacitated patients without such depressive symptoms would have their previous wishes honoured via substituted judgment. This commentary argues for reconsidering this approach and for using a substituted judgment standard for a subset of EMP/LQL patients seeking death. (shrink)

The public discourse surrounding sex and severe disability over the past 40 years has largely focused on protecting vulnerable populations from abuse. However, health professionals and activists are increasingly recognising the inherent sexuality of disabled persons and attempting to find ways to accommodate their intimacy needs. This essay explores several ethical issues arising from such efforts.

Many jurisdictions prohibit or severely restrict the use of evidence about a defendant’s character to prove legal culpability. Situationists, who argue that conduct is largely determined by situational features rather than by character, can easily defend this prohibition. According to situationism, character evidence is misleading or paltry. -/- Proscriptions on character evidence seem harder to justify, however, on virtue ethical accounts. It appears that excluding character evidence either denies the centrality of character for explaining conduct—the situationist position—or omits probative evidence. (...) Situationism is, after all, presented as antithetical to virtue ethics. -/- This essay provides a virtue ethical defense of character evidence exclusion rules. We show that existing virtue ethical rebuttals to situationism themselves support prohibitions on character evidence; even if behavior arises from stable character traits, character evidence should be prohibited. In building our case, we provide a taxonomy of kinds of character judgment and reconcile the ubiquity and reasonableness of character judgments in ordinary life with the epistemic legitimacy of character evidence prohibitions in law. (shrink)