How much by way of economic reward is due to health care providers?Although this problem usually presents itself as a practical matter of policy, it has buried within it a number of philosophical issues, for it can be regarded as a question in the theory of economic justice. The formal principle of justice is that we should render persons what is due to them. But on what consideration in the case of health care providers can we make an assessment of (...) what is due?The answer we give to this question has significant implications for the ethical appraisal of the allocation of resources in the health care system. Some of the most difficult issues of ethical appraisal emerge when we consider the problems of allocating potentially life-saving resources between different groups of patients. Many of the most significant current issues in medical ethics—the role of QALYs, the meaning of equality and the economic evaluation of life—find their point of reference in the ‘tragic choices’ that are created when there are insufficient resources to meet apparently legitimate medical need. Yet, as Robert Evans has pointed out, it is a simple matter of accounting identity that health care expenditures must equal health providers' incomes. So, in asking how we limit or allocate costly health care resources, we are implicitly offering an answer to the question of how much we should pay providers. I hope by seeking an answer explicitly to that question to throw light on the problems that are raised when considering ethically the allocation of health care resources. (shrink)

Modern Social Contract Theory provides an exposition and evaluation of major work in social contract theory from 1950 to the present. It locates the central themes of that theory in the intellectual legacy of utilitarianism, particularly the problems of defining principles of justice and of showing the grounds of moral obligation. It demonstrates how theorists responded in a novel way to the dilemmas articulated in utilitarianism, developing in their different approaches a constructivist method in ethics, a method that aimed to (...) vindicate a liberal, democratic and just political order. A distinctive feature of the book is its comparative approach. By placing the works of Barry, Buchanan and Tullock, Harsanyi, Gauthier, Grice, Rawls, and Scanlon alongside one another, similarities and differences are brought out, most notably in the way in which principles are derived by each author from the contractual construction as well as the extent to which the obligation to adopt those principles can be rationally grounded. Each theory is placed in its particular intellectual context. Special attention is paid to the contrasting theories of rationality adopted by the different authors, whether that be utility theory or a deliberative conception of rationality, with the intention of assessing how far the principles advanced can be justified by reference to the hypothetical choices of rational contracting agents. The book concludes with a discussion of some principal objections to the enterprise of contract theory, and offers its own programme for the future of that theory taking the form of the empirical method. (shrink)

Chiara Cordelli’s The Privatized State is a book that should be widely read for many reasons.1 In the first place, it engages with an important set of issues in governance and public administration...

The key difference between the two concepts is that power acts directly on the actions of others by providing incentives and penalties for action, whereas influence operates on beliefs. From this distinction it follows that the exercise of influence is not simply a sub-class of instances of the exercise of power. It can be perfectly reasonable to attribute influence where there is no power, as in the example of the influence of Cervantes on subsequent writers.

The two books offer a contextual reinterpretation of Rawlsian and post-Rawlsian liberalism. Nelson’s main thesis is that debates in liberal political theory re-enact theological debates about theodicy going back to the Pelagian controversy. This claim is criticized for its historical inaccuracy. Nelson’s invocation of theodicy as a refutation of luck egalitarianism and the Rawlsian rejection of desert rest on a claim of possibility that is too weak to uphold a plausible refutation. Forrester locates Rawls’s rejection of desert in the thinking (...) of his contemporaries. She not only shows the development of Rawls’s thought but also details its broad influence. However, her thesis that the role of economic planning in a theory of justice remained undeveloped by Rawls ignores the intrinsic difficulties of designing a system of economic planning. The persistent antinomies of grace and free will in metaphysics, and of planning and the price mechanism in economics, show the continuing relevance of meaning beyond context. (shrink)

Populism sees representative government as intrinsically elitist, preferring to think about democracy in terms of the will of the people, expressed through devices such as referendums. However, this view is not one that can be made sense of and seeking to pursue the will of the people is dangerous to democracy. Citizen engagement is important in a representative democracy, but this is best conceived on a model of civil society organizations undertaking practical public deliberation. A philosophical model of deliberation leading (...) to choice is introduced, and the argument that such a theory is itself elitist is considered but found wanting. (shrink)

1. Justice, social contracts, and democracy -- 2. The democratic social contract -- 3. Economic justice and the democratic contract -- 4. The theory of democratic social contracts -- 5.The great transformation -- 6. Political democracy in the great society -- 7. Just returns in the great society -- 8. The sense of democratic justice.

Ganghof’s Beyond Presidentialism and Parliamentarianism advances three main claims: an innovative typology of comparative government, introducing the category of semi-parliamentarianism; an explication of two conceptions of majority rule, simple majoritarianism and complex majoritarianism; and a demonstration that there are viable systems of government embodying the political equality associated with each majoritarian conception. This paper explains these claims and identifies issues discussed in this symposium.

There are two discourses that are used in connection with the provision of good healthcare: a rights discourse and a beneficial design discourse. Although the logical force of these two discourses overlaps, they have distinct and incompatible implications for practical reasoning about health policy. The language of rights can be interpreted as the ground of a well-designed healthcare system stressing the values of equality and inclusion, but it has less application when dealing with questions of cost-effectiveness. This difference reflects the (...) distinction between the deontological status of rights claims and a teleological approach presupposed in the language of beneficial design. However, the value of the separateness of persons contained in the discourse of rights can impose constraints on the adoption of a simple maximizing principle when thinking about the allocation of healthcare resources within a social contract for health. Throughout these issues are discussed by reference to the work of Peter Jones. (shrink)

The political theory of the property-owning democracy can be seen as a way of overcoming the ideological conflict between individualism and collectivism. Rawls offers the contemporary reference-point for this theory. Rawls contrasted the ideal-type of the property-owning democracy with the ideal-type of a capitalist welfare state. However, the terms of that contrast are not well drawn and raise a number of questions, in particular regarding Rawls’s a priori specification of the welfare state. An inductively derived specification of ideal-typical welfare states (...) suggests that horizontal redistribution, in line with the principle of social savings, is more important than vertical redistribution. Rawls’s preference for a social dividend or negative income tax scheme can be contrasted with the use of social insurance, but the latter has a claim to instantiate Rawlsian ideals better than a social dividend. There is a potential problem with the pre-emption of private savings in the welfare state, but this turns out not to be troublesome empirically or conceptually. The irony of the discussion is that those who have interpreted Rawlsian theory as justifying the welfare state have the better of the argument, despite Rawls’s own views. (shrink)

The two books offer a contextual reinterpretation of Rawlsian and post-Rawlsian liberalism. Nelson’s main thesis is that debates in liberal political theory re-enact theological debates about theod...

Is it possible to reconcile a classical liberal approach to economics with a concern for the environment? The contributors to Economics and the Environment: A Reconciliation contend that it is. But they fail to distinguish properly between classical liberalism and a widespread orthodoxy in environmental policy communities in Europe and North America to the effect that economic instruments for environmental policy need more serious attention than they have hitherto received. Once this orthodoxy is distinguished from classical liberalism, the latter is (...) seen to be implausible. In particular, the classical liberal approach fails to deal with the practical and administrative problems involved in enforcing private property rights solutions to problems of environmental protection, wrongly generalizes from the failures of U.S. environmental policy to the failure of public regulation as such, and fails to take into account the claim that nature should be accorded intrinsic value. (shrink)

Brian Barry was the leading European normative political theorist of his generation, his intellectual influence being felt in Europe, North America, Australasia, and indeed wherever normative political theory in the analytical mode is practised. As well as being a Fellow of the British Academy, he was a Fellow of the American Academy of Arts and Sciences and the only Briton to have received the prestigious Johann Skytte prize from the University of Uppsala for achievement in the study of political science. (...) During his life Barry published seven single-authored books and five co-edited volumes, as well as over seventy articles and a large number of reviews and review essays, some of the latter being full-length and original articles in their own right. He had a deep and abiding commitment to the professionalization of the study of politics and was an inspiration to many younger scholars. (shrink)

Health systems that provide for universal patient access through a scheme of prepayments—whether through taxes, social insurance, or a combination of the two—need to make decisions on the scope of coverage that they secure. Such decisions are inherently controversial, implying, as they do, that some patients will receive less than comprehensive health care, or less than complete protection from the financial consequences of ill-heath, even when there is a clinically effective therapy to which they might have access.Controversial decisions of this (...) sort call for a public justification for covering or not covering a given treatment. Priority-setting agencies play a key role in providing such a justification. A recent... (shrink)

John Horton has argued for an associative theory of political obligation in which such obligation is seen as a concomitant of membership of a particular polity, where a polity provides the generic goods of order and security. Accompanying these substantive claims is a methodological thesis about the centrality of the phenomenology of ordinary moral consciousness to our understanding of the problem of political obligation. The phenomenological strategy seems modest but in some way it is far-reaching promising to dissolve some long-standing (...) problems of political theory. However, it fails at just the point at which a theory of political obligation is needed, namely when individuals question the grounds of their political obligation. A principle of obligation is needed to provide individuals with a reason for compliance with authoritative social rules when the exercise of that obligation is irksome. It is at this point that we need to invoke the idea of society as an implicit social contract, in which obligations are seen as stemming from those terms that it would be in the interests of individuals to agree in a social contract. This is consistent with the method of reflective equilibrium. (shrink)

This report is about ethical thinking in the field of health and health care. But it is no abstract philosophical tract. It is designed to be of practical help to those struggling with the complex questions of allocating resources in health care and to encourage a wider involvement at all levels in health debates. The questions it raises stimulate new thinking about today's institutional structures. As we proceeded with our work, we became aware that it is easier to state problems (...) than to solve them. However, we were also aware of the opposite danger of oversimplification implicit in the view that there was a moral calculus to which decisionmakers could turn when they were confronted by an ethical problem in the allocation of resources, and which would yield mechanical solutions to human problems. (shrink)

This paper identifies and responds to four critiques of democratic contractarianism, as advocated in Democratic Justice and the Social Contract, to be found in this symposium. The first is that, as a contingent practice-dependent account of justice, democratic contractarianism lacks the capacity to explain civic cooperation. The second is that, despite its intentions, Democratic Justice does not lay out an authentic contractarian theory. The third is that the theory is incompatible with our considered judgements about justice. And the fourth is (...) that the ambition of Democratic Justice to use the empirical method to compensate for the failures of hypothetical contract theory fails because all social science needs interpretation. To each of these critiques, replies are offered, drawing attention to the way in which democratic contractarianism exemplifies a logic of social cooperation to mutual advantage that is compatible with justice provided the cooperation emerges from a bargaining situation of roughly equal power. (shrink)

(2012). Introduction: The value and limits of rights: essays in honour of Peter Jones. Critical Review of International Social and Political Philosophy: Vol. 15, The Value and Limits of Rights: Essays in Honour of Peter Jones, pp. 387-394. doi: 10.1080/13698230.2012.699394.

In order to create sustainable health systems, many countries are introducing ways to prioritize health services underpinned by a process of health technology assessment. While this approach requires technical judgments of clinical effectiveness and cost-effectiveness, these are embedded in a wider set of social (societal) value judgments, including fairness, responsiveness to need, non-discrimination and obligations of accountability and transparency. Implementing controversial decisions faces legal, political and public challenge. To help generate acceptance for the need for health prioritization and the resulting (...) decisions, the purpose of this paper is to develop a novel way of encouraging key stakeholders, especially patients and the public, to become involved in the prioritization process. (shrink)

As health policy-makers around the world seek to make progress towards universal health coverage, they must navigate between two important ethical imperatives: to set national spending priorities fairly and efficiently; and to safeguard the right to health. These imperatives can conflict, leading some to conclude that rights-based approaches present a disruptive influence on health policy, hindering states’ efforts to set priorities fairly and efficiently. Here, we challenge this perception. We argue first that these points of tension stem largely from inadequate (...) interpretations of the aims of priority setting as well as the right to health. We then discuss various ways in which the right to health complements traditional concerns of priority setting and vice versa. Finally, we set out a three-step process by which policy-makers may navigate the ethical and legal considerations at play. (shrink)

One rationale policy-makers sometimes give for declining to fund a service or intervention is on the grounds that it would be ‘unaffordable’, which is to say, that the total cost of providing the service or intervention for all eligible recipients would exceed the budget limit. But does the mere fact that a service or intervention is unaffordable present a reason not to fund it? Thus far, the philosophical literature has remained largely silent on this issue. However, in this article, we (...) consider this kind of thinking in depth. Albeit with certain important caveats, we argue that the use of affordability criteria in matters of public financing commits what Parfit might have called a ‘mistake in moral mathematics’. First, it fails to abide by what we term a principle of ‘non-perfectionism’ in moral action: the mere fact that it is practically impossible for you to do all the good that you have reason to do does not present a reason not to do whatever good you can do. And second, when used as a means of arbitrating between which services to fund, affordability criteria can lead to a kind of ‘numerical discrimination’. Various attendant issues around fairness and lotteries are also discussed. (shrink)

'Justice' and 'democracy' have alternated as dominant themes in political philosophy over the last fifty years. Since its revival in the middle of the twentieth century, political philosophy has focused on first one and then the other of these two themes. Rarely, however, has it succeeded in holding them in joint focus. This volume brings together leading authors who consider the relationship between democracy and justice in a set of specially written chapters. The intrinsic justness of democracy is challenged, the (...) relationship between justice, democracy and impartiality queried and the relationship between justice, democracy and the common good examined. Further chapters explore the problem of social exclusion and issues surrounding sub-national groups in the context of democracy and justice. Authors include Keith Dowding, Richard Arneson, Norman Schofield, Albert Weale, Robert E. Goodin, Jon Elster, David Miller, Phillip Pettit, Julian LeGrand and Russell Hardin. (shrink)

I reply to each of the contributions in this issue. I agree with much that Hillel Steiner argues, especially his insistence that the associated ideas of impartiality and discontinuity are crucial to dealing satisfactorily with a diversity of competing claims. I am, however, less willing to conceive provision for that diversity as the role, rather than a role, that we should ascribe to rights. I question the success of David Miller’s endeavour to provide a unified justification of human rights grounded (...) in the concept of need. It is the notion of a minimally decent human life, rather than need itself, that does most of the justificatory work in Miller’s argument and, arguably, that notion does not deliver a genuinely unitary account of human rights. I concede the case for state funding of opera and the arts more generally to John Horton’s argument, but defend neutralism, and its associated distinction between the right and the good, as a strategy for dealing with diversity, including cultural diversity. I resist Richard Bellamy’s attempt to ground all basic rights in democracy and suggest that his argument relies upon idealized assumptions about the functioning of democracy. I share much of his objection to substituting judicial for political decision-making but argue that a strong moral commitment to rights need not imply a shift in power from democratic processes to courts. I endorse Albert Weale’s argument for favouring a beneficial design approach over a rights approach to healthcare and to many other social goods. Rights should not monopolize our moral and political thinking. (shrink)

What is the role of lay deliberation – if any – in health-care rationing, and administration more generally? Two potential answers are suggested by recent debates on the subject. The one, which I will call the technocratic answer, suggests that there is no distinctive role for lay participation once ordinary democratic politics have set the goals and priorities which reform should implement. Determining how best to achieve those ends, and then actually achieving them, this view suggests, is a matter for (...) experts, armed with the best evidence available to them, both of the subject area involved, and of management and administrative excellence. -/- By contrast, the second, deliberative, view holds that lay deliberation has an important role in the administration and execution of government policy, both because these latter inevitably have a political element which needs to reflect democratic norms and values, and because lay people are, themselves, a source of information, even of wisdom, that experts will want to use in fulfilling their professional responsibilities. Recent debates on the value of lay participation in healthcare provision can illuminate the strengths and weaknesses of both approaches, as can the experience of NICE. So, I will start by examining two articles by Albert Weale, which attempt to clarify the role that lay deliberation should have in healthcare, before turning to the dilemmas for both the technocratic and deliberative views which emerge from the experience of NICE. (shrink)

Here the philosopher and physicist David Z Albert argues, among other things, that the difference between past and future can be understood as a mechanical phenomenon of nature and that quantum mechanics makes it impossible to present the entirety of what can be said about the world as a narrative of “befores” and “afters.”.

This book is an attempt to get to the bottom of an acute and perennial tension between our best scientific pictures of the fundamental physical structure of the world and our everyday empirical experience of it. The trouble is about the direction of time. The situation (very briefly) is that it is a consequence of almost every one of those fundamental scientific pictures--and that it is at the same time radically at odds with our common sense--that whatever can happen can (...) just as naturally happen backwards. Albert provides an unprecedentedly clear, lively, and systematic new account--in the context of a Newtonian-Mechanical picture of the world--of the ultimate origins of the statistical regularities we see around us, of the temporal irreversibility of the Second Law of Thermodynamics, of the asymmetries in our epistemic access to the past and the future, and of our conviction that by acting now we can affect the future but not the past. Then, in the final section of the book, he generalizes the Newtonian picture to the quantum-mechanical case and (most interestingly) suggests a very deep potential connection between the problem of the direction of time and the quantum-mechanical measurement problem. The book aims to be both an original contribution to the present scientific and philosophical understanding of these matters at the most advanced level, and something in the nature of an elementary textbook on the subject accessible to interested high-school students. Table of Contents: Preface 1. Time-Reversal Invariance 2. Thermodynamics 3. Statistical Mechanics 4. The Reversibility Objections and the Past-Hypothesis 5. The Scope of Thermodynamics 6. The Asymmetries of Knowledge and Intervention 7. Quantum Mechanics Appendix: Gedankenexperiments with Heat Engines Index Reviews of this book: The foundations of statistical mechanisms are often presented in physics textbooks in a rather obscure and confused way. By challenging common ways of thinking about this subject, Time and Chance can do quite a lot to improve this situation. --Jean Bricmont, Science Albert is perfecting a style of foundational analysis that is uniquely his own...It has a surgical precision...and it is ruthless with pretensions. The foundations of thermodynamics is a topic that has accumulated a good deal of dead wood; this is a fire that will burn and burn. --Simon W. Saunders, Oxford University As usual with Albert's work, the exposition is brisk and to the point, and exceptionally clear...The book will be an extremely valuable contribution to the literature on the subject of philosophical issues in thermodynamics and statistical mechanics, a literature which has been thin on the ground but is now growing as it deserves to. --Lawrence Sklar, University of Michigan. (shrink)

Albert approaches critical rationalism as an alternative to other philosophical standpoints dominant in Germany: the conceptions of the Frankfurt School, hermeneutical thinking as represented by Gadamer, analytic philosophy, and logical empiricism. The author's purpose is to find a way out of the foundationalism of classical philosophy without falling back on the skeptical views so prevalent in today's philosophical thinking. Originally published in 1985. The Princeton Legacy Library uses the latest print-on-demand technology to again make available previously out-of-print books from (...) the distinguished backlist of Princeton University Press. These editions preserve the original texts of these important books while presenting them in durable paperback and hardcover editions. The goal of the Princeton Legacy Library is to vastly increase access to the rich scholarly heritage found in the thousands of books published by Princeton University Press since its founding in 1905. (shrink)

Once upon a time, the twentieth-century investigations of the behaviors of sub-atomic particles were thought to have established that there can be no such thing as an objective, observer-independent, scientifically realist, empirically adequate picture of the physical world.

In medical ethics, business ethics, and some branches of political philosophy (multi-culturalism, issues of just allocation, and equitable distribution) the literature increasingly combines insights from ethics and the social sciences. Some authors in medical ethics even speak of a new phase in the history of ethics, hailing "empirical ethics" as a logical next step in the development of practical ethics after the turn to "applied ethics." The name empirical ethics is ill-chosen because of its associations with "descriptive ethics." Unlike descriptive (...) ethics, however, empirical ethics aims to be both descriptive and normative. The first question on which I focus is what kind of empirical research is used by empirical ethics and for which purposes. I argue that the ultimate aim of all empirical ethics is to improve the context-sensitivity of ethics. The second question is whether empirical ethics is essentially connected with specific positions in meta-ethics. I show that in some kinds of meta-ethical theories, which I categorize as broad contextualist theories, there is an intrinsic need for connecting normative ethics with empirical social research. But context-sensitivity is a goal that can be aimed for from any meta-ethical position. (shrink)

Albert and De Ruiter provide an introduction to the Conversation Analytic approach to ‘repair’: the ways in which people detect and deal with troubles in speaking, hearing and understanding in conversation. They explain the basic turn‐taking structures involved, provide examples, explain recent developments in the field and highlight some important points of contact and contrast with work in the Cognitive Sciences.

This paper challenges the traditional assumption that descriptive and prescriptive sciences are essentially distinct by presenting a study on the implicit normativity of the production and presentation of biomedical scientific facts within evidence-based medicine. This interdisciplinary study serves as an illustration of the potential worth of the concept of implicit normativity for bioethics in general and for integrated empirical ethics research in particular. It demonstrates how both the production and presentation of scientific information in an evidence-based decision-support contain implicit presuppositions (...) and values, which pre-structure the moral environment of the clinical process of decision-making. As a consequence, the evidence-based decision support did not only support the clinical decision-making process; it also transformed it in a morally significant way. This phenomenon undermines the assumption within much of the literature on patient autonomy that information disclosure is a conditional requirement before patient autonomy even starts; patient autonomy is already influenced during the production and presentation of information. These results imply an increased responsibility of those who produce and present evidence-based facts(i.e. scientists in general and physicians in particular). The insights of this study not only involve a different focus on both theory and practice of patient autonomy and informed consent, but they also call for a broader scope of morality than does traditional empirical research in bioethics. The concept of implicit normativity within integrated empirical ethics research calls for a strong cooperation between bioethicists and descriptive scientists, i.e., a cooperation that goes beyond the discipline-specific epistemic values and that takes place during all phases of the research process. (shrink)