The arguments used by Gavin Mooney in his scornful response to Castigating QALYs, are examined. In spite of the rhetoric there is a broad measure of agreement about the deficiencies of QALYs as a means of distributing scarce resources. The main area of conflict is that John Rawles favours compaigning for more resources while Gavin Mooney, constrained by his remit as a health economist, favours acceptance of the present level of funding and better methods of distributing resources.

The “prescription” of humans' social learning bifocals is fine-tuned by cultural norms and, as a result, the readiness with which the instrumental or conventional lenses are used to view behavior differs across cultures. We present evidence for this possibility from cross-cultural work examining children's imitation and innovation.

The ethical problem of how to apportion limited resources amongst the needy has been forced on us by arbitrary limitation of health expenditure. Its solution would not be required if health expenditure were higher. Distribution of resources according to best value for money, assessed as Quality Adjusted Life Years (QALYs) per unit cost, has been suggested as a possible solution, but leads to absurd anomalies. In the calculation of QALYs the implied value of life is no more than the absence (...) of suffering. The use of QALYs for the comparison of treatments that are symptomatic or life-saving therefore leads to serious undervaluation of life and treatments that prolong it. Moreover, distribution of resources by best value for money, however assessed, is inequitable since for a given degree of suffering those whose illnesses happen to be cheaper to treat will be treated in preference to those whose treatments are more expensive. (shrink)

Editors provide a substantive introduction to the history and theories of perfectionism and neutrality, expertly contextualizing the essays and making the collection accessible.

The Last Gift is an observational HIV cure-related research study conducted with people with HIV at the end of life (EOL) at the University of California San Diego. Participants agree to voluntarily donate blood and other biospecimens while living and their bodies for a rapid research autopsy postmortem to better understand HIV reservoir dynamics throughout the entire body. The Last Gift study was initiated in 2017. Since then, 30 volunteers were enrolled who are either (1) terminally ill with a concomitant (...) condition and have a prognosis of 6 months or less or (2) chronically ill with multiple comorbidities and nearing the EOL.Multiple ethical and logistical challenges have been revealed during this time; here, we share our lessons learnt and ethical analysis. Issues relevant to healthcare research include surrogate informed consent, personal and professional boundaries, challenges posed conducting research in a pandemic, and clinician burnout and emotional support. Issues more specific to EOL and postmortem research include dual roles of clinical care and research teams, communication between research personnel and clinical teams, legally required versus rapid research autopsy, identification of next of kin/loved ones and issues of inclusion. Issues specific to the Last Gift include logistics of body donation and rapid research autopsy, and disposition of the body as a study benefit.We recommend EOL research teams to have clear provisions around surrogate informed consent, rotate personnel to maintain boundaries, limit direct contact with staff associated with clinical care and have a clear plan for legally required versus research autopsies, among other recommendations. (shrink)

The question 'Why should I obey the law?' introduces a contemporary puzzle that is as old as philosophy itself. The puzzle is especially troublesome if we think of cases in which breaking the law is not otherwise wrongful, and in which the chances of getting caught are negligible. Philosophers from Socrates to H.L.A. Hart have struggled to give reasoned support to the idea that we do have a general moral duty to obey the law but, more recently, the greater number (...) of learned voices has expressed doubt that there is any such duty, at least as traditionally conceived. (shrink)

Equality and Liberty: Analysing Rawls and Nozick is an indispensable source for those seriously interested in some rigorous assessments of the ideas of America's two most popular political philosophers. The essays in this volume cover a wide range of topics, some engaging each other in their analyses of particular Rawlsian or Nozickian themes. This collection of recent essays brings the student up-to-date concerning some of the more recent developments and assessments of Rawlsian and Nozickian ideas.

Scanlon suggests a buck-passing account of goodness. To say that something is good is not to give a reason to, say, favour it; rather it is to say that there are such reasons. When it comes to wrongness, however, Scanlon rejects a buck-passing account: to say that j ing is wrong is, on his view, to give a sufficient moral reason not to j. Philip Stratton-Lake 2003 argues that Scanlon can evade a redundancy objection against his (Scanlon’s) view of wrongness (...) by adopting a buck-passing account of wrongness. We argue that this manoeuvre does not succeed. Scanlon’s notion of wrongness rests on the idea of a reasonably rejectable principle. As Stratton-Lake points out, Scanlon offers two accounts, one in terms of permission, the other in terms of proscription. The permission account is tricky to formulate. Scanlon’s account (quoted in Stratton-Lake 2003: 71) might suggest any of the following four formulations (where the principles in question are principles ‘governing how one may act’ (Scanlon.. (shrink)

The Rawls–Habermas debate is having a revival. In this article I argue that both philosophers develop different freestanding conceptions of political legitimacy, and show how they diverge when it comes to how political legitimacy can be justified. Habermas is looking for a deeper justification than Rawls will allow for. I then proceed to show how the different meta-ethical positions yield two different versions of democratic theory, focusing in particular on rights and popular sovereignty. I demonstrate how both conceive (...) of the co-originality of private and public autonomy, and subsequently take issue with Habermas’ reading of Rawls. I argue that Rawls should not be understood as a natural rights theorist, that Habermas misunderstands the role of the original position, and that Rawls cannot be considered a strong constitutionalist. Thus, the real difference between Rawls and Habermas revolves around their different conceptions of political legitimacy. (shrink)

Several areas of welfare economics seek to evaluate states of affairs as a function of interpersonally comparable individual utilities. The aim is to map each state of affairs onto a vector of individual utilities, and then to produce an ordering of these vectors that can be represented by a mathematical function assigning a real number to each. When this approach is used in intertemporal contexts, a central theoretical question concerns the evaluative weight to be applied to utility coming at different (...) times. This question concerns the rate of pure time preference, which is one key determinant of the social discount rate. This article argues that the standard philosophical account of pure time preference is mistaken, because it ascribes to economists a methodological commitment they need not, and often do not, accept. This in turn undercuts the most common philosophical objection to pure time preference, which traces at least to Rawls’s A Theory of Justice. The article then evaluates three further objections to pure time preference, concluding that it might still be defensible under certain circumstances. The article closes by articulating a final argument that is suggested by the “Social, Economic and Ethical Concepts and Methods” chapter of the most recent Intergovernmental Panel on Climate Change report. If this further argument is sound, it would constitute a decisive objection to pure time preference as it currently figures in much intertemporal welfare economics. (shrink)

The meaning of valid proxy consent for children has recently been the subject of an important debate between Richard McCormick and Paul Ramsey on the ethics of experimenting with children. Ramsey is willing to agree with McCormick that parental consent for a child to undergo some medical procedure is valid only if parents consider what the child would consent to if he could. But beyond this, Ramsey has a fundamentally different conception of the child from McCormick, and therefore gives a (...) very different interpretation to this standard for valid proxy consent. In Ramsey's view, McCormick's basic mistake is to think of the child as a small adult, thereby overlooking the child's peculiar vulnerabilities and needs. In particular, McCormick fails to attend to the child's needs for "preservation in life and healthful growth". In this paper, the author pursues Ramsey's suggestion that a correct analysis of valid proxy consent for children would replace the "language of consent" with the "language of need". He does this by sketching a theory of parenthood that rests on two central notions: that of primary goods, as found in the writing of John Rawls, and that of autonomy. (shrink)

After some preliminaries concerning the original character of Rawls's formulation of the problem of social justice the author discusses the question, whether the proposed principles of justice for the basic structure of society bear the marks of a liberal theory.The conclusion of this part (IA) is that Rawls seems to have in view a mixed society, or perhaps rather a society which transcends the contrast between liberalism and socialism.Some critics have ascribed to Rawls the view of man (...) of classical liberalism and for this reason have considered him a liberal. The author contends that these critics do not seem to have grasped the purely methodological significance of the concept of the original position. After some preliminaries concerning the original character of Rawls's formulation of the problem of social justice the author discusses the question, whether the proposed principles of justice for the basic structure of society bear the marks of a liberal theory.The conclusion of this part (IA) is that Rawls seems to have in view a mixed society, or perhaps rather a society which transcends the contrast between liberalism and socialism.Some critics have ascribed to Rawls the view of man of classical liberalism and for this reason have considered him a liberal. The author contends that these critics do not seem to have grasped the purely methodological significance of the concept of the original position. After a short interlude in which the conceptions of justice of Marx and Rawls are compared (IB) the author presents some considerations of a critical nature as regards the principles of justice (IC). The distinction between the general and the special conception of justice hinges on the lixical priority of freedom. Now, a contradiction seems to emerge between the fact that the choice in favor of the special conception is an absolute one, valid for all societies regardless of time and place, and the fact that the general conception is sometimes presented as a first phase in the evolution of a well-ordered society (sect.82). This is an indication that in Rawl's theory the priority of freedom is not as absolute as he thinks it to be. The decisive point in this respect seems to be the fact that the „fair value of liberty” (Sect. 36) would demand that a subsistence minimum is lexically prior to freedom. These seem to be serious inconsistencies for which nnno remedy can be found and which are apt to lead us back to „instuitionism” The author considers next (and this is his main point) the logical structure of Rawls's contract theory, which in his opinion stands in urgent need of clarification. It is argued that the concept of contract as such implies a certain indifference or indeterminateness as regards its result. At the other hand, the result (that which is agreed upon, i.e. the principles of justice) is ex hypothesi considered to explain „our considered judgements” in reflective equilibrium. In this way it appears that Rawl's central idea (rather implicitly) is : there exists a consensus as regards our considered judgements concerning justice and this consensus may be explained as resulting from a (hypothetical) contract. So the argument really is of a hypothetico-deductive nature and it would have been much better if Rawls had been clear about it himself. Some critical considerations follow. First attention is paid to the fact that strict observance is an essential element of the concept of contract and that from this point of view the three psychological laws (chapt. VIII) are of crucial importance to the theory. Their nature, however, is not altogether clear. They are neither empirical laws (because they presuppose a just institutional structure and a just society is said not to exist), nor are they a priori ones. So it is only left for us to say that they are construed as empirical laws. Now, the difficulty for Rawls with this must be that reliance on such laws is inconsistent with the rationality of the parties in the original position, because as a matter of fact these laws have not been tested empirically (the fact that they can not be tested in this way makes no difference at all). Secondly it is asked whether we are dealing with a contract doctrine at all. Starting from the question, whether in this theory the notion of contract (intended to explain our considered judgements as givens) really is an ultimate explanatory concept, it is argued that there are some anthropological presuppositions, which rather point in the direction of a theory of self-realization. This seems to be confirmed by some other features of the theory, e. g. the Aristotelian principle, the Kantian interpretation, the concept of natural rights, and society as a social union of social unions. In conclusion, neither Rawls's principles of justice nor his contract theory are sufficiently consistent to escape the need of reconsideration. (shrink)

This paper explicates and challenges John Rawl's argument concerning a rule-utilitarian theory of punishment. In so doing, it argues in favour of a retributivist theory of punishment, one that seeks to justify, not only particular forms of punishment, but the institution of punishment itself. Some crucial objections to retributivism are then considered: one regarding the adverse effects of punishment on the innocent, another concerning proportional punishment, a third pertaining to vengeance and retribution, a Marxian concern with retributive punishment, and a (...) concern with the concept of desert. Each objection is deflected in order to ward-off what seem to be the most serious criticisms of a retributivist view of punishment and to clarify the depth of the retributivist position. (shrink)

For over twenty years, Paul Weithman has explored the thought of John Rawls to ask how liberalism can secure the principled allegiance of those people whom Rawls called 'citizens of faith'. This volume brings together ten of his major essays, which reflect on the task and political character of political philosophy, the ways in which liberalism does and does not privatize religion, the role of liberal legitimacy in Rawls's theory, and the requirements of public reason. The essays (...) reveal Rawls as a thinker deeply engaged with political and existential questions that trouble citizens of faith, and explore how - in firm opposition to political realism - he tries to show that the possibility of liberal democracy and the natural goodness of humanity are objects of reasonable faith. The volume will be of interest to political philosophers, political theorists, moral theologians, and religious ethicists. (shrink)

Should scientific facts and methods have an epistemically privileged status in public reason? In Rawls’s public reason account he asserts what we will label the Scientific Standard Stricture: citizens engaged in public reason must be guided by non-controversial scientific methods, and public reason must be in line with non-controversial scientific conclusions. The Scientific Standard Stricture is meant to fulfill important tasks such as enabling the determinateness and publicity of the public reason framework. However, Rawls leaves us without elucidation (...) with regard to when science is and is not ‘non-controversial’ and more importantly, we are left without a justification for a stricture which excludes certain controversial beliefs and methods of inquiry from the realm of political justification. In this article, we offer what we deem to be the most plausible interpretation of Rawls’s Scientific Standards Stricture. We then use Rawls’s general theoretical framework to examine various potential justifications for privileging these ‘non-controversial’ scientific methods and conclusions. We conclude that no viable justification is available to Rawls. (shrink)

Would a just society or government absolutely refrain from shaming or humiliating any of its members? "No," says this essay. It describes morally acceptable uses of shame, stigma and disgust as tools of social control in a decent (just) society. These uses involve criminal law, tort law, and informal social norms. The standard of moral acceptability proposed for determining the line is a version of perfectionistic prioritarian consequenstialism. From this standpoint, criticism is developed against Martha Nussbaum's view that to respect (...) the dignity of each person, society absolutely must refrain from certain ways of shaming and humiliating its members and rendering them objects of communal disgust. (shrink)

This essay disputes G. A. Cohen's claim that John Rawls's argument for the difference principle involves an argument from moral arbitrariness to equality and then an illicit move away from equality. Moreover, the claim that an argument from moral arbitrariness establishes equality as the essential distributive justice ideal is found wanting.

This paper discusses the attempt in this issue of the journal by Peter Singer, John McKie, Helga Kuhse and Jeff Richardson, to defend QALYs against the argument from double jeopardy which I first outlined in 1987. In showing how the QALY and other similar measures which combine life expectancy and quality of life and use these to justify particular allocations of health care resource, remain vulnerable to the charge of double jeopardy I am able to clarify some of the central (...) issues concerning the value of life. In particular, the idea that the value of a life varies with its life expectancy and with its quality, understood in terms of its richness, variety, success etc, is subjected to special examination. It is shown how defenders of QALYs are committed to the view that so far from all lives being of equal value, all lives are necessarily of subtly different value. The paper then analyses the use to which the notorious 'veil of ignorance' has been put both by Singer et al and by others and shows how this device of John Rawls's cannot do the work so often assigned to it. The paper then considers the issue of hypothetical consent and the role that it can play in justifying disposing of the lives of people who have not in fact consented to their lives being disposed of in particular ways. Finally, the paper makes some points about the comprehensive nature of the data collection and storage which would be required by QALY advocates and points out the independent problems attaching to licensing such comprehensive collection and use of personal data. (shrink)

In recent years Michael Sandel’s communitarian criticism of John Rawls’s theory of justice has gained much attention in philosophical circles. Specifically, he takes issue with the conception of the self—implicit in Rawls’s “veil of ignorance”: an extraction of the individual from their social environment, which creates an “unencumbered self” that is then used to theorize about justice. Sandel believes that some social ties are so deeply embedded in the human experience that even hypothetical isolation of the individual is (...) likely to lead ethical thinking astray. Additionally, he thinks that human emotions and other circumstantial considerations need to be taken into account. His emphasis on the situated self has... (shrink)

Suppose two players wish to divide a finite set of indivisible items, over which each distributes a specified number of points. Assuming the utility of a player’s bundle is the sum of the points it assigns to the items it contains, we analyze what divisions are fair. We show that if there is an envy-free (EF) allocation of the items, two other desirable properties—Pareto-optimality (PO) and Maximinality (MM)—can also be satisfied, rendering these three properties compatible. But there may be no (...) EF division, in which case some division must satisfy a modification of Bentham’s (1789/2017) “greatest satisfaction of the greatest number” property, called maximum Nash welfare (MNW), that satisfies PO. However, an MNF division may be neither MM nor EFX, which is a weaker form of EF. We conjecture that there is always an EFX allocation that satisfies MM, ensuring that an allocation is maximin, precisely the property that Rawls (1971/1999) championed. We discuss four broader philosophical implications of our more technical analysis. (shrink)

A liberal society seeks not to impose a single way of life, but to leave its citizens as free as possible to choose their own values and ends. It therefore must govern by principles of justice that do not presuppose any particular vision of the good life. But can any such principles be found? And if not, what are the consequences for justice as a moral and political ideal? These are the questions Michael Sandel takes up in this penetrating critique (...) of contemporary liberalism. Sandel locates modern liberalism in the tradition of Kant, and focuses on its most influential recent expression in the work of John Rawls. In the most important challenge yet to Rawls' theory of justice, Sandel traces the limits of liberalism to the conception of the person that underlies it, and argues for a deeper understanding of community than liberalism allows. (shrink)

Here I argue that the hyper-individualistic and rationalistic ethical paradigms – originating in the late eighteenth century and dominating moral philosophy, in various permutations, ever since – cannot capture the moral concerns evoked by the prospect of global climate change. Those paradigms are undone by the temporal and spatial scales of climate change. To press my argument, I deploy two famous philosophical tropes – John Rawls's notion of the original position and Derek Parfit's paradox – and another that promises (...) to become famous: Dale Jamieson's six little ditties about Jack and Jill. I then go on to argue that the spatial and especially the temporal scales of global climate change demand a shift in moral philosophy from a hyper-individualistic ontology to a thoroughly holistic ontology. It also demands a shift from a reason-based to a sentiment-based moral psychology. Holism in environmental ethics is usually coupled with non-anthropocentrism in theories constructed to provide moral considerability for transorganismic entities – such as species, biotic communities, and ecosystems. The spatial and temporal scales of climate, however, render non-anthropocentric environmental ethics otiose, as I more fully explain. Thus the environmental ethic here proposed to meet the moral challenge of global climate change is holistic but anthropocentric. I start with Jamieson's six little ditties about Jack and Jill. (shrink)

There is a tension between Robert Talisse's rejection of Deweyan democracy and his project of formulating a workable Peircean conception of democracy. If he follows Rawls in taking reasonable pluralism to be a permanent condition, then his Peircean conception of democracy is undermined. But, if he does not commit to the permanence of reasonable pluralism, then his rejection of Deweyan democracy is problematic. Since he chooses the latter interpretation, Talisse must bite the bullet and recognize that Peircean epistemic perfectionists (...) cannot yet bid a definitive farewell to Deweyan democracy. (shrink)

G.A. Cohen criticizes Rawls’s account of justice because his difference principle permits inequalities that reflect the relative scarcity of different skills and natural abilities. Instead of viewing the ‘basic structure’ as the primary subject of justice, Cohen argues that individual citizens should cultivate an egalitarian ethos, which would enable a just society to dispense with the use of incentive payments to induce individuals to use their talents in socially ideal ways. This study examines Cohen’s critique, including his rejection of (...) ‘incentives,’ and vindicates Rawls’s approach. Ultimately, Cohen’s argument fails to grapple with the moral pluralism that characterizes modern, democratic societies, whereas Rawls’s theory is constructed to accommodate such pluralism. (shrink)