My invitation to respond to Lepora and Goodin may be the result of my work on complicity—in particular, the participation of health professionals in torture and aggressive interrogation in the so-called ‘war on terror’.1,2 However, instead of responding to the précis, I intend to address the section of the authors' book dealing with compromise and to explore the implications of their approach for some pressing public health issues.3,4 In their chapter entitled ‘Compromise as a Template’, Lepora and Goodin contend that (...) ‘[i]t is only when the intra-personal conflict forces an agent to choose among items of principled concern … to her that a compromise is genuinely involved’ (p. 19). The authors are right to emphasise the ethical significance of setting aside, forsaking or violating one's principles to reach an agreement. There may be serious implications for the integrity of an individual or an institution that makes such a compromise. But we should ensure that the intrapersonal focus does not lead to the neglect of other important ethical dimensions. A compromise may be problematic because of its impact on others who are affected by, but are not …. (shrink)

This paper firstly distinguishes between principles of “global justice” that apply the same anywhere and everywhere – Tännsjö’s utilitarianism, egalitarianism, prioritarianism and such like – and principles of “local justice” that apply within the specific sphere of health-care. Sometimes the latter might just be a special case of the former – but not always. Secondly, it discusses reasons, many psychological in nature, why physicians might devote excessive resources to prolonging life pointlessly, showing once again that those reasons might themselves be (...) morally significant. (shrink)