The use of the Quality Adjusted Life-Year (QALY) as a measure of the benefit obtained from health care expenditure has been attacked on the ground that it gives a lower value to preserving the lives of people with a permanent disability or illness than to preserving the lives of those who are healthy and not disabled. The reason for this is that the quality of life of those with illness or disability is ranked, on the QALY scale, below that of (...) someone without a disability or illness. Hence we can, other things being equal, gain more QALYs by saving the lives of those without a permanent disability or illness than by saving the lives of those who are disadvantaged in these ways. But to do so puts these disadvantaged people under a kind of double jeopardy. Not only do they suffer from the disability or illness, but because of it, a low priority is given to forms of health care that can preserve their lives. This, so the objection runs, is unjust or unfair. This article assesses this objection to the use of QALYs as a basis for allocating health care resources. It seeks to determine what is sound in the double jeopardy objection, and then to show that the defender of QALYs has an adequate response to it. (shrink)

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)

Harris levels two main criticisms against our original defence of QALYs (Quality Adjusted Life Years). First, he rejects the assumption implicit in the QALY approach that not all lives are of equal value. Second, he rejects our appeal to Rawls's veil of ignorance test in support of the QALY method. In the present article we defend QALYs against Harris's criticisms. We argue that some of the conclusions Harris draws from our view that resources should be allocated on the basis of (...) potential improvements in quality of life and quantity of life are erroneous, and that others lack the moral implications Harris claims for them. On the other hand, we defend our claim that a rational egoist, behind a veil of ignorance, could consistently choose to allocate life-saving resources in accordance with the QALY method, despite Harris's claim that a rational egoist would allocate randomly if there is no better than a 50% chance of being the recipient. (shrink)

Section 75 of the Criminal Justice Act (CJA) of 2003 overturned the principle in English law that a person cannot be retried for an offense of which he has been acquitted, recognizing advances in forensic science that uses modern analysis of DNA in adducing in evidence. The special plea of autrefois acquit can be overturned based on finding of compelling evidence after a previous acquittal of a suspect who can now be tried again for the same offense. The double (...) jeopardy arises only after a lawful acquittal or autrefois convict of the accused for the first offense and these principles have allowed exceptions to the rule against double jeopardy developed by the courts. There is an analogous rule in common law courts based on the unreasonable splitting of the case when there is a severing of indictments which overrides the bar on the accused being retried for the same offense. This paper examines the difficulty of trying a defendant fairly in the English courts when the defense has pleaded an abuse of process and there is no clear overall argument for trial. This question needs an appraisal of legal ethics in criminal courts because a retrial of the accused on the same charge breaches the autrefois acquit doctrine, and severing of an indictment can cause the fair trial process to be undermined. (shrink)

There have been recent concerns about an “epidemic of loneliness” during the pandemic, given the pervasiveness of loneliness in the population and its harmful effects on health and well-being. Therefore, it is important to establish the correlates of loneliness. The purpose of the current study was to explore how loneliness relates to a construct termed mattering, which is the feeling of being important to other people. Mattering was assessed with multiple measures in the current study (e.g., mattering in general, fears (...) of not mattering, and mattering to peers). A sample of 172 female psychology undergraduate students aged 18–25 years completed self-report measures of general mattering, mattering to peers, anti-mattering, fear of not mattering, and state and trait loneliness. As predicted, lower levels of both general mattering and mattering to peers were associated with higher state loneliness. Higher feelings of anti-mattering (feelings of being invisible and insignificant to others) and fears of not mattering were associated with greater trait loneliness, as well as a reduced sense of mattering to friends. The findings illustrate that feeling as though one does not matter to others (i.e., feeling insignificant and unimportant) is associated with increased state and trait loneliness among young women. Implications are discussed for loneliness theory and how these results can enhance both clinical understanding and practice. (shrink)

In this study we aim to analyze the combined effect of age-based and gender stereotype threat on work identity processes and on work performance. The research utilizes an ample sample of over fifty-year-old workers from diverse organizations in Italy. Using a person-centered approach four clusters of workers were identified: low in both age-based and gender stereotype threat, high in gender and low in age-based stereotype threat, high in age-based and low in gender stereotype threat and high in both gender and (...) age-based stereotype threat. Gender was significantly associated with these clusters and women were more frequently present in those groups with high gender stereotype threat. ANOVA results show that workers in the last two clusters score significantly lower in authenticity, organizational identification and self-rate performance. All in all, if ageism is undoubtedly problematic for older workers’ identity processes, ageism and gender-stereotypes represent a double risk for women over fifty in the workplace. The analysis of the results can be beneficial both for the theoretical advancement and for the practical insights offered in the organizational and management field, where new policies of HR management can be elaborated, in order to value and to improve the workers experience. (shrink)

A second demonstration (more powerful because more subtle) of how a prevalent scope error can render a model invalid, and thus how difficult modeling really is. The prevalence indicates the difficulty, as the error is often built-in and very subtle and thus easily escapes notice.

Research ethics committees ‘ members’ perceptions of their role in regard to the science of research proposals are discussed. Our study, which involved the interviewing of 20 participants from amongst the UK’s independent ethics committees, revealed that the members consider that it is the role of the REC to examine and approve the scientific adequacy of the research – and this notwithstanding the fact that a more competent body will already have done this and even when that other body has (...) the legal responsibility for this function. The problematic nature of this situation, tantamount to double jeopardy, is considered: it can delay research and so add to costs whilst offering no countervailing benefits, or the double jeopardy may be just the cost society imposes, through its RECs, on researchers as the price for research on human subjects. (shrink)

George C. Thomas III, Double Jeopardy: The History, the Law New York University Press, 1998,349 pp.

The foundational conviction of contemporary liberal thought is that all persons possess equal moral worth and are entitled to equal concern and respect by others. At the same time, nation states, as the primary organs of our collective self-governance, frequently pursue policies that are strikingly partial towards the interests of compatriots over those of foreigners. A common strategy for justifying this national partiality is to view it as grounded in associative obligations that we incur by standing in special relationships with (...) our fellow citizens. For instance, according to familiar arguments from ‘fair play’, voluntarily partaking in and benefiting from cooperative relationships with our fellow citizens gives us reciprocal obligations to maintain these social institutions and care for needy compatriots. By contrast, we do not have corresponding associative obligations towards foreigners. I maintain that such arguments from associative obligations face an important stumbling block. I argue for the following “Boundary Principle”, according to which we cannot appeal to special relationships amongst members of a group to justify an attitude of partiality towards them unless the boundaries of this group, and the fact that they exclude other persons from membership, can also be justified. If this is right, arguments from associative obligations, by themselves, are necessarily incomplete. Most modern states severely limit the scope of economic migration, and thereby prevent many would-be contributors to the collective enterprises of affluent societies from entering into those special relationships with us that would give rise to associative obligations on our part. Not only are would-be immigrants excluded from the benefits that participation in the cooperative schemes of affluent nation-states would itself confer; in addition, the fact that they do not stand in such cooperative relationships with us is then appealed to in order to justify the fact that we assign significantly less weight to their interests in the formulation of state policy. The upshot of my discussion is not that a defense of national partiality in terms of associative obligations cannot succeed. It is rather that a successful defense of national partiality in these terms is more closely tied to the question whether principled restrictions can be placed on immigration than most political philosophers have hitherto assumed. (shrink)

The traditional disputants in the free will discussion--the libertarian, soft determinist, and hard determinist--agree that free will is a coherent concept, while disagreeing on how the concept might be satisfied and whether it can, in fact, be satisfied. In this innovative analysis, Richard Double offers a bold new argument, rejecting all of the traditional theories and proposing that the concept of free will cannot be satisfied, no matter what the nature of reality. Arguing that there is unavoidable conflict within (...) our understanding of moral responsibility and free choice, Double seeks to prove that when we ascribe responsibility, blame, or freedom, we merely express attitudes, rather than state anything capable of truth or falsity. Free will, he concludes, is essentially an incoherent notion. (shrink)

Why is debate over the free will problem so intractable? In this broad and stimulating look at the philosophical enterprise, Richard Double uses the free will controversy to build on the subjectivist conclusion he developed in The Non-Reality of Free Will (OUP 1991). Double argues that various views about free will--e.g., compatibilism, incompatibilism, and even subjectivism--are compelling if, and only if, we adopt supporting metaphilosophical views. Because metaphilosophical considerations are not provable, we cannot show any free will theory (...) to be most reasonable. Metaphilosophy and Free Will deconstructs the free will problem and, by example, challenges philosophers in other areas to show how their philosophical argumentation can succeed. (shrink)

Confidence ratings have often been integrated into reasoning and intelligence tasks as a means for assessing meta-reasoning processes. Although it is often assumed that eliciting these judgements throughout reasoning tasks has no effect on the underlying performance outcomes, this is yet to be established empirically. The current study examines whether eliciting CR from participants during a fluid-reasoning task influences their performance and how this effect is moderated by their initial self-confidence in their own reasoning abilities. In a first experiment, we (...) found that participants performing CR during Raven's Progressive Matrices significantly outperformed a control group who did not provide ratings. Additionally, a second experiment demonstrated that CR only facilitated performance in participants who have a high level of initial self-confidence in their reasoning ability, whereas they were detrimental to participants low in self-confidence. (shrink)

The following is a criticism designed to apply to most libertarian free will theorists. I argue that most libertarians hold three beliefs that jointly show them to be unsympathetic or hard-hearted to persons whom they hold morally responsible: that persons are morally responsible only because they make libertarian choices, that we should hold persons responsible, and that we lack epistemic justification for thinking persons make such choices. Softhearted persons who held these three beliefs would espouse hard determinism, which exonerates all (...) persons of moral responsibility, or, at least, would not espouse libertarianism. I do not address the view held by some libertarians that we do have epistemic justification for thinking that persons make libertarian choices, a minority position that I believe cannot be sustained. (shrink)

Philosophers’ intuitions about what constitutes autonomy are largely driven by the exemplars or paradigms that we recognize. There are indefinitely many exemplars, inasmuch as there are relatively private personae that serve as autonomy exemplars such as our parents, third grade teacher, or, for the megalomaniac, oneself. But among Western philosophers there are doubtless some exemplars that are widely shared and broadly influential. Philosophical exemplars include Socrates, Aristotle’s magnanimous man, Kant’s noumenal self that is perfectly attuned to the moral law, Mill’s (...) anti-authoritarian non-conformist, Marx’s manin-society, Nietzsche’s Zarathustra, and Sartre’s authentic youth who must decide whether to join the French resistance or stay at home for the sake of his mother. Exemplars from outside of philosophy include Antigone, Christ, Faust, Ibsen’s Enemy of the People, Winston Churchill, and even figures from popular culture such as the baseball player Ted Williams, the free spirited flower children of the 1960s, and practically any character that John Wayne ever played. (shrink)

In this article I consider when the question of whether entities exist subjectively (only in the minds of subjects) or objectively (in themselves, independently of the minds of subjects) is important, both theoretically and practically. I argue that when it comes to the metaphysics underlying three types of moral questions, broadly conceived, the subjectivity question does not matter practically, although it is widely thought to matter. Subjectivism does not matter in these moral questions in the same way(s) it matters in (...) some nonmoral metaphysical issues. The moral questions I consider are the meaning of life, normative ethics, and the free‐will problem. The nonmoral issues I address are the existence of God, the traditional mind/body problem, and personal identity. I explain the difference by noting that certain metaphysical issues on the fact side of the fact/value distinction impinge on persons' lives more prominently than do the metaphysics behind the three moral questions. (shrink)

The objection to R-S accounts that was raised by the possibility of external agents requires the acceptance of two premises, viz., that all R-S accounts allow for puppeteers and that puppeteers necessarily make us unfree. The Metaphilosophical reply shows that to the extent that puppeteers are more problematic than determinism per se, pup-peteers may be explicitly excluded since they violate our paradigm of free will. The Metaphilosophical reply also suggests that we should not expect our mature R-S account to supply (...) logically necessary and sufficient conditions for free will, but rather give us answers that agree with our intuitions regarding paradigms of free and unfree decisions. The Irrelevancy reply completed our reply to incompatibilists who continue to object that determinism per se destroys the R-S program. It may be debated whether my autonomy variable account is a satisfactory way to spell out the Irrelevancy reply, but I think that this type of approach suggests the way to vindicating the R-S view from an important type of objection. (shrink)

In “The Moral Hardness of Libertarianism”, I accuse libertarians of being morally unsympathetic if they hold three widely shared beliefs: that persons are morally responsible only if they make libertarian choices; that we should hold persons morally responsible; and that we lack epistemic justification for thinking persons make libertarian choices. In “Hard-Heartedness and Libertarianism”, John Lemos, relying on the Kantian principle of ends, suggests a way for libertarians to accept these three beliefs while avoiding the charge of hard-heartedness. In this (...) paper, I criticize Lemos’s rebuttal. (shrink)

Psychiatry is increasingly dominated by the reductionist claim that mental illness is caused by neurobiological abnormalities such as chemical imbalances in the brain. Critical psychiatry does not believe that this is the whole story and proposes a more ethical foundation for practice. This book describes an original framework for renewing mental health services in alliance with people with mental health problems. It is an advance over the polarization created by the "anti-psychiatry" of the past.

The belief that only free will supports assignments of moral responsibility -- deserved praise and blame, punishment and reward, and the expression of reactive attitudes and moral censure -- has fueled most of the historical concern over the existence of free will. Free will's connection to moral responsibility also drives contemporary thinkers as diverse in their substantive positions as Peter Strawson, Thomas Nagel, Peter van Inwagen, Galen Strawson, and Robert Kane. A simple, but powerful, reason for thinking that philosophers are (...) correct in making moral responsibility the prize of the free will problem is this: If we disassociate free will from deserved praise, blame, punishment and reward, reactive attitudes and moral censure, then why care about free will? If free will is not pinned down as that degree of freedom in our choices that we need for moral responsibility, it is difficult to see why anyone would or should care about free will. In this article I argue that some of the most prominent recent writing on free will becomes sidetracked from this key issue. For this reason, a good deal of the literature is so much spilled ink as philosophers misdirect their energies. In section 1 I elaborate just what I believe the key issue in the free will problem is. In section 2 I illustrate what an answer to the key issue requires. In section 3 I suggest motivations for misdirection. In sections 4, 5, and 6 I provide detailed examples of misdirection from compatibilists and libertarians. In sections 7 and 8 I describe some non-misdirected answers to the key question. (shrink)

In "The Illusion of Conscious Will," Daniel Wegner (2002) argues that our commonsense belief that our conscious choices cause our voluntary actions is mistaken. Wegner cites experimental results that suggest that brain processes initiate our actions before we become consciously aware of our choices, showing that we are systematically wrong in thinking that we consciously cause our actions. Wegner's view leads him to conclude, among other things, that moral responsibility does not exist. In this article I propose some ways that (...) traditional philosophical defenders of moral responsibility, both compatibilists and libertarians, might accept Wegner's empirical premise regarding the will but amend their theories so that they may reject his conclusion regarding moral responsibility. (shrink)

Richard Double takes us through James' defence of belief in God, exposing a few fallacies along the way.

John searle has recently claimed to have dissolved what daniel dennett calls 'hume's problem'--The question whether the explanation of behavior by appeal to mental representations can be done without circularity or infinite regress. Searle argues that a careful analysis of the concept of an intentional state shows that mental representations do not require intentional "homunculi" to explain how intentional states have their contents, And, Hence dennett's worry is groundless. I argue that searle's conceptual analysis of intentional states, Even if correct, (...) Provides no clue of an answer to the worry underlying hume's problem. (shrink)

Adopting meta‐level Free Will Subjectivism is one among several ways to maintain that persons never experience moral freedom in their choices. The other ways of arguing against moral freedom I consider are presented by Saul Smilansky, Ted Honderich, Bruce Waller, Galen Strawson, and Derk Pereboom. In this paper, without arguing for the acceptance of free will subjectivism, I argue that subjectivism has some moral and theoretical advantages over its kindred theories.

Psychologists and common sense recognize blaming the victim as a cognitive error (fallacy) that many of us use to support the just-world hypothesis — the view that life is basically fair. In this article Richard Double compares a related phenomenon, blaming the culprit. When we commit the fallacy of blaming the culprit we mistakenly conclude that judging a culprit to deserve blame for an action exonerates everyone else from blame for that action. Double provides several examples of the (...) fallacy. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Eclecticism and Adolf Meyer’s Functional Understanding of Mental IllnessD. B. Double (bio)KeywordsAdolf Meyer, eclecticism, functionalism, biopsychosocial modelGhaemi’s Commentary and Meyer’s ‘Eclecticism’I am not against humanism. How could anyone be against the humanistic wisdom rooted in the worthy writings of Socrates, Hippocrates, Shakespeare, Cervantes, Osler, and the others listed by Nassir Ghaemi? Psychiatry should recognize the dignity and value of all people. The problem is that it may not (...) always do so, coming from a reductionist paradigm as it so often does.Ghaemi appreciates that Meyer’s compromising attitude meant that he was “unable to inoculate psychiatry from biological dogmatism.” My emphasis is on the challenge of Meyer’s psychobiology to biomedicine. In the same way, Engel’s biopsychosocial model acknowledged the need to neutralize the power of an impersonal and mechanical medicine. Doctors tend to overemphasize physical abnormalities at the expense of dealing with difficult personal issues.At the risk of oversimplification, I am juxtaposing biopsychosocial and biomedical models in psychiatry. Or in other terms, for our modern understanding, I am asserting a neo-Meyerian approach in contrast to neo-Kraepelinianism. Merely restating the Meyerian perspective will not do, because of Meyer’s ‘give and take,’ and his consequent failure to follow through the implication of his position. At least the ethical ramifications of his conceptual framework need to be acknowledged.Neo-Meyerianism also needs to be realized in the context of the reaction to anti-psychiatry. After anti-psychiatry’s attack, our modern understanding of mental illness has tended to be been subsumed into the binary opposition of ‘pro-psychiatry’ and ‘anti-psychiatry.’ But neo-Meyerianism is as much pro-psychiatric as biomedical psychiatry. It is in this sense that biopsychological approaches have been undermined by the biomedical reaction to anti-psychiatry. [End Page 355]I also agree with Ghaemi that there is a way in which the failures of the biopsychosocial model allowed the development of anti-psychiatry. For example, even though Laing quoted favorably from psychologically minded psychiatrists such as Manfred Bleuler, as far as I know he never made any reference to Meyer. There was never a systematic Meyerian theory to which Laing could refer. In fact, Laing wished to move beyond an interpretative understanding to abandon the metaphor of pathology (Double 2006). Perhaps if the biopsychosocial model had been more clearly defined, Laing would not have felt he needed to take this step. Or, at least in doing so, he would have been clearer about where he stood on this issue. When labeling Laing’s views as ‘anti-psychiatry,’ biomedical psychiatry would have had to state more precisely how Laing’s position was anti- rather than pro-psychiatric.My main disagreement with Ghaemi is his view of Meyer as eclectic. Meyer’s willingness to allow ‘anything goes’ in psychiatry meant that he did not oppose or challenge too much the views of those with whom he disagreed. Nonetheless, he did not combine together different sources to create an unintegrated philosophical and conceptual understanding. His theoretical position is internally consistent.Modern American psychiatry studied by participant observation is “of two minds,” in that there is a divided consciousness created between the practices of drug therapy and psychotherapy (Luhrmann 2000). In this sense, it is eclectic because there is no consistent theory that combines the two practice modes. True, psychiatry often claims that the foundation for this mixture is the biopsychosocial model. It asserts that everyday psychiatry is not as purely biomedical as is often maintained because it takes into account psychosocial factors that may precipitate mental disorders. It, therefore, says that it bring together the biological and psychosocial. This compromise avoids the adoption of any one model and was proposed to neutralize the dogmatism engendered by the anti-psychiatry debate (Clare 1980). I agree with Ghaemi that such eclecticism has outlived its usefulness.Where I think Ghaemi is mistaken is that he sees Meyer and Engel as the originators of this eclecticism. I regard the Meyerian approach as more genuinely pragmatic than Ghaemi suggests. Meyer’s dynamic psychology sought an integration of mind and brain as a way of dealing with the philosophical dilemma of the mind–body... (shrink)

Metaethical subjectivism, the idea that the truth or falsity of moral statements is contingent upon the attitudes or conventions of observers, is often regarded as a lurid philosophical doctrine which generates much psychological resistance to its acceptance. In this accessible book, Richard Double, presents a vigorous defense of metaethical subjectivism, arguing that the acceptance of this doctrine need have no deleterious effects upon theorizing either in normative ethics or in moral practice. Proceeding from a 'worldview' methodology Double criticizes (...) the rival doctrine of metaethical objectivism for lacking both 'completeness' and 'soundness', argues that a defense of metaethical subjectivism requires no special semantic analysis of moral language and defends the plausibility of metaethical subjectivism as explaining key intractable disagreements in moral philosophy. Double concludes by suggesting that the acceptance of metaethical subjectivism is better for constructing theories of normative ethics and moral practice than is metaethical objectivism. (shrink)