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Douglas MacKay [21]Douglas P. MacKay [2]
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Douglas MacKay
University of North Carolina, Chapel Hill
  1.  21
    The Ethics of Organ Donor Registration Policies: Nudges and Respect for Autonomy.Douglas MacKay & Alexandra Robinson - 2016 - American Journal of Bioethics 16 (11):3-12.
    Governments must determine the legal procedures by which their residents are registered, or can register, as organ donors. Provided that governments recognize that people have a right to determine what happens to their organs after they die, there are four feasible options to choose from: opt-in, opt-out, mandated active choice, and voluntary active choice. We investigate the ethics of these policies' use of nudges to affect organ donor registration rates. We argue that the use of nudges in this context is (...)
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  2. Geographic Location and Moral Arbitrariness in the Allocation of Donated Livers.Douglas MacKay & Samuel Fitz - 2019 - Journal of Law, Medicine and Ethics 47 (2):308-319.
    The federal system for allocating donated livers in the United States is often criticized for allowing geographic disparities in access to livers. Critics argue that such disparities are unfair on the grounds that where one lives is morally arbitrary and so should not influence one's access to donated livers. They argue instead that livers should be allocated in accordance with the equal opportunity principle, according to which US residents who are equally sick should have the same opportunity to receive a (...)
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  3.  19
    The Duty to Rescue and Investigators' Obligations.Douglas MacKay & Tina Rulli - 2017 - Kennedy Institute of Ethics Journal 27 (1):71-105.
    The duty to rescue is a highly plausible and powerful ethical principle. It requires agents to assist others in extreme need in cases where doing so does not conflict with some weighty moral aim; requires little personal sacrifice; and is likely to significantly benefit the recipients.1 As a general obligation, it binds all persons simply qua persons, and it is owed to all persons simply qua persons. Clinical investigators working in low-income countries frequently encounter sick or destitute people to whom (...)
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  4. Standard of Care, Institutional Obligations, and Distributive Justice.Douglas MacKay - 2015 - Bioethics 29 (4):352-359.
    The problem of standard of care in clinical research concerns the level of treatment that investigators must provide to subjects in clinical trials. Commentators often formulate answers to this problem by appealing to two distinct types of obligations: professional obligations and natural duties. In this article, I investigate whether investigators also possess institutional obligations that are directly relevant to the problem of standard of care, that is, those obligations a person has because she occupies a particular institutional role. I examine (...)
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  5.  18
    The Ethics of Public Policy RCTs: The Principle of Policy Equipoise.Douglas MacKay - 2018 - Bioethics 32 (1):59-67.
    In this article, I ask whether a principle analogous to the principle of clinical equipoise should govern the design and conduct of RCTs evaluating the effectiveness of policy interventions. I answer this question affirmatively, and introduce and defend the principle of policy equipoise. According to this principle, all arms of a policy RCT must be, at minimum, in a state of equipoise with the best proven policy that is also morally and practically attainable and sustainable. For all arms of a (...)
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  6.  56
    Opt-Out and Consent.Douglas MacKay - 2015 - Journal of Medical Ethics 41 (10):1-4.
    A chief objection to opt-out organ donor registration policies is that they do not secure people's actual consent to donation, and so fail to respect their autonomy rights to decide what happens to their organs after they die. However, scholars have recently offered two powerful responses to this objection. First, Michael B Gill argues that opt-out policies do not fail to respect people's autonomy simply because they do not secure people's actual consent to donation. Second, Ben Saunders argues that opt-out (...)
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  7.  7
    Health Research Priority Setting: A Duty to Maximize Social Value?Douglas MacKay - 2018 - American Journal of Bioethics 18 (11):25-26.
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  8. Are Skill-Selective Immigration Policies Just?Douglas MacKay - 2016 - Social Theory and Practice 42 (1):123-154.
    Many high-income countries have skill-selective immigration policies, favoring prospective immigrants who are highly skilled. I investigate whether it is permissible for high-income countries to adopt such policies. Adopting what Joseph Carens calls a " realistic approach " to the ethics of immigration, I argue first that it is in principle permissible for high-income countries to take skill as a consideration in favor of selecting one prospective immigrant rather than another. I argue second that high-income countries must ensure that their skill-selective (...)
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  9.  8
    Calculating Qalys: Liberalism and the Value of Health States.Douglas MacKay - 2017 - Economics and Philosophy 33 (2):259-285.
    The value of health states is often understood to depend on their impact on the goodness of people's lives. As such, prominent health states metrics are grounded in particular conceptions of wellbeing – e.g. hedonism or preference satisfaction. In this paper, I consider how liberals committed to the public justification requirement – the requirement that public officials choose laws and policies that are justifiable to their citizens – should evaluate health states. Since the public justification requirement prohibits public officials from (...)
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  10.  63
    Incentive Inequalities and Freedom of Occupational Choice.Douglas Mackay - 2016 - Economics and Philosophy 32 (1):21-49.
    In Rescuing Justice and Equality, G.A. Cohen argues that the incentive inequalities permitted by John Rawls's difference principle are unjust since people cannot justify them to their fellow citizens. I argue that citizens of a Rawlsian society can justify their acceptance of a wide range of incentive inequalities to their fellow citizens. They can do so because they possess the right to freedom of occupational choice, and are permitted – as a matter of justice – to exercise this right by (...)
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  11.  23
    Rawlsian Justice and the Social Determinants of Health.Jayna Fishman & Douglas MacKay - forthcoming - Journal of Applied Philosophy.
    In this article, we suggest that the evidence regarding the social determinants of health calls for a deep re‐thinking of our understanding of distributive justice. Focusing on John Rawls's theory of distributive justice in particular, we argue that a full reckoning with the social determinants of health requires a re‐working of Rawls's principles of justice. We argue first that the social bases of health – a Rawlsian conception of the social determinants of health – should be considered a social primary (...)
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  12.  11
    Basic Income, Cash Transfers, and Welfare State Paternalism.Douglas MacKay - forthcoming - Journal of Political Philosophy.
    Journal of Political Philosophy, EarlyView.
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  13.  30
    Ending SNAP-Subsidized Purchases of Sugar-Sweetened Beverages: The Need for a Pilot Project.Nicole M. V. Ross & Douglas P. MacKay - 2017 - Public Health Ethics 10 (1).
    Recent efforts by legislative officials and public health advocates to reform the US food stamp program, or Supplemental Nutrition Assistance Program, have focused on restricting the types of foods eligible for purchase with SNAP benefits, specifically sugar-sweetened beverages. We argue that it is, in principle, permissible for the US government to enact a SNAP-specific SSB ban prohibiting the purchase of SSBs with SNAP benefits. While the government has a duty to ensure that citizens meet their nutritional needs, since SSBs provide (...)
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  14.  15
    Federalism and Responsibility for Health Care.Douglas MacKay & Marion Danis - 2016 - Public Affairs Quarterly 30 (1):1-29.
    Political philosophers often formulate the problem of distributive justice as the problem of how the government ought to distribute different types of goods—for example, income or health care—to its citizens. They therefore presuppose that the government is a unitary agent that governs its citizens directly. However, although a number of governments are unitary in this way, many are federations, exhibiting a division of sovereignty between two or more levels of government having independent grounds of authority. In contrast to unitary states, (...)
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  15.  30
    Incentive Inequalities and Talents: A Reply to Shiffrin.Douglas MacKay - 2013 - Philosophia 41 (2):521-526.
    In a recent article, Seana Valentine Shiffrin offers a distinctive egalitarian critique of the types of incentive inequalities that are permitted by John Rawls's difference principle. She argues that citizens of a well-ordered society, who publicly accept Rawls's two principles of justice and their justifications, may not demand incentives to employ their talents in productive ways since such demands are inconsistent with a major justification for the difference principle: the moral arbitrariness of talent. I argue that there is no such (...)
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  16.  7
    Government Policy Experiments and Informed Consent.Douglas MacKay & Averi Chakrabarti - forthcoming - Public Health Ethics:phy015.
    Governments are increasingly making use of field experiments to evaluate policy interventions in the spheres of education, public health and welfare. However, the research ethics literature is largely focused on the clinical context, leaving investigators, institutional review boards and government agencies with few resources to draw on to address the ethical questions they face regarding such experiments. In this article, we aim to help address this problem, investigating the conditions under which informed consent is required for ethical policy research conducted (...)
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  17.  24
    Experienced Utility or Decision Utility for QALY Calculation? Both.Paige A. Clayton & Douglas P. MacKay - 2018 - Public Health Ethics 11 (1):82-89.
    Policy-makers must allocate scarce resources to support constituents’ health needs. This requires policy-makers to be able to evaluate health states and allocate resources according to some principle of allocation. The most prominent approach to evaluating health states is to appeal to the strength of people’s preferences to avoid occupying them, which we refer to as decision utility metrics. Another approach, experienced utility metrics, evaluates health states based on their hedonic quality. In this article, we argue that although decision utility metrics (...)
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  18.  4
    Immigrant Selection, Health Requirements, and Disability Discrimination.Douglas MacKay - 2018 - Journal of Ethics and Social Philosophy 14 (1).
    Australia, Canada, and New Zealand currently apply health requirements to prospective immigrants, denying residency to those with health conditions that are likely to impose an “excessive demand” on their publicly funded health and social service programs. In this paper, I investigate the charge that such policies are wrongfully discriminatory against persons with disabilities. I first provide a freedom-based account of the wrongness of discrimination according to which discrimination is wrong when and because it involves disadvantaging people in the exercise of (...)
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  19.  24
    Patients with Passports: Medical Tourism, Law, and Ethics by I Glenn Cohen.Douglas MacKay - 2016 - Kennedy Institute of Ethics Journal 26 (3):1-10.
    I. Glenn Cohen’s Patients with Passports: Medical Tourism, Law, and Ethics offers a thorough examination of the growing practice of medical tourism, the legal regulations governing it, and the many ethical issues it raises for policy-makers, health care providers, and prospective medical tourists. Demonstrating mastery of the relevant literatures in the social sciences, law, ethics, and political philosophy, Cohen provides a comprehensive overview of the current practice of medical tourism, and offers well-argued, sensible policy advice to guide its reform. Cohen’s (...)
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  20.  17
    Fair Subject Selection in Clinical Research: Formal Equality of Opportunity.Douglas MacKay - 2016 - Journal of Medical Ethics 42 (10):672-677.
    In this paper, I explore the ethics of subject selection in the context of biomedical research. I reject a key principle of what I shall refer to as the standard view. According to this principle, investigators should select participants so as to minimise aggregate risk to participants and maximise aggregate benefits to participants and society. On this view, investigators should exclude prospective participants who are more susceptible to risk than other prospective participants. I argue instead that investigators should select subjects (...)
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  21.  5
    Weighing Obligations to Home Care Workers and Medicaid Recipients.Paul C. Treacy & Douglas MacKay - 2019 - Nursing Ethics 26 (2):418-424.
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  22.  3
    Returning Incidental Findings in Low‐Resource Settings: A Case of Rescue?Douglas Mackay - 2018 - Hastings Center Report 48 (3):28-30.
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  23.  7
    Nudges, Autonomy, and Organ Donor Registration Policies: Response to Critics.Douglas MacKay - 2017 - American Journal of Bioethics 17 (2):W4 - W8.