This paper argues that societal duties of health promotion are underwritten (at least in large part) by a principle of beneficence. Further, this principle generates duties of justice that correlate with rights, not merely “imperfect” duties of charity or generosity. To support this argument, I draw on a useful distinction from bioethics and on a somewhat neglected approach to social obligation from political philosophy. The distinction is that between general and specific beneficence; and the approach from political philosophy has at (...) times been called equality of concern. After clarifying the distinction and setting out the basis of the equality of concern view, I argue that the result is a justice-based principle of “specific” beneficence that should be reflected in a society’s health policy. I then draw on this account to criticize, refine, and extend some prominent health care policy proposals from the bioethics literature. (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)
What is the correct metric of distributive justice? Proponents of the capability approach claim that distributive metrics should be articulated in terms of individuals’ effective abilities to achieve important and worthwhile goals. Defenders of resourcism, by contrast, maintain that metrics should instead focus on the distribution of external resources. This debate is now more than three decades old, and it has produced a vast and still growing literature. The present paper aims to provide a fresh perspective on this protracted debate. (...) It does so by defending capability metrics while also criticizing the two most common arguments used to support them, and sympathetically reconstructing the arguments for resourcism. I ultimately argue that while sweeping defenses of the capability approach do not succeed, capability theorists can indeed vindicate the justice-relevance of certain capabilities while still accommodating what is plausible in resourcism. (shrink)
Interpersonal aggregation involves the combining and weighing of benefits and losses to multiple individuals in the course of determining what ought to be done. Most consequentialists embrace thoroughgoing interpersonal aggregation, the view that any large benefit to each of a few people can be morally outweighed by allocating any smaller benefit to each of many others, so long as this second group is sufficiently large. This would permit letting one person die in order to cure some number of mild headaches (...) instead. Most non-consequentialists reject thoroughgoing interpersonal aggregation despite also believing it is permissible to let one person die in order to prevent many cases of paraplegia instead. Non-consequentialists defend this asymmetry largely on the basis of intuition, and some rely on the notion of relevance to formalize the grounding intuitions. This article seeks to clarify and strengthen the non-consequentialist notion of relevance by engaging with three objections to it. (shrink)
Much of the philosophical literature on health inequalities seeks to establish the superiority of one or another conception of luck egalitarianism. In recent years, however, an increasing number of self-avowed egalitarian philosophers have proposed replacing luck egalitarianism with alternatives that stress the moral relevance of distinct relationships, rather than the moral relevance of good or bad luck. After briefly explaining why I am not attracted to luck egalitarianism, I seek in this chapter to distinguish and clarify three views that have (...) been characterized in the philosophical literature as forms of relational egalitarianism. I call these three relational views equality of treatment, equality of concern, and social egalitarianism. I will explain why each claims to be a form of egalitarianism and why these three views should not be seen as competitors. I will argue that each brand of relational egalitarianism describes a plausible plank of distributive justice that bears on the evaluation of health inequalities and on the political institutions that create, sustain, or exacerbate them. To illustrate this pluralistic relational egalitarian approach, I will draw on a case study by Horton and Barker (this volume) to discuss how each of the three planks might be brought to bear on the evaluation of oral health disparities among the children of migrant Latino farmworkers in California. (shrink)
John Broome claims that there is a sacrifice-free solution to climate change. He says this is a consequence of elementary economics. After explaining the economic argument in somewhat more detail than Broome, I show that the argument is unsound. A main problem with it stems from Derek Parfit's ‘nonidentity effect.’ But there is hope, since the nonidentity effect underwrites a more philosophical yet more plausible route to a sacrifice-free solution. So in the end I join Broome in asking economists and (...) policymakers to help make this a reality. (shrink)
Norman Daniels’s theory of health justice is the most comprehensive and systematic such theory we have. In one of the few articles published so far on Daniels’s new book, Just Health, Benjamin Sachs argues that Daniels’s core “principle of equality of opportunity does not do the work Daniels needs it to do.” Yet Sachs’s objections to Daniels’s framework are deeply flawed. Where these arguments do not rely on significant misreadings of Daniels, they ignore sensible strands in Just Health that considerably (...) dull their force. After disarming Sachs’s arguments against Daniels’s theory, I explain why I agree with Sachs’s conclusion: Daniels’s equality of opportunity-based account of health justice rests on shaky foundations. (shrink)
Efficiency and equity are central concepts for the normative assessment of health policy. Drawing on the work of academic philosophers and philosophically sophisticated economists, this article identifies important philosophical questions implicated by the notions of efficiency and equity and then summarizes influential answers to them. Promising avenues for further philosophical research are also highlighted, especially in the context of health equity and its elusive ethical foundations.
Emergency contraception — also known as the morning after pill — is marketed and sold, under various brand names, in over one hundred countries around the world. In some countries, customers can purchase the drug without a prescription. In others, a prescription must be presented to a licensed pharmacist. In virtually all of these countries, pharmacists are the last link in the chain of delivery. This article examines and ultimately rejects several standard moves in the bioethics literature on the right (...) of pharmacists conscientiously to refuse to dispense emergency contraception. Its central thesis is that the standard ‘moderate’ solution to this problem is mistaken. Thus, when all publicly relevant interests are given their due, it is not acceptable to allow refusals in the big city, where pharmacies are plentiful, but forbid them in rural settings, where pharmacies are scarce. Rather, there should be strong public policy requiring that all pharmacists dispense emergency contraception to customers who request it, regardless of pharmacists' moral or religious objections. (shrink)
Contrary to popular belief, population-wide preventive measures are rarely cost-reducing. Yet they can still be cost-effective, and indeed more cost-effective than treatment. This is often true of preventive measures that work by slightly reducing the already low risks of death faced by many people. This raises a difficult moral question: when we must choose between life-saving treatment, on the one hand, and preventive measures that avert even more deaths, on the other, is the case for prevention weakened when it works (...) by reducing many healthy people’s already low risks by a further tiny amount? I argue the answer is no. (shrink)
In Canada, all research conducted by individuals associated with universities must be subjected to review by research ethics boards (REB). Unfortunately, decisions reached by REBs may seriously compromise the integrity of university-based research. In this paper attention will focus on how requirements of REBs and a legal department in four Canadian universities affected response rates to a survey of domestic and international students. It will be shown that in universities in which students were sent a legalistic cover letter to a (...) mail survey, or were required to sign a consent form, lower response rates were achieved than in universities in which students were sent a relatively friendly letter. In turn, lower response rates resulted in: sample characteristics that deviated from population characteristics; a reduction in the possibility of testing research hypotheses; and increased survey costs. As a consequence, it is argued that the unreasonable demands of REBs are seriously compromising the quality of research that can be carried out on Canadian university students. (shrink)
The novel represents a formal attempt to come to terms with innovation and originality and to accept the limitations of tradition; it reflects the larger cultural embracing of the present moment as a legitimate subject not only for passing conversation but for serious discourse. For at least a half century before the novel emerged, the world of print had experimented in assuming, absorbing, and exploiting that new cultural consciousness based on human curiosity—on the one hand “preparing” readers for novels and (...) on the other offering later writers of novels some sense of potential subject matter and potential form, a sense of how the present could be won over to serious literature. The process was a curious and unstructured one; in its early manifestations it hardly seemed destined to lead to a significant new literary form. Even in retrospect, the print novelties of the turn of the century hardly seem part of a teleology of form or thought, but the broad ferment that authenticated the new, together with the apparent permanence that print seemed to bestow on accounts of the temporary and passing, ultimately led to a mind and art that transcended occasions and individuals even though it engaged them first of all—energetically, enthusiastically, evangelically. The first fruits of the modern moment-centered consciousness were not very promising, but the emergence of that consciousness enabled, when other cultural contexts were right, an altogether new aesthetic and a wholly different relation between life and literature. J. Paul Hunter, professor of English at the University of Chicago, is the author of The Reluctant Pilgrim, Occasional Form, and of a forthcoming book on literacy, readership, and the contexts of early English fiction, Before Novels. (shrink)
New communication technologies such as the microcomputer, videotex/teletext systems, the videocassette recorder, and satellite receiving dishes have been available to farmers since the early 1980s. This longitudinal study examines ethical issues associated with the impact that differential patterns of adoption and use of these technologies have had on inequalities among farmers from 1982 to 1989. The results demonstrate a strong adoption and use bias toward larger scale farmers who already have well-developed skills for handling information. This bias is especially strong (...) for microcomputer and videotex/teletext systems, and it isincreasing over time. Although the same farmers are not adopting all communication innovations, there is a strong tendency toward the already information-rich making the most use of the innovations they adopt. The article concludes with several recommendations that would help minimize some of these information inequalities. (shrink)
Stakeholder theory provides a framework for investigating the relationship between corporate social performance (CSP) and corporate financial performance. This relationship is investigated by examining how change in CSP is related to change in financial accounting measures. The findings provide some support for a tenet in stakeholder theory which asserts that the dominant stakeholder group, shareholders, financially benefit when management meets the demands of multiple stakeholders. Specifically, change in CSP was positively associated with growth in sales for the current and subsequent (...) year. This indicates that there are short-term benefits from improving CSP. Return on sales was significantly positively related to change in CSP for the third financial period, indicating that long-term financial benefits may exist when CSP is improved. (shrink)
The purported failures of ergodic theory (seen in its often proved ineptitude to ground a mechanical explanation of thermodynamics) are shown to arise from misconception of the functions served by scientific explanation. In fact, the predictive failures of ergodic theory are precisely its points of greatest physical utility, where genuinely new knowledge about actual physical systems can be obtained, once the links between explanation and reconstructive estimation are recognized.
In 1997, the World Bank Group1 published in English one of its many country studies, entitled Vietnam: Education Financing. Its goal was to measure 'what changes in educational policies will ensure that students who pass through the system today will acquire the knowledge, skills and attitudes needed for Vietnam to complete the transition successfully from a planned to a market economy'(World Bank 1997: xiii). Skills, knowledge, and attitude designate the successfully 'educated' Vietnamese national subjects for the bank. The educational 'system' (...) performs, therefore, a disciplinary function by using the technologies of the nation state to cultivate productive humans—measured by technical expertise and computer and business skills—for transnational companies who do business in the region. (shrink)
This paper distinguishes between five different approaches to social discount rates in climate change economics, criticizes two of these, and explains how the other three are to some degree mutually compatible. It aims to shed some new light on a longstanding debate in climate change economics between so-called “descriptivists” and “prescriptivists” about social discounting. The ultimate goal is to offer a sketch of the conceptual landscape that makes visible some important facets of the debate that very often go unacknowledged.
This paper discusses some ethically relevant aspects of William Nordhaus’s contribution to climate change policy evaluation. Nordhaus's approach can shed light on one—but only one—dimension of the climate change problem. His boldest claims notwithstanding, there is nothing particularly "optimal" about the temperature increases associated with his most famous modeling choices.
The social cost of carbon (SCC) is a central concept in climate change economics. This chapter explains the SCC and investigates it philosophically. As is widely acknowledged, any SCC calculation requires the analyst to make choices about the infamous topic of discount rates. But to understand the nature and role of discounting, one must understand how that concept—and indeed the SCC concept itself—is yoked to the concept of a value function, whose job is to take ways the world could be (...) across indefinite timespans and to rank them from better to worse. A great deal, therefore, turns on the details of the value function and on just what is meant by “better” and “worse.” This chapter seeks to explicate these and related issues, and then to situate them within the evolving landscape of federal climate policy in the United States. (shrink)
The third of a century between the late 1680s and the early 1720s—a time when a vast number of prolific poets flourished—is almost completely overlooked in literary history, perhaps because there was no single poetic leader and no dominant direction in the poetry. But it was a very fertile period in poetry, with many talented poets and many potential directions that did not develop into dominant trends. Because literary history almost inevitably looks at dominant directions, it tends to pass over (...) not only individual poets who don't quite fit, but also poetic kinds and directions that don't turn out to be the winning ones. One valuable poetic mode in this period is what we might call the fallen, or disappointed, or misdirected lyric—exemplified most notably by Matthew Prior but also created by a host of other poets (Egerton, Chudleigh, Dixon, Hill, and Swift, for example). “Lost” years between distinct eras or directions also raise larger questions about the premises and practices of literary history itself. (shrink)
The analysis of belief ascriptions has been a central problem in philosophy for the past one hundred years. Working within a direct reference framework, the dissertation begins with a look at several of the most influential analyses of belief ascriptions over this period of time. It is argued that they all suffer from a common defect; they ignore important contextual factors which affect how belief ascriptions are interpreted. To repair this defect it is necessary to enter the realm of pragmatics--the (...) study of linguistic acts and the contexts in which they are performed. It is argued that the information conveyed by an utterance may differ significantly from its literal content. "Information conveyed" is a purely pragmatic concept; an utterance may potentially convey different information for every one of its interpreters, even though it has only one literal content. ;Following the development of the literal content/information conveyed distinction, three recent pragmatic theories of belief ascription are examined. Counterexamples are presented to each of these in turn. Finally, a theory of belief ascription is presented which is based on the literal content/information conveyed distinction. This new theory fits all of the examples that gave the other theories trouble. (shrink)
In recent years an increasing amount of information leaves no doubt that the costs to the victims of plant closures are more than economic. The stress occasioned by job loss often results in ill health. These findings aside, little systematic research has been done of the consequences of unemployment for the spouses of the unemployed. In this article, a comparison is made between the effects of a closure on unemployed male employees and their wives. It is found that both groups (...) suffer a high degree of anxiety over future job prospects and both experience a high level of stress as a result of the closure. However, for wives, anxiety, but not general stress, leads to ill health. For men, neither appears to have health implications: post-closure illness is related to illness prior to the shutdown. In one sense, two months after the closure, it can be argued that the impact of the shutdown was greater on wives than unemployed former employees. (shrink)