This paper defends an ‘opt-out’ scheme for organ procurement, by distinguishing this system from ‘presumed consent’ (which the author regards as an erroneous justification of it). It, first, stresses the moral importance of increasing the supply of organs and argues that making donation easier need not conflict with altruism. It then goes on to explore one way that donation can be increased, namely by adopting an opt-out system, in which cadaveric organs are used unless the deceased (or their family) registered (...) an objection. Such policies are often labelled ‘presumed consent’, but it is argued that critics are right to be sceptical of this idea—consent is shown to be an action, rather than a mental attitude, and thus not something that can be presumed. Either someone has consented or they have not, whatever their attitude to the use of their organs. Thankfully, an opt-out scheme need not rest on the presumption of consent. Actual consent can be given implicitly, by one's actions, so it is argued that the failure to register an objection (given certain background conditions) should itself be taken as sign of consent. Therefore, it is permissible to use the organs of someone who did not opt out, because they have—by their silence—actually consented. (shrink)

Democracy is commonly associated with political equality and/or majority rule. This essay shows that these three ideas are conceptually separate, so the transition from any one to another stands in need of further substantive argument, which is not always adequately given. It does this by offering an alternative decision-making mechanism, called lottery voting, in which all individuals cast votes for their preferred options but, instead of these being counted, one is randomly selected and that vote determines the outcome. This procedure (...) is democratic and egalitarian, since all have an equal chance to influence outcomes, but obviously not majoritarian. (shrink)

Until relatively recently, few democrats had much to say about the constitution of the ‘demos' that ought to rule. A number of recent writers have, however, argued that all those whose interests are affected must be enfranchised if decision-making is to be fully democratic. This article criticizes this approach, arguing that it misunderstands democracy. Democratic procedures are about the agency of the people so only agents can be enfranchised, yet not all bearers of interests are also agents. If we focus (...) on agency, rather than who is affected, then this leads us to focus on the permissible limits of action, rather than who makes the decision. Just as individual sovereignty is ordinarily limited by the requirement not to injure others, we may apply similar restrictions to what a demos can permissibly do. Thus, any collection of individuals may choose to regulate their affairs collectively for mutual benefit, but should be prohibited from imposing negative externalities on outsiders. On this view, the constitution or definition of the demos is arbitrary, from the democratic point of view. Moreover, democracy does not require the expansion of the franchise, unless injuries cannot be avoided. (shrink)

Proposals for increasing organ donation are often rejected as incompatible with altruistic motivation on the part of donors. This paper questions, on conceptual grounds, whether most organ donors really are altruistic. If we distinguish between altruism and solidarity – a more restricted form of other-concern, limited to members of a particular group – then most organ donors exhibit solidarity, rather than altruism. If organ donation really must be altruistic, then we have reasons to worry about the motives of existing donors. (...) However, I argue that altruism is not necessary, because organ donation supplies important goods, whatever the motivation, and we can reject certain dubious motivations, such as financial profit, without insisting on altruism.Once solidaristic donation is accepted, certain reforms for increasing donation rates seem permissible. This paper considers two proposals. Firstly, it has been suggested that registered donors should receive priority for transplants. While this proposal appears based on a solidaristic norm of reciprocity, it is argued that such a scheme would be undesirable, since non-donors may contribute to society in other ways. The second proposal is that donors should be able to direct their organs towards recipients that they feel solidarity with. This is often held to be inconsistent with altruistic motivation, but most donation is not entirely undirected in the first place (for instance, donor organs usually go to co-nationals). While allowing directed donation would create a number of practical problems, such as preventing discrimination, there appears to be no reason in principle to reject it. (shrink)

Mill’s harm principle is commonly supposed to rest on a distinction between self-regarding conduct, which is not liable to interference, and other-regarding conduct, which is. As critics have noted, this distinction is difficult to draw. Furthermore, some of Mill’s own applications of the principle, such as his forbidding of slavery contracts, do not appear to fit with it. This article proposes that the self-regarding/other-regarding distinction is not in fact fundamental to Mill’s harm principle. The sphere of protected liberty includes not (...) only self-regarding conduct, but also actions that affect only consenting others. On the other hand, the occasional permissibility of interfering with self-regarding conduct can plausibly be explained by reference to the agent’s consent. Thus, the more important distinction appears to be that between consensual and non-consensual harm, rather than that between the self-regarding and non-self-regarding action. That is, interference can be justified in order to prevent non-consensual harms, but not to prevent consensual harms. It is argued that the harm principle, thus reformulated, both captures Mill’s intentions and is a substantively plausible position. (shrink)

The three most common responses to Taurek’s ‘numbers problem’ are saving the greater number, equal chance lotteries and weighted lotteries. Weighted lotteries have perhaps received the least support, having been criticized by Scanlon What We Owe to Each Other ( 1998 ) and Hirose ‘Fairness in Life and Death Cases’ ( 2007 ). This article considers these objections in turn, and argues that they do not succeed in refuting the fairness of a weighted lottery, which remains a potential solution to (...) cases of conflict. Moreover, it shows how these responses actually lead to a new argument for weighted lotteries, appealing to fairness and Pareto-optimality. (shrink)

Sometimes, two unfair distributions cancel out in aggregate. Paradoxically, two distributions each of which is fair in isolation may give rise to aggregate unfairness. When assessing the fairness of distributions, it therefore matters whether we assess transactions piecemeal or focus only on the overall result. This piece illustrates these difficulties for two leading theories of fairness before offering a formal proof that no non-trivial theory guarantees aggregativity. This is not intended as a criticism of any particular theory, but as a (...) datum that must be taken into account in constructing a theory of fairness. (shrink)

Fairness is a central, but under-theorized, notion in moral and political philosophy. This paper makes two contributions. Firstly, it criticizes Broome’s seminal account of fairness in Proc Aristotelian Soc 91:87–101, showing that there are problems with restricting fairness to a matter of relative satisfaction and holding that it does not itself require the satisfaction of the claims in question. Secondly, it considers the justification of lotteries to resolve cases of ties between competing claims, which Broome claims as support for his (...) theory, and contrasts random procedures to contests of skill, which may also be considered lotteries in a broader sense. I offer no alternative account of fairness of my own, but hope to point the way for future research on the nature of fairness. (shrink)

Lotteries have long been used to resolve competing claims, yet their recent implementation to allocate school places in Brighton and Hove, England led to considerable public outcry. This article argues that, given appropriate selection is impossible when parties have equal claims, a lottery is preferable to an auction because it excludes unjust influences. Three forms of contractualism are discussed and the fairness of lotteries is traced to the fact that they give each person an equal chance, as a surrogate for (...) their equal claim to the good. It is argued that this can be a reason to favour an artificially-constructed lottery to a 'natural' lottery where there is suspicion that the latter may be biased. (shrink)

The spread of vaccine misinformation may contribute to vaccine refusal/hesitancy and consequent harms. Nonetheless, censorship is often rejected on the grounds of free expression. This article examines John Stuart Mill’s influential defence of free expression but finds that his arguments for freedom apply only to normal, reasonably favourable circumstances. In other cases, it may be permissible to restrict freedom, including freedom of speech. Thus, while Mill would ordinarily defend the right to express false views, such as that vaccines cause autism, (...) he might have accepted restrictions on anti-vaccine misinformation during the present pandemic. This illustrates that even the staunchest defenders of free speech can permit temporary restrictions in exceptional circumstances. (shrink)

It has traditionally been assumed that organ donation must be altruistic, though the necessity of altruistic motivations has recently been questioned. Few, however, have questioned whether altruism is always a good motive. This paper considers the possibility that excessive altruism, or self-abnegation, may be intrinsically bad. How this may be so is illustrated with reference to Tom Hurka’s account of the value of attitudes, which suggests that disproportionate love of one’s own good—either excessive or deficient—is intrinsically bad. Whether or not (...) we accept the details of this account, recognising that altruistic motivations may be intrinsically bad has important implications for organ procurement. One possible response is to say that we should take further measures to ensure that donors have good motives—that they are altruistic is no longer enough. An alternative is to say that, since altruistic donation need not be intrinsically good, we have less reason to object to other motivations. (shrink)

Interference is paternalistic when it restricts an individual’s freedom for their own good. Anti-paternalists, such as John Stuart Mill, object to this for various reasons, including that the individual is usually a better judge of her own interests than the would-be paternalist. However, Wilkinson argues that a Parfitian reductivist approach to personal identity opens the door to what he calls ‘identity-relative paternalism’ where someone’s present action is restricted for the sake of a different future self.1 This is an interesting argument, (...) but it is not clear whether it involves permissible paternalism. At the risk of stating the obvious, permissible paternalism must be both permissible and paternalistic. Wilkinson’s identity-relative paternalism could be either, but not obviously both. If the present and future selves are different individuals, then interference is potentially permissible but no longer paternalistic. Alternatively, they are identical, in which case the interference is genuine paternalism, but cannot be justified by appeal to their distinctness. Wilkinson may escape this dilemma by invoking Parfit, who challenges the common notion that identity is all or nothing.2 According to Parfit’s revisionary view, the present and future self may share some connections but not others. However, once we have identified these similarities and differences, there is no further question whether or not they …. (shrink)

New reproductive technologies allow parents some choice over their children. Various moral principles have been suggested to regulate such choices. This article starts from a discussion of Julian Savulescu's Principle of Procreative Beneficence, according to which parents ought to choose the child expected to have the best quality of life, before combining two previously separate lines of attack against this principle. First, it is suggested that the appropriate moral principles of guiding reproductive choices ought to focus on general wellbeing rather (...) than prioritizing that of the child and, second, that they ought to be non-maximizing. Though neither of these suggestions is entirely novel, combining them results in a new, and arguably more plausible, principle to regulate procreative choices, which I call the Principle of Generalized Procreative Non-Maleficence. According to this principle, the primary obligation on parents is not to cause harm to other people through their reproductive choices. (shrink)

Arash Abizadeh has recently argued that political communities have no right to close their borders unilaterally, since by doing so they subject outsiders to coercion which lacks democratic justification. His conclusion is that any legitimate regime of border controls must be justified to outsiders. David Miller has sought to defend closed borders by distinguishing between coercion and prevention and arguing that the latter does not require democratic justification. This paper explores a different route, arguing firstly that the requirements of democracy (...) do not provide us with practical guidance unless we also consider other values, such as rights, and secondly that being subject to coercion does not entitle one to democratic justification. These arguments suggest that Abizadeh is wrong to hold closed borders in need of democratic justification. (shrink)

Douglas Diekema influentially argues that interference with parental decisions is not in fact guided by the child’s best interests, but rather by a more permissive standard, which he calls the harm principle. This article first seeks to clarify this alternative position and defend it against certain existing criticisms, before offering a new criticism and alternative. This ‘harm principle’ has been criticized for (i) lack of adequate moral grounding, and (ii) being as indeterminate as the best interest standard that it seeks (...) to replace. I argue that these are not serious problems. I take Diekema’s negative point to be right—our actual standard for intervention is not literally the best interests of the child—but I disagree with his proposed replacement. First, Diekema’s proposed harm threshold should be more carefully distinguished from Mill’s harm principle. Second, there is no reason to assume that the standard for permissible intervention coincides with the threshold for harm (or serious harm). Thus, I propose that the best alternative to the best interests standard is not a harm principle, but rather a sufficiency threshold between adequate (or ‘good enough’) and inadequate (or ‘substandard’) parenting. (shrink)

Mill's most famous departure from Bentham is his distinction between higher and lower pleasures. This article argues that quality and quantity are independent and irreducible properties of pleasures that may be traded off against each other higher pleasures’ lexically dominate lower ones, and that the distinction is compatible with hedonism. I show how this interpretation not only makes sense of Mill but allows him to respond to famous problems, such as Crisp's Haydn and the oyster and Nozick's experience machine.

Mill's most famous departure from Bentham is his distinction between higher and lower pleasures. This article argues that quality and quantity are independent and irreducible properties of pleasures that may be traded off against each other – as in the case of quality and quantity of wine. I argue that Mill is not committed to thinking that there are two distinct kinds of pleasure, or that ‘higher pleasures’ lexically dominate lower ones, and that the distinction is compatible with hedonism. I (...) show how this interpretation not only makes sense of Mill but allows him to respond to famous problems, such as Crisp's Haydn and the oyster and Nozick's experience machine. (shrink)

Miller has recently argued that fetuses have the same inherent value as non-disabled adults. However, we do not need to postulate some property possessed equally by all humans, including fetuses, in order to explain the equality of non-disabled adults. It would suffice if there were some property possessed by all non-disabled adults, but not by fetuses.

Changing patterns of political participation observed by political scientists over the past half-century undermine traditional democratic theory and practice. The vast majority of democratic theory, and deliberative democratic theory in particular, either implicitly or explicitly assumes the need for widespread citizen participation. It requires that all citizens possess the opportunity to participate and also that they take up this opportunity. But empirical evidence gathered over the past half-century strongly suggests that many citizens do not have a meaningful opportunity to participate (...) in the ways that many democratic theorists require, and do not participate in anything like the numbers that they believe is necessary. This paper outlines some of the profound changes that have been experienced by liberal democratic states in the 20th and early 21st Centuries, changes which are still ongoing, and which have resulted in declines in citizens participation and trust, the marginalisation of citizens from democratic life, and the entrenchment of social and economic inequalities which have damaged democracy. The paper challenges the conventional wisdom in rejecting the idea that the future of democracy lies in encouraging more widespread participation. The paper takes seriously the failure of the strategies adopted by many states to increase participation, especially among the poor, and suggests that instead of requiring more of citizens, we should in fact be requiring less of them. Instead of seeking to encourage more citizen participation, we should acknowledge that citizens will probably not participate in the volume, or in the ways, many democratic theorists would like, and that therefore we need an alternative approach: a regime which can continue to produce democratic outcomes, and which satisfies the requirements of political equality, in the absence of widespread participation by citizens. (shrink)

Arash Abizadeh has recently argued that political communities have no right to close their borders unilaterally, since by doing so they subject outsiders to coercion which lacks democratic justification. His conclusion is that any legitimate regime of border controls must be justified to outsiders. David Miller has sought to defend closed borders by distinguishing between coercion and prevention and arguing that the latter does not require democratic justification. This paper explores a different route, arguing firstly that the requirements of democracy (...) do not provide us with practical guidance unless we also consider other values, such as rights, and secondly that being subject to coercion does not entitle one to democratic justification. These arguments suggest that Abizadeh is wrong to hold closed borders in need of democratic justification. (shrink)

There has been much argument over whether procreative selection is obligatory or wrong. Rebecca Bennett has recently challenged the assumption that procreative choices are properly moral choices, arguing that these views express mere preferences. This article challenges Bennett's view on two fronts. First, I argue that the Non-Identity Problem does not show that there cannot be harmless wrongs – though this would require us to abandon the intuitively attractive ‘person-affecting principle’, that may be a lesser cost than abandoning some more (...) firmly-held intuition. But, even if we accept Bennett's claim that these choices are not moral, that does not show them to be mere personal preferences. I argue that there is a class of non-moral ‘categorical preferences’ that have much the same implications as moral preferences. If a moral preference for able-bodied children is problematic, then so is a non-moral categorical preference. Thus, showing that these preferences are not moral does not show that they are not problematic, since they may still be categorical. (shrink)

This paper examines the problem of selecting a number of candidates to receive a good (admission) from a pool in which there are more qualified applicants than places. I observe that it is rarely possible to order all candidates according to some relevant criterion, such as academic merit, since these standards are inevitably somewhat vague. This means that we are often faced with the task of making selections between near-enough equal candidates. I survey one particular line of response, which says (...) that we should allow our choice of borderline candidates to be guided by non-relevant criteria such as gender-balancing. I argue that this would not, as commonly objected, be a case of sex discrimination if it is to be applied either in favour of men or women. Nonetheless, I argue that such policies are problematic because they violate the demand for publicity, which is required for legitimacy and to assure everyone that discrimination has not in fact taken place. Instead, I suggest that, if we are concerned to avoid discrimination, there may be a case for using lotteries as tie-breakers, not on grounds of fairness but to prevent taint of bias. (shrink)

abstract This paper examines the problem of selecting a number of candidates to receive a good (admission) from a pool in which there are more qualified applicants than places. I observe that it is rarely possible to order all candidates according to some relevant criterion, such as academic merit, since these standards are inevitably somewhat vague. This means that we are often faced with the task of making selections between near‐enough equal candidates. I survey one particular line of response, which (...) says that we should allow our choice of borderline candidates to be guided by non‐relevant criteria such as gender‐balancing. I argue that this would not, as commonly objected, be a case of sex discrimination if it is to be applied either in favour of men or women. Nonetheless, I argue that such policies are problematic because they violate the demand for publicity, which is required for legitimacy and to assure everyone that discrimination has not in fact taken place. Instead, I suggest that, if we are concerned to avoid discrimination, there may be a case for using lotteries as tie‐breakers, not on grounds of fairness but to prevent taint of bias. (shrink)

Opponents of compulsory voting often allege that it violates a ‘right not to vote’. This paper seeks to clarify and defend such a right against its critics. First, I propose that this right must be understood as a Hohfeldian claim against being compelled to vote, rather than as a mere privilege to abstain. So construed, the right not to vote is compatible with a duty to vote, so arguments for a duty to vote do not refute the existence of such (...) a right. The right against compulsion is most easily defended within a liberal framework, hence its critics often appeal instead to a republican conception of freedom. In the latter part of the paper, I argue that even these republican arguments are inconclusive. Even non-dominating interference still conditions freedom, which may require justification. Further, citizens can live up to republican ideals, so long as they are vigilant; they need not actually vote. Thus, republican arguments fail to refute a right not to vote. (shrink)

In an earlier article, I argued that David Estlund's notion of ‘normative consent’ could provide justification for an opt-out system of organ donation that does not involve presumptions about the deceased donor's consent. Where it would be wrong of someone to refuse their consent, then the fact that they have not actually given it is irrelevant, though an explicit denial of consent may still be binding. My argument has recently been criticised by Potts et al, who argue that such a (...) policy would involve taking organs from people whose organs should not be taken and would be a recipe for totalitarianism. The present response seeks to rebut both the ethical and political objections. I argue that people can indeed be under a moral obligation to donate their organs, even if they are not technically dead at the time and their donation does not save anyone else's life. Moreover, I argue that an opt-out system—unlike mandatory donation—is not totalitarian because it preserves the right of individuals to act morally wrongly, by opting out when they have no good moral reason to do so. The policy I propose is neither immoral nor totalitarian. (shrink)

Endörfer has recently argued that proponents of the harm principle are wrong to exempt market harms as potential justifications for state interference. I argue that – contrary to suggestions in Endörfer’s article – John Stuart Mill did not exempt market harms from his harm principle. On Mill’s view, the state can (as a matter of principle) legitimately interfere with free markets to prevent market harms where they occur but, on the whole, it is better policy not to interfere. Mill’s general (...) preference for free trade rests on utilitarian considerations and not on his harm principle, which does not exclude market harms. (shrink)

The novel coronavirus (SARS-CoV-2) pandemic has refocused attention on the issue of mandatory vaccination. Some have suggested that vaccines ought to be mandatory, while others propose more moderate alternatives, such as incentives. This piece surveys a range of possible interventions, ranging from mandates through to education. All may have their place, depending on circumstances. However, it is worth clarifying the options available to policymakers, since there is sometimes confusion over whether a particular policy constitutes a mandate or not. Further, I (...) illustrate a different kind of alternative to mandatory vaccination. Rather than seeking less coercive alternatives to a mandate, we might instead employ an alternative mandate, which requires people to do something less than get vaccinated. For instance, we might merely require people to attend an appointment at a vaccine clinic. Whether this mandatory attendance policy is justified will depend on specific circumstances, but it represents another way to promote vaccination, without mandating it. In some cases, this may represent an appropriate balance between promoting public health goals and respecting individual liberty. (shrink)

According to the Principle of Procreative Beneficence, reproducers should choose the child, of those available to them, expected to have the best life. Savulescu argues reproducers are therefore morally obligated to select for nondisease traits, such as intelligence. Carter and Gordon recently challenged this implication, arguing that Savulescu fails to establish that intelligence promotes well-being. This paper develops two responses. First, I argue that higher intelligence is likely to contribute to well-being on most plausible accounts. Second, I argue that, even (...) if it does not, one can only resist the conclusion that reproducers should select on the basis of intelligence if its expected net effect is neutral. If intelligence reduces expected well-being, then reproducers should select offspring of low intelligence. More likely, the effect of increased intelligence on expected well-being varies at different levels, which makes identifying an optimum for well-being more complex than hitherto appreciated. (shrink)

A number of authors criticise opt-out (or ‘deemed consent’) systems for failing to secure valid consent to organ donation. Further, several suggest that mandated choice offers a more ethical alternative. This article responds to criticisms that opt-out does not secure informed consent. If we assume current (low) levels of public awareness, then the explicit consent secured under mandated choice will not be informed either. Conversely, a mandated choice policy might be justifiable if accompanied by a significant public education campaign. However, (...) if this entitles us to assume that members of the public are informed, then an opt-out system would also be justified in the same circumstances. The alleged advantages of mandated choice seem to rest on an unfair comparison, between mandated choice with a public education campaign and an opt-out system without one. While it may be that some countries with opt-out systems should do more to inform their publics, I see no reason to assume that this cannot be done. Indeed, advocates of mandated choice seem committed to thinking it possible to raise awareness. If opt-out systems adopt the same methods, such as writing to every individual, this should also address concerns about whether consent is informed. (shrink)

In this reply to Wilkinson and De Wispelaere, I argue that an opt-out donation system can be regarded as tacit consent. I first separate the opt-in/opt-out issue from that of the role that the family ought to play. I then argue that what De Wispelaere calls minimal approval-tracking is not obviously necessary and that, even if it were, opt-out schemes can satisfy this requirement.

This essay reconsiders the haphazard arrangement of Donne's first printed collection of poems in relation to an elegy written for Donne by one Thomas Browne, published for the first and only time in that same volume. The earliest recorded response we have to Donne's verse considered as a complete body of work, Browne's elegy thematizes the readerly tendency to interpret this textual body in the light of "subjective" notions of "proper" desire. Through a close reading of Browne's poem, in which (...) I contextualize his key image of the bad reader as a "circumciser" within the theological and medical discourses of the period, I argue that Browne's response to Donne's text is at once instructively prescient -- providing a useful allegory of reading for the contemporary critic -- and also helpful in situating Donne at the cusp of a historical transformation between "medieval" and "early modern" conceptions of the sexual and the spiritual.IThe structural organization of John Donne's first printed book of poetry makes no obvious sense. Published posthumously in 1633, the collection eschews even the basic generic distinctions so familiar to Donne's modern audience: "Songs and Sonnets," "Satires," "Verse Letters," and "Divine Poems" . Several readers over the years have commented upon the disorderly configuration of Donne's 1633 text; and most recently, Leah Marcus has provided a detailed analysis of the collection in Unediting The Renaissance, itself an ambitious attempt to combine the traditional skills of textual bibliography with the insights of poststructuralist theory. Among other things, Marcus asserts that the very layout and internal composition of Donne's first collection constitute graphic evidence for the ultimate impossibility of "fixing" him within any reductively binary scheme. Indeed, for Marcus, the version of Donne projected by the 1633 Poems confirms not only her deconstructivist principles but also her aesthetic taste more generally. In her words, the collection is a striking melange of sacred and secular that refuses to separate John Donne from Jack. Verse epistles . . . jostle up against scurrilous amatory verses and evocations of human decay in a rough gallimaufry of mingled passions that projects a John Donne very like the Donne most of us value, a Donne for whom the sacred and secular are so closely entwined as to be inseparable.This reading would probably not be considered controversial in most quarters, and I too am in agreement with the main points of Marcus's argument, insofar as they go. However, I want to pause for a moment over one of the more undeveloped aspects of Marcus's interpretation, encoded in her use of the phrase "most of us." As the context makes clear, by "most of us" Marcus means a rather small band of nonreligious or liberal, professionalized, twentieth-century readers. Of course, Marcus is perfectly justified in assuming that her audience will be drawn from exactly this narrow demographic , but at the same time it must also be admitted that "most of us" therefore only refers to the tiniest portion of Donne's actual historical readership. Given that Marcus is performing an analysis of Donne's 1633 Poems, then, one obvious question emerges from her account: How might readers in 1633 have responded to the collection's juxtaposition of the religious with the secular? What might its disorganization have signified for them?One possible answer to this question has been suggested by Arthur F. Marotti, perhaps the most influential of Donne's textualist critics. In Manuscript, Print, and the English Renaissance Lyric, Marotti suggests, against Marcus, that Donne's first editors deliberately delay the readerly encounter with Donne's more earthly lyrics by burying them toward the back of the book. In other words, according to Marotti, the appearance of random disorganization that Marcus values is actually an intentional blind -- the result of a conscious attempt to "protect the reputation of Dean Donne from moral taint."However, this ingenious theory is not without flaws. For example, we are required to accept Marotti's contention. (shrink)

In the event of a pandemic, demand for vaccines may exceed supply. One proposal for allocating vaccines is to use a lottery, to give all citizens an equal chance, either of getting the vaccine or of surviving. However, insistence on strict equality can result in seriously suboptimal outcomes. I argue that the requirement to treat all citizens impartially need not be interpreted to require equal chances, particularly where citizens are differently situated. Assuming that we want to save lives, we should (...) also seek to use vaccine efficiently, so far as this is compatible with equality. Thus, in allocating vaccine, we may want to be sensitive to different levels of need and/or effects on vaccine production. While such policies may result in unequal chances, they may even improve everyone’s chances. In such cases, the resultant inequality is not a violation of impartiality, but a consequence of considering each person’s claim seriously. (shrink)

There has been much discussion of the justifiability of strikes by healthcare workers, but comparatively little discussion of the political processes through which strikes occur. This article focuses on the Trade Union Act 2016, which currently governs strike ballots in the UK. This legislation has important implications for healthcare workers being balloted on strikes (or other forms of industrial action). The article first explains the legal requirements for a strike mandate and illustrates how votes in strike ballots can be counterproductive, (...) bringing about outcomes opposite of what the voter wanted. Second, it argues that the turnout threshold responsible for these surprising results is undemocratic, since it means that outcomes need not reflect the wishes of those balloted. Third, it suggests that this has consequences for how balloted workers ought to vote, if they want the process to be more democratic. In particular, I propose that those who are neutral or indifferent have reason to cast spoiled ballots, in order to negate the turnout threshold. Further, those who oppose a strike also have reasons—if they value democratic decision-making—to vote, even though this may be less effective than abstaining. As I write, in August 2023, junior doctors in the UK are once again being balloted over strike action.1 While the global picture is more varied, strikes by medical professionals have historically been rare in the UK. When British doctors went on strike in 2012, over changes to pensions, it was the first time since 1975.2 Since then, however, industrial action has become more common. Some attribute this to an erosion of patient-centred professional values, which has made workers more prepared to strike in response to deteriorating pay and conditions.3 4 Whether or not this is the explanation, the increased prevalence of strikes has caused some concern. It is often …. (shrink)