Alex Voorhoeve

Philosophy of Science is a mid-level text for students with some grounding in philosophy. It introduces the questions that drive enquiry in the philosophy of science, and aims to educate readers in the main positions, problems and arguments in the field today. Alex Rosenberg is certainly well qualified to write such an introduction. His works cover a large area of the philosophy of natural and social sciences. In addition, the author of the argument that the ‘queen of the social sciences’, economics, is not a science at all, can be counted on to show how the philosophy of science can be relevant to the understanding of the status of scientific knowledge and can provide a critical assessment of practitioners’ view of their field.

I argue that Scanlon's Value of Choice View does not offer a plausible account of substantive responsibility. I offer a new account, which I call the Potential Value of Opportunities View. On this view, when a person is in a position to freely and capably make an informed choice, we assess her situation not by the outcome she achieves but by the potential value of her opportunities. This value depends on the value of the various things that she can achieve through her choices, as well as on how disposed she is to choose her better options and avoid her worse options. This view explains the priority we give to preventing harm that a person cannot avoid by choosing appropriately over harm that a person can so avoid by the fact that the second person has a valuable opportunity that the first does not have. It explains the importance of protecting people against choosing badly by the value of being placed in circumstances in which one is disposed to choose well, and the disvalue of being exposed to the danger of coming to harm by choosing badly.

Control measures, such as “lockdowns”, have been widely used to suppress the COVID-19 pandemic. Under some conditions, they prevent illness and save lives. But they also exact an economic toll. How should we balance the impact of such policies on individual lives and livelihoods (and other dimensions of concern) to determine which is best? A widely used method of policy evaluation, benefit–cost analysis (BCA), answers these questions by converting all the effects of a policy into monetary equivalents and then summing them up. A different method, social welfare analysis, proceeds by determining the effects of a policy on individual wellbeing and then applying an aggregation formula to them to evaluate the overall effects of a policy. In this chapter, we survey these methods and argue that social welfare analysis has important advantages. One crucial advantage is that it enables ethical considerations relating to the impact of policies on individual wellbeing and its distribution to be incorporated into policy assessments in a transparent way. We illustrate this with a simple numerical model for evaluating pandemic policies that vary in terms of the stringency of the controls that they impose on individual behaviour, showing how the evaluation depends on the ethical significance accorded to their impact on the wellbeing of different age and income groups.

Stuart Rachels and Larry Temkin have offered a purported counter-example to the acyclicity of the relationship 'all things considered better than'. This example invokes our intuitive preferences over pairs of alternatives involving a single person's painful experiences of varying intensity and duration. These preferences, Rachels and Temkin claim, are confidently held, entirely reasonable, and cyclical. They conclude that we should drop acyclicity as a requirement of rationality. I argue that, together with the findings of recent research on the way people evaluate episodes of pain, the use of a heuristic known as similarity-based decision-making explains why our intuitive preferences may violate acyclicity in this example. I argue that this explanation should lead us to regard these preferences with suspicion, because it indicates that they may be the result of one or more biases. I conclude that Rachels' and Temkin's example does not provide sufficient grounds for rejecting acyclicity

Philippe van Parijs (2003) has argued that an egalitarian ethos cannot be part of a post- Political Liberalism Rawlsian view of justice, because the demands of political justice are confined to principles for institutions of the basic structure alone. This paper argues, by contrast, that certain principles for individual conduct—including a principle requiring relatively advantaged individuals to sometimes make their economic choices with the aim of maximising the prospects of the least advantaged—are an integral part of a Rawlsian political conception of justice. It concludes that incentive payments will have a clearly limited role in a Rawlsian theory of justice.

Social Networking Services provide services in return for rights to commercialize users’ personal data. We argue that what makes this transaction permissible is not users’ autonomous consent but the provision of sufficiently valuable opportunities to exchange data for services. We argue that the value of these opportunities should be assessed for both (a) a range of users with different decision-making abilities and (b) third parties. We conclude that regulation should shift from aiming to ensure autonomous consent towards ensuring that users face options that they will use to advance individual and common interests.

In On Liberty, Mill famously propounded a view of the good life as the autonomous life. On this view, it is crucial that people develop and exercise, to a high degree, their ability to reason independently about what to believe and what to aim at in life. It is also important that they be able to freely hold and express their beliefs and effectively act on their aims. As Mill put it: The mental and the moral, like the muscular, powers are improved only by being used. ... He who lets the world ... choose his plan of life for him has no need of any other faculty than the ape-like one of imitation. He who chooses his plan of life for himself ... must use observation to see, reasoning and judgment to foresee, activity to gather materials for decision, discrimination to decide, and when he has decided, firmness and self-control to hold his deliberate decision. And these qualities he requires and exercises exactly in proportion as the part of his conduct which he determines according to his own judgment and feelings.... It is possible that he may be guided in some good path ... without any of these things. But what will be his comparative worth as a human being? (p. 56). Two of Mill’s arguments for familiar liberal rights—which include children’s right to a decent education, freedom of conscience, freedom of expression, and freedom of association— appeal to this ideal of autonomy. First, these rights are generally crucial for establishing the conditions under which people can freely make up their own minds about what to believe and how to live, and to act accordingly. Second, a society that respected these rights would, Mill thought, be more likely to have a vibrant public culture, in which divergent opinions and lifestyles lead to a ‘generally high scale of mental activity’, which together ‘raise even persons of the most ordinary intellect to something of the dignity of thinking beings’ (p. 33).

The political and philosophical problems John Rawls set out to solve arise out of the identity and conflicts of interests between citizens. There is identity of interests because social cooperation makes possible for everyone a life that is much better than one outside of society. There is a conflict of interests because people all prefer a larger to a smaller share of the benefits of social cooperation, and people have ideological differences. The problem a theory of justice has to solve is how, in the face of these conflicts, effective social cooperation can come about on terms that are justifiable to all.

Progress towards Universal Health Coverage (UHC) requires making difficult trade-offs. In this journal, Dr. Margaret Chan, the WHO Director-General, has endorsed the principles for making such decisions put forward by the WHO Consultative Group on Equity and UHC. These principles include maximizing population health, priority for the worse off, and shielding people from health-related financial risks. But how should one apply these principles in particular cases and how should one adjudicate between them when their demands conflict? This paper by some members of the Consultative Group and a diverse group of health policy professionals addresses these questions. It considers three stylized versions of actual policy dilemmas. Each of these cases pertains to one of the three principal dimensions of progress towards UHC: which services to cover first, which populations to prioritize for coverage, and how to move from out-of-pocket expenditures to pre-payment with pooling of funds. Our cases are simplified to highlight common trade-offs. While we make specific recommendations, our primary aim is to demonstrate both the form and substance of the reasoning involved in striking a fair balance between competing interests on the road to UHC.

We analyse three moral dilemmas involving resource allocation in care for HIV-positive patients. Ole Norheim and Kjell Arne Johansson have argued that these cases reveal a tension between egalitarian concerns and concerns for better population health. We argue, by contrast, that these cases reveal a tension between, on the one hand, a concern for equal *chances*, and, on the other hand, both a concern for better health and an egalitarian concern for equal *outcomes*. We conclude that, in these cases, there is much less tension than Norheim and Johansson claim between egalitarian concerns and concerns for better population health.

The publication of the first Report of the International Panel on Social Progress is a significant intellectual event, both because of its hugely ambitious aim – of uniting the world's leading researchers from social sciences and the humanities to develop research-based, multi-disciplinary, non-partisan, action-guiding solutions to the central challenges of our time – and because it represents the completion of a mammoth effort in the service of this aim by a diverse set of 269 authors. In its attempt to synthesize and render accessible to social actors a broad range of the latest social scientific knowledge, as well as in its confidence that knowledge can empower those actors to make progress, it recalls D'Alembert and Diderot's famous Encyclopédie. Indeed, one can say that the Report is a quintessential Enlightenment project. For example, in his famous Outlines of a Historical View of the Progress of the Human Mind, Condorcet asserts the possibility of an accumulation of empirical and theoretical knowledge and the concomitant expansion in our capacities to alleviate social and natural evils. And Condorcet and many of his contemporaries were motivated to propose political institutions that would enable such an indefinite increase in knowledge so as to bring about the attendant improvement to people's lives.

Due to constraints on institutional capacity and financial resources, the road to universal health coverage (UHC) involves difficult policy choices. To assist with these choices, scholars and policy makers have done extensive work on criteria to assess the substantive fairness of health financing policies: their impact on the distribution of rights, duties, benefits and burdens on the path towards UHC. However, less attention has been paid to the procedural fairness of health financing decisions. The Accountability for Reasonableness Framework (A4R), which is widely applied to assess procedural fairness, has primarily been used in priority-setting for purchasing decisions, with revenue mobilization and pooling receiving limited attention. Furthermore, the sufficiency of the A4R framework’s four criteria (publicity, relevance, revisions and appeals, and enforcement) has been questioned. Moreover, research in political theory and public administration (including deliberative democracy), public finance, environmental management, psychology, and health financing has examined the key features of procedural fairness, but these insights have not been synthesized into a comprehensive set of criteria for fair decision-making processes in health financing. A systematic study of how these criteria have been applied in decision-making situations related to health financing and in other areas is also lacking. This paper addresses these gaps through a scoping review. It argues that the literature across many disciplines can be synthesized into 10 core criteria with common philosophical foundations. These go beyond A4R and encompass equality, impartiality, consistency over time, reason-giving, transparency, accuracy of information, participation, inclusiveness, revisability and enforcement. These criteria can be used to evaluate and guide decision-making processes for financing UHC across different country income levels and health financing arrangements. The review also presents examples of how these criteria have been applied to decisions in health financing and other sectors.

This paper explores whether people recognise inconsistency in their own and others’ judgments when they are explicitly prompted to review them. It reports two pre-registered experimental online studies with samples broadly representative of the UK population (N = 814 and N = 1,623). In Study 1, people are more likely to recognise inconsistency in others’ moral (and non-moral) judgments than in their own (positive OTHER-OWN difference). Study 2 replicates this finding and test three explanations of the observed effect offered by previous literature: motivated reasoning, selective cognitive effort, and limited insight into others’ reasoning. It finds that the effect is not moderated by social accountability, which implies that if there is motivated reasoning at play, it must operate outside of a person’s awareness. While a small part of the effect is mediated by the time spent on the consistency assessment task (a proxy for cognitive effort), the study finds no support for the limited insight hypothesis. The core finding that people are better at recognizing inconsistency in others’ moral judgments aligns with interactionist accounts of reasoning; more research is needed to fully uncover the cognitive mechanisms behind this effect.

If a potential person would have a good life if he were to come into existence, can we coherently regard his coming into existence as better for him than his never coming into existence? And can we regard the situation in which he never comes into existence as worse for him? In this paper, we argue that both questions should be answered affirmatively. We also explain where prominent arguments to differing conclusions go wrong. Finally, we explore the relevance of our answers to issues in population ethics.

Stuart Rachels and Larry Temkin have offered a purported counterexample to the acyclicity of the relationship “all things considered better than”. This example invokes our intuitive preferences over pairs of alternatives involving a single person’s painful experiences of varying intensity and duration. These preferences, Rachels and Temkin claim, are confidently held, entirely reasonable, and cyclical. They conclude that we should drop acyclicity as a requirement of rationality. I argue that, together with the findings of recent research on the way people evaluate episodes of pain, the use of a heuristic known as similarity-based decision-making explains why our intuitive preferences may violate acyclicity in this example. I argue that this explanation should lead us to regard these preferences with suspicion, because it indicates that they may be the result of one or more biases. I conclude that Rachels’ and Temkin’s example does not provide sufficient grounds for rejecting acyclicity.

Preferences are often thought to be relevant for well-being: respecting preferences, or satisfying them, contributes in some way to making people's lives go well for them. A crucial assumption that accompanies this conviction is that there is a normative standard that allows us to discriminate between preferences that do, and those that do not, contribute to well-being. The papers collected in this volume, written by moral philosophers and philosophers of economics, explore a number of central issues concerning the formulation of such a normative standard. They examine what a defensible account of how preferences should be formed for them to contribute to well-being should look like; whether preferences are subject to requirements of rationality and what reasons we have to prefer certain things over others; and what the significance is, if any, of preferences that are arational or not conducive to well-being.

Shlomi Segall’s Why Inequality Matters contains many novel ideas. It should engage researchers with an interest in debates between luck egalitarians and two of their principal opponents, prioritarians and sufficientarians. While, as I shall argue below, not all of its arguments succeed, it also makes contributions which deserve to profoundly influence debates on distributive justice. I proceed as follows. In Section 1, I summarize the book’s central points; in Section 2, I evaluate some of its arguments.

Philippe van Parijs (2003) has argued that an egalitarian ethos cannot be part of a post- Political Liberalism Rawlsian view of justice, because the demands of political justice are confined to principles for institutions of the basic structure alone. This paper argues, by contrast, that certain principles for individual conduct—including a principle requiring relatively advantaged individuals to sometimes make their economic choices with the aim of maximising the prospects of the least advantaged—are an integral part of a Rawlsian political conception of justice. It concludes that incentive payments will have a clearly limited role in a Rawlsian theory of justice.

In 2017, Ukraine’s Parliament passed legislation establishing a single health benefit package for the entire population called the Programme of Medical Guarantees,‎ financed through general taxes and administered by a single national purchasing agency. This legislation was in line with key principles for financing universal health coverage. However, health professionals and some policymakers have been critical of elements of the reform, including its reliance on general taxes as the source of funding. Using qualitative methods and drawing on deliberative democratic theory and criteria for procedural fairness, this study argues that the acceptance and sustainability of these reforms could have been strengthened by making the decision-making process fairer. It suggests that three factors limited the extent of stakeholders’ participation in this process: first, a perception among reformers that fast-paced decision-making was required because there was only a short political window for much needed reforms; second, a lack of trust among reformers in the motives, representativeness, and knowledge of some stakeholders; and third, an under-appreciation of the importance of dialogic engagement with the public. These findings highlight a profound challenge for policymakers. In retrospect, some of those involved in the reform’s design and implementation believe that a more meaningful engagement with the public and stakeholders who opposed the reform might have strengthened its legitimacy and durability. At the same time, the study shows how difficult it is to have an inclusive process in settings where some actors may be driven by unconstrained self-interest or lack the capacity to be representative or knowledgeable interlocutors. It suggests that investments in deliberative capital (the attitudes and behaviours that facilitate good deliberation) and in civil society capacity may help overcome this difficulty.