Alex Voorhoeve

We examine the ethics of enrolling individuals in research that poses net health risks by appealing to their altruism. We argue that it is permissible to enrol individuals who are motivated by altruism when (i) they autonomously consent; and (ii) the net health risks are outweighed by the combination of (ii-a) the extent to which participation furthers their considered aims and thereby contributes to their wellbeing and agency and (ii-b) the study’s social value. Further, it is permissible to enrol altruistic individuals who cannot consent when: (I) their surrogate consents and they assent, ideally because it furthers their aims; and (II) the net health risks are outweighed by the extent to which participation contributes to their wellbeing and agency. This account leads us to suggest a revision of consent forms to include more information about studies’ social value and a reduction of barriers to the enrolment of participants who cannot consent.

As health policy-makers around the world seek to make progress towards universal health coverage they must navigate between two important ethical imperatives: to set national spending priorities fairly and efficiently; and to safeguard the right to health. These imperatives can conflict, leading some to conclude that rights-based approaches present a disruptive influence on health policy, hindering states’ efforts to set priorities fairly and efficiently. Here, we challenge this perception. We argue first that these points of tension stem largely from inadequate interpretations of the aims of priority setting as well as the right to health. We then discuss various ways in which the right to health complements traditional concerns of priority setting and vice versa. Finally, we set out a three-step process by which policy-makers may navigate the ethical and legal considerations at play.

This paper explores whether people are more likely to recognize inconsistency in others’ judgments than in their own, and if so, why. It reports two pre-registered online experiments with samples representative of the UK population (N = 814 and N = 1,623). In Study 1, people are more likely to recognize inconsistency in others’ moral (and non-moral) judgments than in their own. Study 2 replicates this finding and tests three explanations: (i) motivated reasoning, (ii) selective cognitive effort, and (iii) limited insight into others’ reasoning. Ad (i), because people’s susceptibility to motivated reasoning is said to diminish when people must account for their judgments, the presence of motivated reasoning was examined by manipulating social accountability. No effect was found. Ad (ii), while people spent significantly more time (a proxy for cognitive effort) on reviewing others’ consistency than their own, this explained only a fraction of the greater rate at which inconsistencies in others’ reasoning were recognized. Ad (iii), using low confidence in consistency evaluations as a proxy for limited insight, the study did not find support for the limited insight hypothesis. The finding that people are better at recognizing inconsistency in others’ moral judgments aligns with the idea that moral consistency reasoning is a social device that operates best when we interact with others, but more research is needed to uncover the psychological mechanisms behind this effect.

As health policy-makers around the world seek to make progress towards universal health coverage they must navigate between two important ethical imperatives: to set national spending priorities fairly and efficiently; and to safeguard the right to health. These imperatives can conflict, leading some to conclude that rights-based approaches present a disruptive influence on health policy, hindering states’ efforts to set priorities fairly and efficiently. Here, we challenge this perception. We argue first that these points of tension stem largely from inadequate interpretations of the aims of priority setting as well as the right to health. We then discuss various ways in which the right to health complements traditional concerns of priority setting and vice versa. Finally, we set out a three-step process by which policy-makers may navigate the ethical and legal considerations at play.

This paper examines the role of a person’s opportunities to choose in the justification of social arrangements. Common judgment gives these opportunities a justificatory role: it holds, for example, that we should prioritise preventing harm that people cannot avoid by choosing appropriately over preventing harm that they can so avoid. Thomas Scanlon argues that such judgments should be explained with reference to the value of a person’s opportunities to choose: if a person is given opportunities which generally lead people to avoid the harm in question, then, Scanlon argues, this can make it the case that she cannot complain about what results from her choices. I argue that while Scanlon is right to focus on the value of a person’s opportunities, his way of determining their value is flawed. Instead, I argue, we should evaluate a person’s opportunity set by taking account of the various outcomes that she can achieve by choosing from this set and how well placed she is, given her dispositions to choose, to achieve the good and avoid the bad outcomes. I argue that this view can explain why we should prioritise preventing harm that people cannot avoid by choosing appropriately over preventing harm that they can so avoid. I also argue that it can account for the importance of protecting people against choices through which they might come to harm.

Experimental results on the Ellsberg paradox typically reveal behavior that is commonly interpreted as ambiguity aversion. The experiments reported in the current paper find the objective probabilities for drawing a red ball that make subjects indifferent between various risky and uncertain Ellsberg bets. They allow us to examine the predictive power of alternative principles of choice under uncertainty, including the objective maximin and Hurwicz criteria, the sure-thing principle, and the principle of insufficient reason. Contrary to our expectations, the principle of insufficient reason performed substantially better than rival theories in our experiment, with ambiguity aversion appearing only as a secondary phenomenon.

The difference between the unity of the individual and the separateness of persons requires that there be a shift in the moral weight that we accord to changes in utility when we move from making intrapersonal trade-offs to making interpersonal trade-offs. We examine which forms of egalitarianism can, and which cannot, account for this shift. We argue that a form of egalitarianism which is concerned only with the extent of outcome inequality cannot account for this shift. We also argue that a view which is concerned with both outcome inequality and with the unfairness of inequality in individuals’ expected utilities can account for this shift. Finally, we limn an alternative view, on which such inequalities are not intrinsically bad, but nonetheless determine the strength of individuals’ competing claims. We argue that this ‘Competing Claims View’ can also account for the shift.

We use probability-matching variations on Ellsberg’s single-urn experiment to assess three questions: (1) How sensitive are ambiguity attitudes to changes from a gain to a loss frame? (2) How sensitive are ambiguity attitudes to making ambiguity easier to recognize? (3) What is the relation between subjects’ consistency of choice and the ambiguity attitudes their choices display? Contrary to most other studies, we find that a switch from a gain to a loss frame does not lead to a switch from ambiguity aversion to ambiguity neutrality and/or ambiguity seeking. We also find that making ambiguity easier to recognize has little effect. Finally, we find that while ambiguity aversion does not depend on consistency, other attitudes do: consistent choosers are much more likely to be ambiguity neutral, while ambiguity seeking is much more frequent among highly inconsistent choosers.

Recent Work on Intrinsic Value brings together for the first time many of the most important and influential writings on the topic of intrinsic value to have appeared in the last half-century. During this period, inquiry into the nature of intrinsic value has intensified to such an extent that at the moment it is one of the hottest topics in the field of theoretical ethics. The contributions to this volume have been selected in such a way that all of the fundamental questions concerning the nature of intrinsic value are treated in depth and from a variety of viewpoints. These questions include how to understand the concept of intrinsic value, what sorts of things can have intrinsic value, and how to compute intrinsic value. The editors have added an introduction that ties these questions together and places the contributions in context, and they have also provided an extensive bibliography. The result is a comprehensive, balanced, and detailed picture of current thinking about intrinsic value, one that provides an indispensable backdrop against which future writings on the topic may be assessed.

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.

Epicurus posited that the best life involves the greatest pleasures. He also held that it involves attaining tranquillity. Many commentators, including Ken Binmore, have expressed scepticism that these two claims are compatible. For, they argue, Epicurus’ tranquil life is so austere that it is hard to see how it could be maximally pleasurable. Here, I offer an Epicurean account of the pleasures of tranquillity. I also consider different ways of valuing lives from a hedonistic point of view. Benthamite hedonists value lives by the sum of pleasures minus the sum of pains, weighted by intensity and duration. Meanwhile, Binmore proposes that Epicurus valued lives by their worst episode. In contrast, I outline an Epicurean argument for why the best life is one in which a person attains tranquillity and tastes its pleasures until death.

A possible person's conditional expected well-being is what the quality of their prospects would be if they were to come into existence. This article examines the role that this form of expected well-being should play in distributing benefits among prospective people and in deciding whom to bring into existence. It argues for a novel egalitarian view on which it is important to ensure equality in people's life prospects, not merely between actual individuals, but also between all individuals who, given our choices, have a chance of coming into existence. The article argues that such egalitarianism for prospective people springs from equal concern for each prospective person and has plausible implications. It further shows that it has a rationale in respect for both the unity of the individual and the separateness of persons. Finally, it defends this view against a key objection and shows it is superior to a rival view.

In the spring of 2009, a novel strain of the H1N1 influenza virus, containing a never before witnessed combination of gene segments from human influenza, two forms of swine influenza, and avian influenza, 1 was declared a global pandemic. The UK Government had to decide whether to undertake, at a cost of £1.2 billion (USD 1.9 billion at the time, equivalent to 1 percent of that year’s health budget), an extensive set of preparatory measures, including the purchase of both antiviral medication and a novel vaccine in quantities sufficient to cover the entire UK population, or whether instead to take substantially less costly measures, which would involve having only a limited supply of these medicines and vaccines at hand.2 The possible.

Epicurus argued that the good life is the pleasurable life. He also argued that “death is nothing to us”. These claims appear in tension. For, if pleasure is good, then it seems that death is bad when it deprives us of deeply enjoyable time alive. Here, I offer an Epicurean view of pleasure and the complete life which dissolves this tension. This view is, I contend, more appealing than critics of Epicureanism have allowed, in part because it assigns higher value to pleasures that we produce by exercising our rational capacities and by establishing control over our lives.

When people must either save a greater number of people from a smaller harm or a smaller number from a greater harm, do their choices reflect a reasonable moral outlook? We pursue this question with the help of an experiment. In our experiment, two-fifths of subjects employ a similarity heuristic. When alternatives appear dissimilar in terms of the number saved but similar in terms of the magnitude of harm prevented, this heuristic mandates saving the greater number. In our experiment, this leads to choices that are inconsistent with all standard theories of justice. We argue that this demonstrates the untrustworthiness of distributive judgements in cases that elicit similarity-based choice.

The COVID-19 crisis and the policy responses to it have impacted many different areas of common concern including public health and the economy. This raises difficult questions about how to balance these concerns in making policy decisions. In this chapter, we review a number of tools that welfare economics offers for conceptualizing and studying such trade-offs. We argue that social welfare analysis is the most useful method for doing so. We show how concerns for the distributive and other effects of a policy on individual wellbeing can be evaluated using a Social Welfare Function (SWF) and survey some of the main features of such functions. As an illustration, we then use this approach to model and evaluate the implications for social welfare of the adoption of pandemic policies that vary in terms of the stringency of the controls that they impose on individual behaviour. Our model reveals how such evaluations not only are determined by empirical facts but may also depend on key judgments about the relative importance of the different determinants of individual wellbeing (health, income, longevity, and so on) and about the extent to which special concern should be given to the worse-off. In doing so, it illustrates how critical transparent modelling of these concerns is in developing responses to pandemics of this kind.

Epicurus argued that the good life is the pleasurable life. He also argued that “death is nothing to us”. These claims appear in tension. For, if pleasure is good, then it seems that death is bad when it deprives us of deeply enjoyable time alive. Here, I offer an Epicurean view of pleasure and the complete life which dissolves this tension. This view is, I contend, more appealing than critics of Epicureanism have allowed, in part because it assigns higher value to pleasures that we produce by exercising our rational capacities and by establishing control over our lives.

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.

In response to our critics, we clarify and defend key ideas in the report Open and Inclusive: Fair Processes for Financing Universal Health Coverage. First, we argue that procedural fairness has greater value than Dan Hausman allows. Second, we argue that the Report aligns with John Kinuthia’s view that a knowledgeable public and a capable civil society, alongside good facilitation, are important for effective public deliberation. Moreover, we agree with Kinuthia that the Report’s framework for procedural fairness applies not merely within the health sector, but also to the wider budget process. Third, we argue that while Dheepa Rajan and Benjamin Rouffy-Ly are right that robust processes for equal participation are often central to a fair process, sometimes improvements in other aspects of procedural fairness, such as transparency, can take priority over strengthening participation. Fourth, while we welcome Sara Bennett and Maria Merritt’s fascinating use of the Report’s principles of procedural fairness to assess the U.S. President’s Emergency Plan for AIDS Relief, we argue that their application of the Report’s principle of equality to development partners’ decision-making requires further justification.