Richard Y. Chappell

Is it ethical to pay patients for selecting cheaper medical treatments? The healthcare system in the United States is notoriously profligate, at least in part because when insurers foot the bill, patients have little incentive to avoid wasteful treatments. One familiar means for dealing with this problem is for insurers to offer reduced co-pays to patients who select cheaper treatments. Would it be ethical to take this one step further, beyond the zero bound, sharing the savings of cheaper treatments by positively paying the patients who select them? Schmidt & Emanuel recently proposed this policy of ‘Inclusive Shared Savings’. This article examines various ethical objections to the idea.

This paper explores two ways in which evaluations of an agent's character as virtuous or vicious are properly influenced by what the agent finds salient or attention-grabbing. First, we argue that ignoring salient needs reveals a greater deficit of benevolent motivation in the agent, and hence renders the agent more blameworthy. We use this fact to help explain our ordinary intuition that failing to give to famine relief is in some sense less bad than failing to help a child who is drowning right before your eyes, in a way that's compatible with the contention that there's no principled reason to see the one life-saving act as any more or less choiceworthy than the other. Second, we argue that alleged ‘virtues of ignorance’ are better understood as ‘virtues of salience’. Rather than placing demands on what we believe, these virtues place demands on what we find salient.