Walter Sinnott-Armstrong

When two people need a kidney transplant, but only one kidney is available, we need to decide who gets it. If one of the potential recipients needs the kidney because of their own voluntary behavior, but the other is not at all responsible for needing a kidney, then we need to decide whether this fault should be a consideration in favor of the other patient getting the kidney. While there has been considerable philosophical debate on this issue, there is far less research into the views of the public. To explore opinions on these issues, we first asked survey participants to ascribe or deny responsibility for the risky behavior for kidney disease, and for being deprived of a kidney in cases of drinking alcohol, drug abuse, smoking and unhealthy eating when the patient did or did not stop the risky behavior after being diagnosed with kidney disease. Next, we asked participants who should get the kidney when the patient who engaged in risky behavior did or did not know, or have easy access to, the information that the behavior was risky. We found that participants generally ascribed responsibility on the basis of knowledge but allocated the kidney on the basis of access to information. These findings have important implications for moral theories as well as medical policies.

Variation in addiction suggests that a good definition will be précising: it should serve a purpose. The authors canvass the various purposes served by a definition of addiction in psychiatric, social, legal, economic, interpersonal and scientific contexts. They argue that addiction is a strong and habitual want that significantly reduces control and leads to significant harm. What counts as significant varies relative to purpose and context. The authors offer a basic account of the nature of control and how and why it can be reduced. The chapter explores the nature of harm and why it is part of the definition. And it concludes by suggesting that progress in understanding addiction depends on bearing in mind the various purposes and contexts of enquiry, together with the common-sense but often neglected point that both control and harm come in degrees.