Allen Buchanan

This essay has two aims: The first is to demonstrate that the basic conceptual framework of principal/agent theory can be fruitfully applied to decisionmaking in health care and in such a way as to facilitate the more efficient pursuit of the moral values of individual well-being and autonomy which health care is supposed to promote. The second is to show that this application results in an enrichment of principal/agent theory itself, by removing some of the limitations on the theory that are valid only for the more exclusively self-interested, commercial contexts to which the theory is usually applied.

The international legal order is beginning to take human rights seriously, yet sound justifications for claims about human rights are conspicuously absent. Philosophers have begun to respond to this “justification deficit” by developing theories of human rights. Although a philosophical conception of human rights is needed, it would not be sufficient. The justification of human rights is a dynamic process in which a provisional philosophical conception of human rights both guides and is fleshed out by public processes of practical reasoning structured by legal institutions. Whether the “justification deficit” can be remedied depends not only upon the content of human rights norms as set out in the major conventions and the arguments philosophers can marshal to justify them but also upon the epistemic virtues of the institutions through which the norms are specified, contested, and revised over time

When advocates of insurance‐privatization consider whether private insurance‐dominated systems achieve justice at all, they tend to rely on an incomplete set of criteria for a just healthcare system. They also mistakenly assume that it is enough to show that justice is in principle achievable within a private insurance‐dominated system. This essay offers a more complete set of criteria for a just healthcare system. It then argues that the motivational assumptions needed to make insurance‐privatization at all plausible are inconsistent with the motivational assumptions needed to show that in practice a private insurance‐dominated system will achieve justice. A private insurance‐dominated system can be expected to satisfy the criteria for just healthcare only if there is extensive and effective regulation to constrain the normal competitive behavior of private insurers or if generous public funds are provided to fill the gaps in access left by the private insurance market. Yet the assumptions about the motivations and abilities of the public, regulators, and public officials needed to satisfy conditions or contradict the privatization advocate's explanations of how privatization will maximize efficiency, choice, and quality of care

Abstract:Liberal thinkers of the Enlightenment understood that surplus moral constraints, imposed by invalid moral norms, are a serious limitation on liberty. They also recognized that overcoming surplus moral constraints — what we call proper de-moralization — is an important dimension of moral progress. Contemporary philosophical theorists of liberty have largely neglected the threat that surplus moral constraints pose to liberty and the importance of proper de-moralization for human emancipation. This essay examines the phenomena of surplus moral constraints and proper de-moralization, utilizing insights from biological and cultural evolutionary thinking.

The Nobel prize-winning molecular biologist Walter Gilbert described the mapping and sequencing of the human genome as “the grail of molecular biology.” The implication, endorsed by enthusiasts for the new genetics, is that possessing a comprehensive knowledge of human genetics, like possessing the Holy Grail, will give us miraculous powers to heal the sick, and to reduce human suffering and disabilities. Indeed, the rhetoric invoked to garner public support for the Human Genome Project appears to appeal to the best of the Western tradition's enthusiasm for progress: the idea of improving human lives through the practical application of scientific knowledge.

This important study, the first book-length treatment of an increasingly crucial topic, treats the moral issues of secession at two levels. At the practical level, Professor Buchanan develops a coherent theory of the conditions under which secession is morally justifiable. He then applies it to historical and contemporary examples, including the U.S. Civil War and more recent events in Bangladesh, Katanga, and Biafra, the Baltic states, South Africa, and Quebec. This is the first systematic account of the conditions and terms that justify secession from a political union.But Buchanan also locates this account of the right to secede in the broader context of contemporary political thought, introducing readers to influential accounts of political society such as contractarianism and communitarianism, and showing how the possibility of secession fits into a more complete understanding of political community and political obligation.At both levels this is an important book. It will interest not just political and social theorists but any reader concerned with one of the most momentous issues of our day: the future of troubled political federations and other states under conditions of ethnic and cultural pluralism.

Today we are witnessing two dramatic processes: the fragmentation of old states and empires, followed by the emergence of new states and new forms of political association; and the construction of new economies out of the ruins of state socialism. These two processes—the redrawing of political boundaries and the creation of economies—are not independent of one another. In some cases, the desire for a new, more productive economy supplements other motives for state-breaking and state-making. In others, even if the fragmentation of political union results from other factors, such as ethnic divisions or the resurgence of nationalism against a weakened imperial center, the fragments may sort themselves out into new states, federations, or commonwealths, according to what they believe to be maximally productive economic units

As global governance institutions proliferate and become more powerful, their legitimacy is subject to ever sharper scrutiny. Yet what legitimacy means in this context and how it is to be ascertained are often unclear. In a previous paper in this journal, we offered a general account of the legitimacy of such institutions and a set of standards for determining when they are legitimate. In this paper we focus on the legitimacy of the UN Security Council as an institution for making decisions concerning the use of military force across state borders. The context for this topic has changed over the last decade as a result of the ongoing development of the responsibility to protect (RtoP) doctrine and extensive discussions about it in the United Nations. Yet the mostly widely accepted proposals for RtoP still require Security Council authorization for forceful intervention, and strictly limit the conditions under which such intervention may take place.

: The mandate of the U.S. Advisory Committee on Human Radiation Experiments required that the Committee take a position on the validity of retrospective moral judgments. However, throughout its period of operation, the Committee remained divided on the question of whether sound judgments of individual culpability and wrongdoing should be included in its Final Report. This essay examines the arguments that various committee members marshalled to support their opposing views on retrospective moral judgment and explains the significance of the controversy

COVID-19 vaccines are likely to be scarce for years to come. Many countries, from India to the U.K., have demonstrated vaccine nationalism. What are the ethical limits to this vaccine nationalism? Neither extreme nationalism nor extreme cosmopolitanism is ethically justifiable. Instead, we propose the fair priority for residents framework, in which governments can retain COVID-19 vaccine doses for their residents only to the extent that they are needed to maintain a noncrisis level of mortality while they are implementing reasonable public health interventions. Practically, a noncrisis level of mortality is that experienced during a bad influenza season, which society considers an acceptable background risk. Governments take action to limit mortality from influenza, but there is no emergency that includes severe lockdowns. This “flu-risk standard” is a nonarbitrary and generally accepted heuristic. Mortality above the flu-risk standard justifies greater governmental interventions, including retaining vaccines for a country's own citizens over global need. The precise level of vaccination needed to meet the flu-risk standard will depend upon empirical factors related to the pandemic. This links the ethical principles to the scientific data emerging from the emergency. Thus, the FPR framework recognizes that governments should prioritize procuring vaccines for their country when doing so is necessary to reduce mortality to noncrisis flu-like levels. But after that, a government is obligated to do its part to share vaccines to reduce risks of mortality for people in other countries. We consider and reject objections to the FPR framework based on a country: having developed a vaccine, raising taxes to pay for vaccine research and purchase, wanting to eliminate economic and social burdens, and being ineffective in combating COVID-19 through public health interventions.

Is it right to use biomedical technologies to make us better than well or even perhaps better than human? Should we view our biology as fixed or should we try to improve on it? College students are already taking cognitive enhancement drugs. The U.S. army is already working to develop drugs and technologies to produce "super soldiers." Scientists already know how to use genetic engineering techniques to enhance the strength and memories of mice and the application of such technologies to humans is on the horizon. In Better Than Human, philosopher-bioethicist Allen Buchanan grapples with the ethical dilemmas of the biomedical enhancement revolution. Biomedical enhancements can make us smarter, have better memories, be stronger, quicker, have more stamina, live much longer, avoid the frailties of aging, and enjoy richer emotional lives. In spite of the benefits that biomedical enhancements may bring, many people instinctively reject them. Some worry that we will lose something important-our appreciation for what we have or what makes human beings distinctively valuable. Others assume that biomedical enhancements will only be available to the rich, with the result that social inequalities will worsen. Buchanan shows that the debate over enhancement has been distorted by false assumptions and misleading rhetoric. To think clearly about enhancement, we have to acknowledge that human nature is a mixed bag and that our species has many "design flaws." We should be open be open to the possibility of becoming better than human, while never underestimating the risks that our attempts to improve may back-fire.

Since the earliest human societies, there has been an ongoing struggle between hierarchy and resistance to hierarchy, and this struggle is a major driver of the evolution of moralities and of institutions. Attempts to initiate or sustain hierarchies are often met with resistance; hierarchs then adopt new strategies, which in turn prompt new strategies of resistance; and so on. The key point is that the struggle is typically conducted using moral concepts in justifications for or against unequal power and involves the stimulation of the moral emotions. Both parties to the struggle treat morality as a valuable strategic resource; and the dynamic of interaction between hierarchs and resisters generates changes in that resource. The hierarch/resister struggle is in part a competition between moral concepts and justifications, and that competition drives the emergence of new moral concepts and justifications, just as competition in other contexts generates innovations. Among the moral concepts generated by the struggle are the following: authority, legitimacy, aristocracy, the divine right of kings, the mandate of heaven, natural rights, civil and political rights, constitutionalism, the rule of law, sovereignty, collective self-determination, exploitation, oppression, and domination.

One of the few things modern liberals, classical liberals, and conservatives can agree on is the charge that some of the worst features oftotalitarian socialist regimes have their origins in the writings of Karl Marx and Friedrich Engels. Nevertheless, the nature of this claim, and therefore the reasons for accepting or rejecting it, are oftenleft obscure. If it is understood simply as a causal statement, then it must be confirmed or disconfirmed by empirical social science. The political philosopher can at most assist by providing a clear characterization of the conceptual content of the beliefs which constitute the independent variable in the alleged causal relation: those beliefs concerning Marx's and Engels's thoughts which are said to have exerted the causal influence in question. Even if empirical research did showthat beliefs about Marxist theory were a significant causal influencein the rise of certain features of totalitarian socialism, this wouldbe of limited philosophical interest if the beliefs in question were misunderstandings of the theory and if the correct explanationof why these misunderstandings occurred appealed to factors external to the theory itself. However, it would be of considerable philosophical interest if correct beliefs about Marxist theory exerted a causalinfluence on some of the more undesirable aspects of totalitarian socialism, or if incorrect beliefs did and the existence of thesemisunderstandings could be traced to ambiguities or gaps in the Marxist theory itself. The political philosopher has a legitimate interestin the relationship between the writings of Marx and Engels on the rise of totalitarian socialism, not because he is interested in articulating and testing causal connections between beliefs and social phenomena in general, but because Marxist theory is supposed – by its authors – to inspire and guide change toward a better society

This essay demonstrates that the management and contestability of power is central to Dewey's understanding of democracy and provides a middle ground between two opposite poles within democratic theory: Either the masses become the genuine danger to democratic governance (à la Lippmann) or elites are described as bent on controlling the masses (à la Wolin). Yet, the answer to managing the relationship between them and the demos is never forthcoming. I argue that Dewey's response to Lippmann for how we ought to conceive of the relationship between citizens and elites if power is not to become arbitrary is located within a larger framework that avoids the problematic distinction Wolin draws between the demos and representative government. For Dewey, the legitimacy of decision-making, and, indeed, the security of freedom, is determined not merely by our actual involvement, but the extent to which non-participation does not preclude the future contestability of power.

David DeGrazia's article provides a careful and fair rendition of my position on the possibility of post-persons. However, I am unconvinced that he has shown that such beings are possible. My view is based on two assumptions: (1) the concept of moral status is a threshold concept; and (2) the most plausible understanding of moral status as a threshold concept is a Kantian respect-based view, according to which all and only those beings who have the capacity to be accountable for reasons have the high status we associate with persons. I argue that the superior beings DeGrazia describes would be more morally admirable than us, but would not have a higher moral status. I also argue that, contrary to DeGrazia, even the most intelligent of canines do not have the capacity for accountability for reasons, even in an attenuated form. I then argue that DeGrazia faces a painful dilemma: either he must give up the assumption that moral status (so far as persons are concerned) is a threshold concept and say that for any two beings with the capacity for accountability for reasons, the one with the greater capacity has a higher moral status; or he must retain the view that moral status is a threshold concept but concede that he has not account of where the threshold lies

The book uses evolutionary principles to explain tribalism, a way of thinking and acting that divides the world into Us versus Them and achieves cooperation within a group at the expense of erecting insuperable obstacles to cooperation among groups. Tribalism represents political controversies as supreme emergencies in which ordinary moral constraints do not apply and as zero-sum, winner take all contests. Tribalism not only undermines democracy by ruling out compromise, bargaining, and respect for the Other; it also reverses one of the most important milestones of progress in how we understand morality: the insight that morality is not a list of commands to be unthinkingly followed, but rather that morality centrally involves the giving and taking of reasons among equals. Tribalism rejects this insight by branding the Other as a being who is incapable of reasoning.

While acknowledging the potential benefits of pharmacogenomics as a methodology, a number of comprehensive reports in the past several years examine a multitude of ethical, legal, and social factors that may limit the extent to which these benefits are realized — and realized in ethically acceptable ways. This article aims to identify and explore the most basic ethical and regulatory issues that are likely to arise if pharmacogenomics becomes widely enough used to have a significant impact on research and clinical practice. First, however, it addresses the question of whether pharmacogenomic tests are unique when compared to other genetic tests and thus deserving of more or less stringent ethical and regulatory requirements.