Alex Voorhoeve

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.

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.

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.

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.

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.

Epicurus posited that the best life involves the greatest pleasures. He also argued that it involves attaining tranquillity. Many commentators 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 offer an Epicurean argument for why the best life is one in which a person attains tranquillity and tastes its pleasures until death.

The COVID-19 crisis has forced a difficult trade-off between limiting the health impacts of the virus and maintaining economic activity. Welfare economics offers tools to conceptualize this trade-off so that policy-makers and the public can see clearly what is at stake. We review four such tools: the Value of Statistical Life (VSL); the Value of Statistical Life Years (VSLYs); Quality-Adjusted Life-Years (QALYs); and social welfare analysis, and argue that the latter are superior. We also discuss how to choose policies that differentially affect people’s wellbeing. We argue in favor of evaluating policies using a Social Welfare Function (SWF), which evaluates the possible distributions of wellbeing across individuals that may result from a policy. Such a function, we argue, should regard increases in the wellbeing of the less well-off as especially valuable. We then use a model to illustrate how such a framework can help evaluate two broad policy types in response to the pandemic: eradication of the virus, and more lenient control of the spread. Our model reveals how such evaluations depend on many empirical facts but also on key value judgments about the relative importance of health and on the extent of special concern for the worse off. The purpose of this brief is not to make precise recommendations, as conditions vary widely across countries and over time, but to provide a methodology.

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.

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.

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 paper examines the role that this form of expected well-being should play in distributing benefits among prospective people and in deciding who 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 paper argues that such egalitarianism for prospective people springs from equal concern for each 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.

How should governments balance saving people from very large individual disease burdens (such as an early death) against saving them from middling burdens (such as erectile dysfunction) and minor burdens (such as nail fungus)? This chapter considers this question through an analysis of a priority-setting proposal in the Netherlands, on which avoiding a multitude of middling burdens takes priority over saving one person from early death, but no number of very small burdens can take priority over avoiding one death. It argues that there is some, albeit imperfect, evidence of substantial public support for such a policy. Furthermore, it provides a principled rationale for it in terms of respect for the person who faces the largest burden.

The experience of Costa Rica highlights the potential for conflicts between the right to health and fair priority setting. For example, one study found that most favorable rulings by the Costa Rican constitutional court concerning claims for medications under the right to health were either for experimental treatments or for medicines that should have low priority based on health gain per unit of expenditure and severity of disease. In order to better align rulings with priority setting criteria, in 2014, the court initiated a reform in its assessment of claims for medicine. This paper assesses this reform’s impact on the fairness of resource allocation. It finds three effects. First, a reduction in successful claims for experimental medication, which is beneficial. Second, an increase in the success rate of medication lawsuits, which is detrimental because most claims are for extremely cost-ineffective medications. Third, a decline in the number of claims for medicine, which is beneficial because it forestalls such low-priority spending. This paper estimates that, taking all three effects into account, the reform has had a modest net positive impact on overall resource allocation. However, it also argues that there is a need for further reforms to lower the number of claims to low-priority medicines that are granted.

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.

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.

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.

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.

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.

A persistent argument against the transitivity assumption of rational choice theory postulates a repeatable action that generates a significant benefit at the expense of a negligible cost. No matter how many times the action has been taken, it therefore seems reasonable for a decision-maker to take the action one more time. However, matters are so fixed that the costs of taking the action some large number of times outweigh the benefits. In taking the action some large number of times on the grounds that the benefits outweigh the costs every time, the decision-maker therefore reveals intransitive preferences, since once she has taken it this large number of times, she would prefer to return to the situation in which she had never taken the action at all. We defend transitivity against two versions of this argument: one in which it is assumed that taking the action one more time never has any perceptible cost, and one in which it is assumed that the cost of taking the action, though (sometimes) perceptible, is so small as to be outweighed at every step by the significant benefit. We argue that the description of the choice situation in the first version involves a contradiction. We also argue that the reasoning used in the second version is a form of similarity-based decision-making. We argue that when the consequences of using similarity-based decision-making are brought to light, rational decision-makers revise their preferences. We also discuss one method that might be used in performing this revision.

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.

Decision-makers face severe uncertainty when they are not in a position to assign precise probabilities to all of the relevant possible outcomes of their actions. Such situations are common—novel medical treatments and policies addressing climate change are two examples. Many decision-makers respond to such uncertainty in a cautious manner and are willing to incur a cost to avoid it. There are good reasons for taking such an uncertainty-averse attitude to be permissible. However, little work has been done to incorporate it into an egalitarian theory of distributive justice. We aim to remedy this lack. We put forward a novel, uncertainty-averse egalitarian view. We analyse when the aims of reducing inequality and limiting the burdens of severe uncertainty are congruent and when they conflict, and highlight practical implications of the proposed view. We also demonstrate that if uncertainty aversion is permissible, then utilitarians must relinquish a favourite argument against egalitarianism.

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.

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.