• Disability discrimination in emergencies: The return of Taurek?
    Ethic@ - An International Journal for Moral Philosophy. forthcoming.
    John Taurek famously held the view that, when deciding whom to rescue, the numbers don’t count: we should instead give everyone the same chance of surviving. Surprisingly little engagement has taken place between the detailed and rich literature on whether the numbers count in rescue cases, and the practical question of whether certain facts about patients are eligible for consideration in real-world prioritisation, e.g., in emergency triage during a pandemic. I suggest that a position close to …Read more
  •  45
    Healthcare practitioners have access to a range of ethical guidance. However, the normative role of this guidance in ethical decision-making is underexplored. This paper considers two ways that healthcare practitioners could approach ethics guidance. We first outline the idea of deference to ethics guidance, showing how an attitude of deference raises three key problems: moral value; moral understanding; and moral error. Drawing on philosophical literature, we then advocate an alternative framin…Read more
  • Introduction: Responsibility and Healthcare, An Overview
    In Ben Davies, Gabriel De Marco, Neil Levy & Julian Savulescu (eds.), Responsibility and Healthcare, Oxford University Press. forthcoming.
  • Physician, heal thyself: Do doctors have a responsibility to practise self-care?
    In Ben Davies, Gabriel De Marco, Neil Levy & Julian Savulescu (eds.), Responsibility and Healthcare, Oxford University Press. forthcoming.
    Burnout among health professionals is at epidemic proportions. In response, many health institutions have emphasised the importance of self-care, relying particularly on the idea that doctors who are burned out provide worse care for their patients. Although not made explicit, this suggests that doctors might have a responsibility to their patients (and perhaps others) to practice self-care. This chapter explores the potential grounds for such an obligation. We suggest that while there is potent…Read more
  •  30
    Responsibility and Healthcare (edited book)
    Oxford University Press. forthcoming.
    This edited collection brings together world-leading authors writing about a wide range of issues related to responsibility and healthcare, and from a variety of perspectives. Alongside a comprehensive introduction by the editors outlining the scope of the relevant debates, the volume contains 14 chapters, split into four sections. This volume pushes forward a number of important debates on responsibility and its role in contemporary healthcare. The first and second groups of chapters focus, res…Read more
  •  18
    What Do ‘Humans’ Need? Sufficiency and Pluralism
    Ethics, Policy and Environment. forthcoming.
    Sufficientarians face a problem of arbitrariness: why place a sufficiency threshold at any particular point? One response is to seek universal goods to justify a threshold. However, this faces difficulties (despite sincere efforts) by either being too low, or failing to accommodate individuals with significant cognitive disabilities. Some sufficientarians have appealed to individuals’ subjective evaluations of their lives. I build on this idea, considering another individualized threshold: ‘tole…Read more
  •  154
    Feeding infants: Choice-specific considerations, parental obligation, and pragmatic satisficing
    with Clare Marie Moriarty
    Ethical Theory and Moral Practice 1-17. forthcoming.
    Health institutions recommend that young infants be exclusively breastfed on demand, and it is widely held that parents who can breastfeed have an obligation to do so. This has been challenged in recent philosophical work, especially by Fiona Woollard. Woollard’s work critically engages with two distinct views of parental obligation that might ground such an obligation—based on maximal benefit and avoidance of significant harm—to reject an obligation to breastfeed. While agreeing with Woollard’s…Read more
  •  170
    Medical need and health need
    Clinical Ethics 18 (3): 287-291. 2023.
    I introduce a distinction between health need and medical need, and raise several questions about their interaction. Health needs are needs that relate directly to our health condition. Medical needs are needs which bear some relation to medical institutions or processes. I suggest that the question of whether medical insurance or public care should cover medical needs, health needs, or only needs which fit both categories is a political question that cannot be resolved definitionally. I also ar…Read more
  •  183
    A new paradox for well-being subjectivism
    Analysis 83 (4): 673-682. 2023.
    Subjectivists think that our well-being is grounded in our subjective attitudes. Many such views are vulnerable to variations on the ‘paradox of desire’, where theories cannot make determinate judgements about the well-being of agents who take a positive valuing attitude towards their life going badly. However, this paradox does not affect all subjectivist theories; theories grounded on agents’ prudential values can avoid it.This paper suggests a new paradox for subjectivist theories which has a…Read more
  •  214
    Rationing, Responsibility, and Vaccination During COVID-19: A Conceptual Map
    American Journal of Bioethics 1-14. forthcoming.
    Throughout the COVID-19 pandemic, shortages of scarce healthcare resources consistently presented significant moral and practical challenges. While the importance of vaccines as a key pharmaceutical intervention to stem pandemic scarcity was widely publicized, a sizable proportion of the population chose not to vaccinate. In response, some have defended the use of vaccination status as a criterion for the allocation of scarce medical resources. In this paper, we critically interpret this burgeon…Read more
  •  269
    Healthcare Priorities: The “Young” and the “Old”
    Cambridge Quarterly of Healthcare Ethics 32 (2): 174-185. 2023.
    Some philosophers and segments of the public think age is relevant to healthcare priority-setting. One argument for this is based in equity: “Old” patients have had either more of a relevant good than “young” patients or enough of that good and so have weaker claims to treatment. This article first notes that some discussions of age-based priority that focus in this way on old and young patients exhibit an ambiguity between two claims: that patients classified as old should have a low priority, …Read more
  •  35
    This article is about the potential justification for deploying some form of affirmative action (AA) in the context of healthcare, and in particular in relation to the pandemic. We call this Affirmative Action in healthcare Resource Allocation (AARA). Specifically, we aim to investigate whether the rationale and justifications for using prioritization policies based on race in education and employment apply in a healthcare setting, and in particular to the COVID-19 pandemic. We concentrate in th…Read more
  •  15
    Doctors as appointed fiduciaries: A supplemental model for medical decision-making
    Cambridge Quarterly of Healthcare Ethics 31 (1): 23-33. 2022.
    How should we respond to patients who do not wish to take on the responsibility and burdens of making decisions about their own care? In this paper, we argue that existing models of decision-making in modern healthcare are ill-equipped to cope with such patients and should be supplemented by an “appointed fiduciary” model where decision-making authority is formally transferred to a medical professional. Healthcare decisions are often complex and for patients can come at time of vulnerability. Wh…Read more
  •  323
    On 26 January 2021, while announcing that the country had reached the mark of 100,000 deaths within 28 days of COVID-19, UK Prime Minister Boris Johnson said that he took “full responsibility for everything that the Government has done” as part of British efforts to tackle the pandemic. The force of this statement was undermined, however, by what followed: What I can tell you is that we truly did everything we could, and continue to do everything that we can, to minimise loss of life and to mini…Read more
  •  306
    Responsibility and the recursion problem
    Ratio 35 (2): 112-122. 2021.
    A considerable literature has emerged around the idea of using ‘personal responsibility’ as an allocation criterion in healthcare distribution, where a person's being suitably responsible for their health needs may justify additional conditions on receiving healthcare, and perhaps even limiting access entirely, sometimes known as ‘responsibilisation’. This discussion focuses most prominently, but not exclusively, on ‘luck egalitarianism’, the view that deviations from equality are justified only…Read more
  •  243
    There is an ongoing increase in the use of mobile health technologies that patients can use to monitor health-related outcomes and behaviours. While the dominant narrative around mHealth focuses on patient empowerment, there is potential for mHealth to fit into a growing push for patients to take personal responsibility for their health. I call the first of these uses ‘medical monitoring’, and the second ‘personal health surveillance’. After outlining two problems which the use of mHealth might …Read more
  •  15
    John Rawls’s ‘just savings’ principle is among the better-known attempts to outline how we should balance the claims of the present with the claims of the future generations on resources. A central element of Rawls’s approach involves endorsing a sufficientarian approach, where our central obligation is to ensure ‘the conditions needed to establish and to preserve a just basic structure’.1 This engaging paper by Christian Munthe, Davide Fumagalli and Erik Malmqvist (‘the authors’) does not expli…Read more
  •  608
    Learning to Discriminate: The Perfect Proxy Problem in Artificially Intelligent Criminal Sentencing
    In Jesper Ryberg & Julian V. Roberts (eds.), Sentencing and Artificial Intelligence, Oxford University Press. 2022.
    It is often thought that traditional recidivism prediction tools used in criminal sentencing, though biased in many ways, can straightforwardly avoid one particularly pernicious type of bias: direct racial discrimination. They can avoid this by excluding race from the list of variables employed to predict recidivism. A similar approach could be taken to the design of newer, machine learning-based (ML) tools for predicting recidivism: information about race could be withheld from the ML tool…Read more
  •  40
    The Right Not to Know: some Steps towards a Compromise
    with Julian Savulescu
    Ethical Theory and Moral Practice 24 (1): 137-150. 2020.
    There is an ongoing debate in medicine about whether patients have a ‘right not to know’ pertinent medical information, such as diagnoses of life-altering diseases. While this debate has employed various ethical concepts, probably the most widely-used by both defenders and detractors of the right is autonomy. Whereas defenders of the right not to know typically employ a ‘liberty’ conception of autonomy, according to which to be autonomous involves doing what one wants to do, opponents of the rig…Read more
  •  334
    The Prospects for ‘Prospect Utilitarianism’
    Utilitas 34 (3): 335-343. 2022.
    Hun Chung argues for a theory of distributive justice – ‘prospect utilitarianism’ – that overcomes two central problems purportedly faced by sufficientarianism: giving implausible answers in ‘lifeboat cases’, where we can save the lives of some but not all of a group, and failing to respect the axiom of continuity. Chung claims that prospect utilitarianism overcomes these problems, and receives empirical support from work in economics on prospect theory. This article responds to Chung's criticis…Read more
  •  169
    Evolutionary debunking accounts claim that the evolutionary origins of our moral beliefs provide a problem for moral realists because evolutionary explanations of our moral beliefs have more plausibility than realist accounts. A certain kind of response, which I term ‘rationalist’ offers a dual response to evolutionary debunking. First, they offer a supposedly plausible account of how we acquire objective moral knowledge through use of our rationality. Second, they claim that certain moral belie…Read more
  •  144
    Subjectivists about welfare face two problems that pull them in opposite directions. The Paradox Problem, outlined by Ben Bradley, is that, for an agent who desires that her life go badly, subjectivist theories are sometimes unable to give a determinate answer about how well her life goes. This problem demands that subjectivists choose a complex mental attitude to ground well-being. The Infant Problem, from Eden Lin, is that many subjective theories end up denying that infants (and some others) …Read more
  •  256
    Vegans do not eat meat. This statement seems so obvious that one might be tempted to claim that it is analytically true. Yet several authors argue that the underlying logic of veganism warrants – perhaps even demands – eating meat. I begin by considering an important principle that has been important in motivating vegan meat-eating, related to an obligation to reduce or minimise harm. I offer an alternative, rights-based view, and suggest that while this might support an obligation to eat meat i…Read more
  •  68
    Kieran Oberman argues that there is no such thing, in realistic circumstances, as an optional war, i.e. a war that it is permissible for a state to wage, but not obligatory. Regarding a central kind of war – humanitarian intervention – this is due to what Oberman calls the Cost Principle, which says that states may not impose humanitarian costs on their citizens that those citizens do not have independent humanitarian obligations to meet. Essentially, this means that if the seriousness of a huma…Read more
  •  221
    From Sufficient Health to Sufficient Responsibility
    with Julian Savulescu
    Journal of Bioethical Inquiry 17 (3): 423-433. 2020.
    The idea of using responsibility in the allocation of healthcare resources has been criticized for, among other things, too readily abandoning people who are responsible for being very badly off. One response to this problem is that while responsibility can play a role in resource allocation, it cannot do so if it will leave those who are responsible below a “sufficiency” threshold. This paper considers first whether a view can be both distinctively sufficientarian and allow responsibility to pl…Read more
  •  362
    No Blame No Gain? From a No Blame Culture to a Responsibility Culture in Medicine
    Journal of Applied Philosophy 37 (4): 646-660. 2020.
    Healthcare systems need to consider not only how to prevent error, but how to respond to errors when they occur. In the United Kingdom’s National Health Service, one strand of this latter response is the ‘No Blame Culture’, which draws attention from individuals and towards systems in the process of understanding an error. Defences of the No Blame Culture typically fail to distinguish between blaming someone and holding them responsible. This article argues for a ‘responsibility culture’, where …Read more
  •  323
    The right not to know and the obligation to know
    Journal of Medical Ethics 46 (5): 300-303. 2020.
    There is significant controversy over whether patients have a ‘right not to know’ information relevant to their health. Some arguments for limiting such a right appeal to potential burdens on others that a patient’s avoidable ignorance might generate. This paper develops this argument by extending it to cases where refusal of relevant information may generate greater demands on a publicly funded healthcare system. In such cases, patients may have an ‘obligation to know’. However, we cannot infer…Read more
  •  235
    Responsibility and the limits of patient choice
    Bioethics 34 (5): 459-466. 2020.
    Patients are generally assumed to have the right to choices about treatment, including the right to refuse treatment, which is constrained by considerations of cost‐effectiveness. Independently, many people support the idea that patients who are responsible for their ill health should incur penalties that non‐responsible patients do not face. Surprisingly, these two areas have not received much joint attention. This paper considers whether restricting the scope of responsibility to pre‐treatment…Read more