•  5
    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
  •  1
    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
  •  87
    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
  •  72
    Responsibility and the recursion problem
    Ratio 35 (2): 112-122. 2022.
    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
  •  35
    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
  •  7
    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 does not explicitly mention Ra…Read more
  •  295
    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. forthcoming.
    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
  •  19
    The Right Not to Know: some Steps towards a Compromise
    with Julian Savulescu
    Ethical Theory and Moral Practice 24 (1): 137-150. 2021.
    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
  •  64
    The prospects for 'Prospect Utilitarianism'
    Utilitas 1-9. forthcoming.
    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
  •  65
    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
  •  48
    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
  •  86
    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
  •  43
    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
  •  52
    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
  •  124
    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
  •  94
    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
  •  47
    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
  •  56
    Health(care) and the temporal subject
    Les Ateliers de l'Éthique / the Ethics Forum 13 (3): 38-64. 2018.
    Many assume that theories of distributive justice must obviously take people’s lifetimes, and only their lifetimes, as the relevant period across which we distribute. Although the question of the temporal subject has risen in prominence, it is still relatively underdeveloped, particularly in the sphere of health and healthcare. This paper defends a particular view, “momentary sufficientarianism,” as being an important element of healthcare justice. At the heart of the argument is a commitment to…Read more
  •  65
    Solidarity and Responsibility in Health Care
    with Julian Savulescu
    Public Health Ethics 12 (2): 133-144. 2019.
    Some healthcare systems are said to be grounded in solidarity because healthcare is funded as a form of mutual support. This article argues that health care systems that are grounded in solidarity have the right to penalise some users who are responsible for their poor health. This derives from the fact that solidary systems involve both rights and obligations and, in some cases, those who avoidably incur health burdens violate obligations of solidarity. Penalties warranted include direct patien…Read more
  •  7212
    Collected and edited by Noah Levin Table of Contents: UNIT ONE: INTRODUCTION TO CONTEMPORARY ETHICS: TECHNOLOGY, AFFIRMATIVE ACTION, AND IMMIGRATION 1 The “Trolley Problem” and Self-Driving Cars: Your Car’s Moral Settings (Noah Levin) 2 What is Ethics and What Makes Something a Problem for Morality? (David Svolba) 3 Letter from the Birmingham City Jail (Martin Luther King, Jr) 4 A Defense of Affirmative Action (Noah Levin) 5 The Moral Issues of Immigration (B.M. Wooldridge) 6 The Ethics of our D…Read more
  •  226
    Bursting Bubbles? QALYs and Discrimination
    Utilitas 31 (2): 191-202. 2019.
    The use of Quality-Adjusted Life Years (QALYs) in healthcare allocation has been criticized as discriminatory against people with disabilities. This article considers a response to this criticism from Nick Beckstead and Toby Ord. They say that even if QALYs are discriminatory, attempting to avoid discrimination – when coupled with other central principles that an allocation system should favour – sometimes leads to irrationality in the form of cyclic preferences. I suggest that while Beckstead a…Read more
  •  1848
    John Rawls' 'A Theory of Justice'
    1000-Word Philosophy: An Introductory Anthology. 2018.
    Some people are multi-billionaires; others die because they are too poor to afford food or medications. In many countries, people are denied rights to free speech, to participate in political life, or to pursue a career, because of their gender, religion, race or other factors, while their fellow citizens enjoy these rights. In many societies, what best predicts your future income, or whether you will attend college, is your parents’ income. To many, these facts seem unjust. Others disagree: eve…Read more
  •  84
    Enhancement and the Conservative Bias
    Philosophy and Technology 30 (3): 339-356. 2017.
    Nicholas Agar argues that we should avoid certain ‘radical’ enhancement technologies. One reason for this is that they will alienate us from current sources of value by altering our evaluative outlooks. We should avoid this, even if enhancing will provide us with novel, objectively better sources of value. After noting the parallel between Agar’s views and G. A. Cohen’s work on the ‘conservative bias’, I explore Agar’s suggestion in relation to two kinds of radical enhancement: cognitive and ant…Read more
  •  146
    Ageing and Terminal Illness: Problems for Rawlsian Justice
    Journal of Applied Philosophy 775-789. 2018.
    This article considers attempts to include the issues of ageing and ill health in a Rawlsian framework. It first considers Norman Daniels’ Prudential Lifespan Account, which reduces intergenerational questions to issues of intrapersonal prudence from behind a Rawslian veil of ignorance. This approach faces several problems of idealisation, including those raised by Hugh Lazenby, because it must assume that everyone will live to the same age, undermining its status as a prudential calculation. I …Read more
  •  156
    Fair Innings and Time-Relative Claims
    Bioethics 30 (6): 462-468. 2016.
    Greg Bognar has recently offered a prioritarian justification for ‘fair innings’ distributive principles that would ration access to healthcare on the basis of patients' age. In this article, I agree that Bognar's principle is among the strongest arguments for age-based rationing. However, I argue that this position is incomplete because of the possibility of ‘time-relative' egalitarian principles that could complement the kind of lifetime egalitarianism that Bognar adopts. After outlining Bogna…Read more
  •  204
    Publish or Perish
    Metaphilosophy 48 (5): 745-761. 2017.
    Funds and positions in philosophy should be awarded through systems that are reliable, objective, and efficient. One question usually taken to be relevant is how many publications people have in a group of well-respected journals. In the context of significant competition for jobs and funding, however, relying on quantity of publications creates a serious downside: the oft-lamented demand that we publish or perish. This article offers a systematic review of the problems involved in contemporary …Read more
  •  225
    Paternalism and evaluative shift
    Moral Philosophy and Politics 4 (2). 2017.
    Many people feel that respecting a person’s autonomy is not sufficiently important to obligate us to stay out of their affairs in all cases; but the ground for interference may often turn out to be a hunch that the agent cannot really be competent, or cannot really know what her decision implies; for if she were both of these things, surely she would not make such a foolish decision. This paper suggests a justification of paternalism that does not rely on such appeals. I argue that in cases wher…Read more