David Wasserman

Priority setting in healthcare is a highly contentious area of public decision making, in which different values often support incompatible policy options and compromise can be elusive. One promising approach to resolving priority-setting conflicts divides the decision-making process into two steps. In the first, a set of eligible options is identified; in the second, one of those options is chosen by a deliberative process. This paper considers the first step, examining proposals for identifying a set of options eligible for deliberation. It focuses on the approach proposed by Anders Herlitz, which limits deliberation to options that are on a par; neither better or worse than, nor strictly equal to the alternatives. Once these “maximal” options are identified, the choice among them is made though a deliberative process that acknowledges the difficult tradeoffs which must be made. While parity and kindred notions are clearly useful in resolving some priority-setting conflicts, this paper argues that the conflicts that arise in setting priorities make it as difficult to decide which options are on a par as it is to decide among those options. The paper draws on priority-setting debates that occurred during the recent pandemic to illustrate the challenges in identifying eligible options: There may be sharp disagreement about how to understand and individuate relevant values; about whether certain values are relevant in a priority-setting context; about how to establish parity between “consequential” and “deontic” options, and about whether one option remains on a par with others after it is modified in various ways.

Disability raises profound and fundamental issues: questions about human embodiment and well-being; dignity, respect, justice and equality; personal and social identity. It raises pressing questions for educational, health, reproductive, and technology policy, and confronts the scope and direction of the human and civil rights movements. Yet it is only recently that disability has become the subject of the sustained and rigorous philosophical inquiry that it deserves. The Oxford Handbook of Philosophy and Disability is the first comprehensive volume on the subject. The volume's contents range from debates over the definition of disability to the challenges posed by disability for justice and dignity; from the relevance of disability for respect, other interpersonal attitudes, and intimate relationships to its significance for health policy, biotechnology, and human enhancement; from the ways that disability scholarship can enrich moral and political philosophy, to the importance of physical and intellectual disabilities for the philosophy of mind and action. The contributions reflect the variety of areas of expertise, intellectual orientations, and personal backgrounds of their authors. Some are founding philosophers of disability; others are promising new scholars; still others are leading philosophers from other areas writing on disability for the first time. Many have disabilities themselves. This volume boldly explores neglected issues, offers fresh perspectives on familiar ones, and ultimately expands philosophy's boundaries. More than merely presenting an overview of existing work, this Handbook will chart the growth and direction of a vital and burgeoning field for years to come.

In this 2001 volume a group of leading philosophers address some of the basic conceptual, methodological and ethical issues raised by genetic research into criminal behavior. The essays explore the complexities of tracing any genetic influence on criminal, violent or antisocial behavior; the varieties of interpretations to which evidence of such influences is subject; and the relevance of such influences to the moral and legal appraisal of criminal conduct. The distinctive features of this collection are: first, that it advances public discussion while clarifying the debate about genetic research and criminal behavior; second, that it explains scientific controversies about behavioral genetics in lucid, non-technical terms; third, that it demonstrates how the possible findings on genetics and crime bear on fundamental issues of moral and criminal responsibility. The volume will be of particular value to philosophers concerned with applied ethics, behavioral geneticists, psychologists, legal theorists, and criminologists.

Home care is one of the fastest‐growing industries in the United States, providing valuable opportunities for millions of older adults and people with disabilities to live at home rather than in institutional settings. Home care workers assist clients with essential activities of daily living, but their wages and working conditions generally fail to reflect the importance of their work. Drawing on the work of Eva Feder Kittay and other care ethicists, we argue that good care involves attending to the needs of another out of a concern for their well‐being. Such care should be standard in the home care system. Yet, because of the pervasive racial, gender, and economic inequalities that the home care industry perpetuates, home care workers and their clients cannot reasonably be expected to care about each other. We endorse reforms aimed at enabling home care workers and their clients to form and maintain professional relationships that cultivate care..

In this article, we defend pairwise comparison as a method to resolve conflicting claims from different people that cannot be jointly satisfied because of a scarcity of resources. We consider Michael Otsuka's recent challenge that pairwise comparison leads to intransitive choices for the (someone who believes the numbers should not count in forced choices among lives) and Frances Kamm's responses to Otsuka's challenge. We argue that Kamm's responses do not succeed, but that the threat they are designed to meet is illusory. Once the method of pairwise comparison is understood in a manner consistent with its proposed use, the challenge disappears. In making this argument, we examine questions about the interpretation of pairwise comparison and maintain that it must be understood as a method for ensuring that decisions are justifiable from the perspective of each affected individual

Advancements in novel neurotechnologies, such as brain computer interfaces and neuromodulatory devices such as deep brain stimulators, will have profound implications for society and human rights. While these technologies are improving the diagnosis and treatment of mental and neurological diseases, they can also alter individual agency and estrange those using neurotechnologies from their sense of self, challenging basic notions of what it means to be human. As an international coalition of interdisciplinary scholars and practitioners, we examine these challenges and make recommendations to mitigate negative consequences that could arise from the unregulated development or application of novel neurotechnologies. We explore potential ethical challenges in four key areas: identity and agency, privacy, bias, and enhancement. To address them, we propose democratic and inclusive summits to establish globally-coordinated ethical and societal guidelines for neurotechnology development and application, new measures, including “Neurorights,” for data privacy, security, and consent to empower neurotechnology users’ control over their data, new methods of identifying and preventing bias, and the adoption of public guidelines for safe and equitable distribution of neurotechnological devices.

Disability raises profound and fundamental issues: questions about human embodiment and well-being; dignity, respect, justice and equality; personal and social identity. It raises pressing questions for educational, health, reproductive, and technology policy, and confronts the scope and direction of the human and civil rights movements. Yet it is only recently that disability has become the subject of the sustained and rigorous philosophical inquiry that it deserves. The Oxford Handbook of Philosophy and Disability is the first comprehensive volume on the subject. The volume's contents range from debates over the definition of disability to the challenges posed by disability for justice and dignity; from the relevance of disability for respect, other interpersonal attitudes, and intimate relationships to its significance for health policy, biotechnology, and human enhancement; from the ways that disability scholarship can enrich moral and political philosophy, to the importance of physical and intellectual disabilities for the philosophy of mind and action. The contributions reflect the variety of areas of expertise, intellectual orientations, and personal backgrounds of their authors. Some are founding philosophers of disability; others are promising new scholars; still others are leading philosophers from other areas writing on disability for the first time. Many have disabilities themselves. This volume boldly explores neglected issues, offers fresh perspectives on familiar ones, and ultimately expands philosophy's boundaries. More than merely presenting an overview of existing work, this Handbook will chart the growth and direction of a vital and burgeoning field for years to come.

This paper examines the moral import of a distinction between natural and social inequalities. Following Thomas Nagel, it argues for a “denatured” distinction that relies less on the biological vs. social causation of inequalities than on the idea that society is morally responsible for some inequalities but not others. It maintains that securing fair equality of opportunity by eliminating such social inequalities has particularly high priority in distributive justice. Departing from Nagel, it argues that society can be responsible for inequalities not only when they are the unintended result of justifiable projects, but even when their alleviation would be very costly. Sharing Nagel’s general concept of ‘social inequality’, then, this paper proposes a far more expansive conception. We argue that many disadvantages due to disability fall under this conception. Eliminating or alleviating those disadvantages should be regarded as securing fair equality of opportunity, not improving the condition of the worst-off.

Judith Jarvis Thomson recently argued that it is impermissible for a bystander to turn a runaway trolley from five onto one. But she also argues that a trolley driver is required to do just that. We believe that her argument is flawed in three important ways. She fails to give proper weight to (a) an agent¹s claims not to be required to act in ways he does not want to, (b) impartiality in the weighing of competing patient-claims, and (c) the role of patient-claims in determining agent-duties. All three of these failures can be understood in terms of what we call the Mechanics of Claims, an approach we develop for identifying and balancing competing claims in determining rights. Using that framework, one can see both why Thomson's most recent argument is mistaken, and how to think more clearly about deontological choices generally

Although philosophers have explored several connections between neuroscience and moral responsibility, the issue of how real-world neurological modifications, such as Deep Brain Stimulation, impact moral responsibility has received little attention. In this article, we draw on debates about the relevance of history and manipulation to moral responsibility to argue that certain kinds of neurological modification can diminish the responsibility of the agents so modified. We argue for a historicist position - a version of the history-sensitive reflection view - and defend that account against a rival, relational view of responsibility. We conclude that DBS can, under certain conditions, diminish responsibility, and explore the circumstances under which this might be so. We conclude by suggesting that philosophical debates about moral responsibility, manipulation, and history have greater practical relevance than is sometimes thought, and that attention to practical cases can help inform and deepen this body of scholarship.

The patient preference predictor is a proposed computer-based algorithm that would predict the treatment preferences of decisionally incapacitated patients. Incorporation of a PPP into the decision-making process has the potential to improve implementation of the substituted judgement standard by providing more accurate predictions of patients’ treatment preferences than reliance on surrogates alone. Yet, critics argue that methods for making treatment decisions for incapacitated patients should be judged on a number of factors beyond simply providing them with the treatments they would have chosen for themselves. These factors include the extent to which the decision-making process recognises patients’ freedom to choose and relies on evidence the patient themselves would take into account when making treatment decisions. These critics conclude that use of a PPP should be rejected on the grounds that it is inconsistent with these factors, especially as they relate to proper respect for patient autonomy. In this paper, we review and evaluate these criticisms. We argue that they do not provide reason to reject use of a PPP, thus supporting efforts to develop a full-scale PPP and to evaluate it in practice. There are no data in this work.

New fetal therapies offer important prospects for improving health. However, having to consider both the fetus and the pregnant woman makes the risk–benefit analysis of fetal therapy trials challenging. Regulatory guidance is limited, and proposed ethical frameworks are overly restrictive or permissive. We propose a new ethical framework for fetal therapy research. First, we argue that considering only biomedical benefits fails to capture all relevant interests. Thus, we endorse expanding the considered benefits to include evidence-based psychosocial effects of fetal therapies. Second, we reject the commonly proposed categorical risk and/or benefit thresholds for assessing fetal therapy research. Instead, we propose that the individual risks for the pregnant woman and the fetus should be justified by the benefits for them and the study’s social value. Studies that meet this overall proportionality criterion but have mildly unfavorable risk–benefit ratios for pregnant women and/or fetuses may be acceptable.

This article asks whether personal ventilators should be redistributed to maximize lives saved in emergency condition, like the COVID-19 pandemic. It begins by examining extant claims that items like ventilators are literally parts of their user’s bodies. Arguments in favor of incorporation for ventilators fail to show that they meet valid sufficient conditions to be body parts, but arguments against incorporation also fail to show that they fail to meet clearly valid necessary conditions. Further progress on this issue awaits clarification of difficult normative, conceptual, and metaphysical questions about the possible boundaries of a person’s body. Rather than relying solely on incorporation arguments, we propose an argument against reallocation from widely accepted anti-discrimination principles. Possession of a personal ventilator is an obvious marker of disability identity; thus, reallocating ventilators from those that already possess them discriminates on the basis of a stigmatized trait – a paradigm case of presumptively wrongful discrimination. This discrimination claim, taken together with uncertainty about the bodily status of ventilators, yields a strong presumption against personal ventilator reallocation

This paper critically engages ethical issues in the allocation of novel, and potentially costly, health care resources to patients with disorders of consciousness. First, we review potential benefits of novel health care resources for patients and their families and outline preliminary considerations to address concerns about cost. We then address two problems regarding the allocation of health care resources to patients with disorders of consciousness: (1) the problem of uncertain moral status; and (2) the problem of accurately measuring the welfare burdens these resources would relieve. We conclude by suggesting that opportunity-based frameworks might complement standard approaches for justifying resources allocation to patients with disorders of consciousness.