James Hart

Sometimes we ought to aggregate lesser harms to many such that they outweigh greater harms to a few, and sometimes we ought not to. This seems self-evident, but it has proven surprisingly difficult to construct a coherent moral theory out of this basic observation. In particular, it is difficult to explain (in a principled way) when we ought to aggregate. Relevance views attempt to solve this problem by arguing that sufficiently lesser harms are irrelevant to greater harms and thus should not be taken into consideration. My thesis develops and defends a new relevance view. The first half of the thesis focuses on when lesser harms can aggregate and outweigh stronger harms. I start by solving a ‘fatal’ dilemma for all relevance views. I show that one horn of the dilemma is fatal but avoidable, whilst the other is unavoidable but not fatal, and that the dilemma rests on a faulty assumption of weak-additivity. I then develop a new relevance view based around the principle that we ought to balance harms by similarity (i.e., we ought to balance greater harms against similarly great harms and lesser harms against other lesser harms) before deciding whether lesser harms are relevant to greater harms. The second half focuses on when lesser harms can aggregate and tiebreak between stronger harms. First, I show that relevance views cannot capture our intuition that sufficiently lesser harms should not tiebreak between greater harms, without forfeiting our intuitions in other important cases. Secondly, I demonstrate that relevance views are sometimes inappropriately insensitive to the number of harms in tiebreaking cases. To solve these problems, I distinguish between two types of relevance, and I introduce Broomean fairness into my account. Doing so allows my view to capture all our intuitions about when lesser harms can tiebreak between stronger harms.

Limited aggregationists argue that when deciding between competing claims to aid we are sometimes required and sometimes forbidden from aggregating weaker claims to outweigh stronger claims. Joe Horton presents a ‘fatal dilemma’ for these views. Views that land on the First Horn of his dilemma suggest that a previously losing group strengthened by fewer and weaker claims can be more choice-worthy than the previously winning group strengthened by more and stronger claims. Views that land on the Second Horn suggest that combining two losing groups together and two winning groups together can turn the losing groups into the winning groups and the winning groups into the losing groups. This paper demonstrates that the ‘fatal dilemma’ is neither fatal nor a dilemma. The First Horn is devastating but avoidable and the Second Horn is unavoidable but not devastating. Nevertheless, Horton’s argument does help to narrow down the acceptable range of views.

In their upcoming article, Henk Jasper van Gils-Schmidt and Sabine Salloch highlight the supposed responsibilities of healthcare professionals in addressing the global health challenges posed by climate change. They argue that healthcare professionals’ duties to future generations and their ‘climate-related obligations’ have been neglected, primarily due to potential conflicts with other responsibilities, such as providing optimal care to current patients and maintaining patient trust. The authors suggest that these competing obligations should be viewed as part of the multifaceted identities individuals hold, encompassing roles as both physicians and environmentalists, each with normative and competing commitments. They propose that a transformative shift in physicians’ professional ethos, expanding from the predominant focus on individual patients to include obligations towards climate protection, could pave the way for identifying effective mechanisms to address these challenges. While acknowledging the authors’ emphasis on sustainable healthcare practices, we argue that a duty to climate protection as part of healthcare professionals’ identity lacks ethical support. We identify serious concerns that stem from the transformative shift in physicians’ professional ethos, particularly in the authors’ presentation of reasons for action. First, envisaging a stable disposition that compels healthcare professionals to ensure optimal care conditions for both immediate and potential future encounters is unrealistic. Such a scenario would necessitate a nuanced and multifaceted evaluation, weighing …

The UK government has recently committed to adopting a new policy—dubbed ‘Martha’s Rule’—which has been characterised as providing patients the right to rapidly access a second clinical opinion in urgent or contested cases. Support for the rule emerged following the death of Martha Mills in 2021, after doctors failed to admit her to intensive care despite concerns raised by her parents. We argue that framing this issue in terms of patient rights is not productive, and should be avoided. Insofar as the ultimate goal of Martha’s Rule is the provision of a clinical service that protects patient safety, an approach that focuses on the obligations of the health system—rather than the individual rights of patients—will better serve this goal. We outline an alternative approach that situates rapid clinical review as part of a suite of services aimed at enhancing and protecting patient care. This approach would make greater progress towards addressing the difficult systemic issues that Martha’s Rule does not, while also better engaging with the constraints of clinical practice.

Sometimes we must choose between competing claims to aid or assistance, and sometimes those competing claims differ in strength and quantity. In such cases, we must decide whether the claims on each opposing side can be aggregated. Relevance views argue that a set of claims can be aggregated only if they are sufficiently strong (compared to the claims with which they compete) to be morally relevant to the decision. Relevance views come in two flavours: Local Relevance and Global Relevance. This paper presents a trilemma for both. Namely, that neither view can capture our intuition in tie-break cases, without forfeiting our intuitions in other important cases. The paper then presents a way to salvage relevance views and capture all our intuitions using a Hybrid view. By distinguishing between two types of relevance we can combine the strengths of Local and Global Relevance views such that we can hold all our intuitions, consistently and in a non-ad-hoc manner. Building on this, the paper demonstrates how we might amend the strongest formulation of a Relevance view, into a Hybrid account. The main focus of this paper is to develop a relevance view that can capture all the intuitions we have; however deeper justifications will still be needed for a full account of any relevance view. Thus, the end of the paper briefly considers what deeper justification might support the Hybrid view, indicating the direction such literature might go. Lastly, the paper considers the advantages of this view over a rival Hybrid view.