James Hart

Risk assessment tools are increasingly used in policing to enhance decision-making accuracy and objectivity; yet their implementation has raised significant ethical concerns regarding issues of bias, transparency, and governance. This paper examines the ethical complexities of risk assessment tools through an analysis of four instruments: the Harm Assessment Risk Tool (HART), previously developed and used by Durham Constabulary; the Active Risk Management System (ARMS), used across all police forces in England and Wales; the Offender Assessment System (OASys), used to profile risk of reoffending by probation services in the UK; and the Correctional Offender Management Profiling for Alternative Sanctions (COMPAS), a widely researched tool deployed in US corrections contexts whose ethical challenges are directly relevant to tools now entering policing practice. A thematic framework identifies 10 key challenges for the field, including disparities in accuracy metrics, fairness trade-offs, bias linked to demographics and social identity, and retraining. The paper contextualises these issues within influential roles, including tool developers, decision-makers, and oversight committees. The credible risk of ethical harms arising from the use of risk assessment tools underscores the need for rigorous validation, transparency, and adaptive governance to minimise these risks. This paper arises from a meeting of an interdisciplinary working group convened at Ethox, University of Oxford, comprising academics in philosophy, law, psychology, psychiatry, and criminology, as well as police stakeholders.

In bioethics, two sorts of normative categories are commonly used. These can be split into two families: the deontic categories, such as ‘right’, ‘ought to’ and ‘requirement’, and the evaluative categories, including ‘good’, ‘bad’, ‘better than’ and ‘the best’. While other normative concepts such as ‘virtue’ and ‘vice’ have also been discussed, the aptic categories, including ‘fitting’, ‘appropriate’ and ‘merited’ have received little to no attention from bioethicists. Drawing on Philip Stratton-Lake's important contributions to the metaethical literature on the aptic categories, this paper investigates the role of fittingness in bioethics. To this end, we first establish four characteristic features of the aptic categories. We then show how fittingness can be applied in four areas of bioethical research, before considering some objections. We conclude that there is much to be gained by expanding the dialogue between recent metaethical work on the aptic categories and practical ethics.

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.

ABSTRACT 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.

The National Health Service operates under significant resource constraints, both financially and in terms of staffing, leading to challenges in providing comprehensive healthcare for all. This poses a problem for commissioners: how do we prioritise treatment allocation? Chris Newdick’s influential work in ethics and law has shaped discourse in this area for over three decades. However, we critique a specific aspect of Newdick’s work concerning individual funding requests (IFRs) within the healthcare resource allocation system. The allocation problem involves balancing population-wide healthcare needs with the ethical imperative to treat individuals. Decision-making frameworks like the ‘Accountability for Reasonableness’ (A4R) framework aim to address this by fostering fair processes. In the United Kingdom, local priority forums, guided by ethical frameworks, play a crucial role in resource allocation decisions. While these processes strive to be fair, they are not flawless. These processes cannot consider every potential patient perspective, circumstance or reason for needing treatment. To address this, A4R frameworks include mechanisms for revision and appeals. IFRs form an important part of this picture by providing a recourse for patients whose cases may not have been adequately considered because they are in some sense unusual or ‘exceptional’. However, current processes often rely on a problematic interpretation of ‘exceptionality’ which fails to align with A4R principles. This interpretation sometimes excludes those who ought to be included, and includes those who ought to be excluded. We argue for a revised understanding of exceptionality to ensure fairness and effectiveness in resource allocation processes informed by Newdick’s work.

Recent literature has drawn attention to the complex relationship between health care and the environmental crisis. Healthcare systems are significant contributors to climate change and environmental degradation, and the environmental crisis is making our health worse and thus putting more pressure on healthcare systems; our health and the environment are intricately linked. In light of this relationship, we might think that there are no trade‐offs between health and the environment; that healthcare decision‐makers have special responsibilities to the environment; and that environmental values should be included in healthcare resource‐allocation decisions. However, we argue that these claims are mistaken. The environmental crisis involves a wider range of considerations than just health. There is a plurality of reasons to act on the environment; we might do so to protect the natural world, to prevent catastrophes in other parts of the world, or to avert climate war and displacement. Trading‐off between health care and environmental sustainability is thus unavoidable and requires sensitivity to all these reasons. Healthcare decision‐makers are not well placed to be sensitive to these reasons, nor do they have the democratic authority to make such value judgements. Therefore, decisions about environmental sustainability interventions should be made at a ‘higher level’ of resource allocation. Importantly, hospitals have environmental duties but not environmental responsibilities; their job is to provide the best healthcare possible within the constraints given to them, not to choose between health care and other goods.

In his article, Johannes Kneiss, argues convincingly that a generational ban of smoking need not necessarily disadvantage, or treat as moral unequals, future generations. While a ban need not be inegalitarian in these particular ways, we argue that this is insufficient to establish a ban to be appropriately relationally egalitarian. In what follows, we raise a couple of other issues that we would like to see addressed before we can be confident in such a law. First, it remains underexplored, whether current generations would be disadvantaged or treated as moral unequals by a ban. Plausibly, being excluded from the ban could show insufficient concern for current generations. By not acting paternalistically towards them, current generations miss out on the health benefits afforded to the young, which might display a greater valuing of younger lives than older lives. Kneiss briefly considers this objection, but quickly dismisses it: “given that some existing smokers strongly wish to retain the option to smoke, […] a ban across the board cannot be said to advance their interests, as conceived by these smokers themselves”.1 However, in our view, this is too quick. Appealing to the smokers’ own conceptions of their interests to establish their interests presumes that the smokers know what is in their …

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.

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.

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.