Uehiro Oxford Institute University of Oxford

The truth about health care policy lies between two exaggerated views: a market view in which individuals purchase their own health care from profit maximizing health-care firms and a control view in which costs are controlled by regulations limiting which treatments health insurance will pay for. This essay suggests a way to avoid on the one hand the suffering, unfairness, and abandonment of solidarity entailed by the market view and, on the other hand, to diminish the inflexibility and inefficiency of the control view. It suggests that the way to mitigate these problems is to recognize the malleability of motivation and the range of factors, in addition to financial incentives, that may influence the behavior of patients and especially physicians.

I argue that political liberals should not support the monopoly of a single educational approach in state sponsored schools. Instead, they should allow reasonable citizens latitude to choose the worldview in which their own children are educated. I begin by defending a particular conception of political liberalism, and its associated requirement of public reason, against the received interpretation. I argue that the values of respect and civic friendship that motivate the public reason requirement do not support the common demand that citizens “bracket” their comprehensive commitments in politics. Rather, citizens should seek to enact policies the justification of which is compatible with the truth of their fellow reasonable citizens’ worldviews. Next I argue that no single educational approach can meet this standard of justification. Many believe that state sponsored education in a pluralist, liberal society ought to present multiple worldviews in a neutral way. I argue that this aspiration is unrealizable, and no other educational model will plausibly meet the justificatory demand. Finally, I address two objections to my favored alternative: that it may allow for the inculcation of disrespect, and that it violates children’s autonomy. Against the first, I claim that political liberals have no grounds for thinking that reasonable citizens will seek to inculcate disrespect. Finally, I argue that there is no conception of autonomy that can sustain the second.

There is a tension between the reasonable desire not to be judgmental of other people’s behaviour or character, and the moral necessity of making negative judgments in some cases. I sketch a way in which we might accommodate both, via an evaluation of the good of reputation and the ethics of judgment of other people’s character and behaviour. I argue that a good reputation is a highly valuable good for its bearer, akin to a property right, and not to be damaged without serious reason deriving from the demands of justice and the common welfare. Rash judgment wrongfully damages reputation and is sometimes a seriously immoral act. Rashness is not merely about lack of evidence, but involves lack of charity and is to be avoided even in some cases where the evidence of bad character or action is epistemically sufficient for judgment. I argue that the desirability of a good name for its holder, whether the reputation is deserved or not, means that in all but a relatively narrow range of cases it is always wrong to think badly of someone, even if they are bad.

We are pleased to present the second issue of the Journal of Practical Ethics, presenting arguments on three important practical matters: education, health, and the judging of others. [...] We think it a very interesting read, but you don’t have to rely on our opinion: we have with this issue introduced a new series of podcasts interviewing an author from the issue to discuss the ideas presented, and our interviewed author for this issue is David Oderberg. You might also be interested to look back on the previous issue with a podcast interview with Seth Lazar. Podcasts are available from the journal website.

Research in psychology indicates that situations powerfully impact human behavior. Often, it seems, features of situations drive our behavior even when we remain unaware of these features or their influence. One response to this research is pessimism about human agency: human agents have little conscious control over their own behavior, and little insight into why they do what they do. In this paper we review classic and more recent studies indicating “the power of the situation,” and argue for a more optimistic response. In our view, though psychological research indicates situational influence, it also indicates that knowledge about the impact of situations on behavior can boost agents’ power to counteract harmful situational effects.

New biotechnologies have the potential to both dramatically improve human well-being and dramatically widen inequalities in well-being. This paper addresses a question that lies squarely on the fault line of these two claims: When as a matter of justice are societies obligated to include a new biotechnology in a national healthcare system? This question is approached from the standpoint of a twin aim theory of justice, in which social structures, including nation-states, have double-barreled theoretical objectives with regard to human well-being. The first aim is to achieve a sufficient level of well-being in each of six core dimensions. In the special case of healthcare systems, this aim is focally but not exclusively attentive to achieving health sufficiency as one of the core dimensions. The second aim is to combat the emergence and persistence of densely woven patterns of systematic disadvantage that tend to undermine the achievement of a sufficient level of health and the other core elements of well-being of some persons and groups. Judgments about entitlements to health related resources, including new biotechnologies, are made in light of a threshold notion of health sufficiency. What is enough or sufficient health? The answer that is defended here is that sufficient health is enough health for a decent human life, understood as enough health to live a full life course without preventable, significant functional disability or decrement in health, or treatable pain or suffering. When a state must include a new biotechnology in its national healthcare system is also influenced by ancillary concerns about the connection between health and other core dimensions of well-being. What counts as a significant functional impairment or health decrement is thus explicated, in part, in relation to the theory’s sufficiency aim for the other essential dimensions of well-being, and thus for a decent life, overall. Those elements of health that play a critical role in the experience of sufficient reasoning, affiliation, security, respect and self determination are especially important; any loss of health function or capacity that threatens the individual’s prospects for sufficiency in these other dimensions, including the relational egalitiarian concerns they entail, constitutes a significant functional impairment. Within national borders, individuals are thus entitled to those health-related goods and services that are essential for a sufficiency of each of the dimensions of well-being; with regard to self determination and respect, what is sufficient by way of guaranteed access to specific goods and services is going to depend on the implications of such access for where an individual stands in relation to her co-nationals. The content of any entitlement to health-related goods and services is also necessarily dynamic. What can be done for health and the other core dimensions of well-being as a function of technological innovation and diffusion is in constant flux. The paper concludes by considering the implications of this analysis for the conditions under which states are obligated to include access in their healthcare systems to one biotechnology, deep brain stimulation.

This paper advances a novel account of part of what justifies killing in war, grounded in the duties we owe to our loved ones to protect them from the severe harms with which war threatens them. It discusses the foundations of associative duties, then identifies the sorts of relationships, and the specific duties that they ground, which can be relevant to the ethics of war. It explains how those associative duties can justify killing in theory—in particular how they can justify overriding the rights to life of some of those who must be killed to win a war. It then shows how these duties can be operationalised in practice: first, showing how soldiers who fight on behalf of their community can act on reasons that apply to the members of that community; second, showing that the argument from associative duties does not prove too much—in particular, that it does not license the intentional killing of noncombatants in war.