Catering for Responsibility: Brute Luck, Option Luck, and the
Neutrality Objection to Luck Egalitarianism
Economics and Philosophy 35 (2019), 259–281.
The distinction between brute luck and option luck is fundamental for luck egalitarianism.
Many luck egalitarians write as if it could be used to specify which outcomes people should be held responsible for.
In this paper, I argue that the distinction can't be used this way. In fact, luck egalitarians tend to rely instead
on rough intuitive judgments about individual responsibility. This makes their view vulnerable to what's known as
the neutrality objection. I show that attempts to avoid this objection are unsuccessful. I conclude that
until it provides a better account of attributing responsibility, luck egalitarianism remains incomplete.
Overpopulation and Procreative Liberty
[preprint]
Forthcoming in Ethics Policy & Environment.
The aim of this paper is to demonstrate that anti-natalist population policies need not involve
the violation of procreative liberty and personal autonomy. To show this, I revive two radical proposals from the
old debate on overpopulation. The first involves mandatory long-term contraception; the second involves the
introduction of tradeable procreation entitlements. I show that contrary to what many people believe, these
policies can be defended on the basis of broadly liberal principles. It turns out that they not only do not
conflict with procreative liberty and personal autonomy, but they can actually increase liberty and promote
autonomy.
Cost-Effectiveness Analysis and Disability
Discrimination [preprint]
Forthcoming in Adam Cureton and David Wasserman (eds.), The Oxford Handbook of Philosophy and
Disability.
Cost-effectiveness analysis (CEA) is an analytical tool in health economics. One of the most
important objections to it is that its use can lead to unjust discrimination against people with disabilities. In
this paper, I evaluate this objection. I argue that the standard examples of disability discrimination are based on
misunderstandings of CEA. However, I do point out that there is one case in which the use of CEA may disadvantage
people with disabilities. I go on to consider several proposals for explaining the wrongness of discrimination, but I
find that none of them accommodates this case.
Scarcity [preprint]
In Hugh LaFollette
(ed.), The International Encyclopedia of
Ethics, 2nd edition.
It is often said that economics is the science of scarcity. But since a lot of economics is
just applied ethics, it is perhaps more apt to say the real science of scarcity is ethics. I show this by considering
a number of issues in ethics, from resource allocation to self-control, where scarcity plays a major role.
Fairness and the Puzzle of Disability
Theoria 84 (2018), 337–355.
Consider two cases. In Case 1, you must decide whether you save the life of a disabled
person or you save the life of a person with no disability. In Case 2, you must decide whether you save the life
of a disabled person who would remain disabled, or you save the life of another disabled person who, in contrast,
would also be cured as a result of your intervention. It seems that most people agree that you should give equal
chances in Case 1: saving the life of the person with no disability would be unfair discrimination against the
person with disability. Yet, in Case 2, it appears that many people believe that you are at least permitted to
save straightaway the person who would have no disability after your intervention. There would be no unfair
discrimination against the other person.
I argue that these judgments present a puzzle for theories of resource allocation in normative ethics. The puzzle
is straightforward for consequentialists: the two cases have the same outcomes, but the judgments are different.
But the puzzle also presents a problem for nonconsequentialist views. After introducing the cases, I show this by
reviewing a number of proposals for solving the puzzle. I argue that none of these proposals are successful. I
then make my own proposal and conclude by spelling out its implications.
Priority Setting and Age
In Eckhard Nagel and Michael Lauerer (eds.), Prioritization in Medicine: An International Dialogue. Springer,
2016, 163–177.
The role of age in priority setting is one of the most controversial issues in health policy.
It has also been a contentious topic for many years in medical ethics and philosophy, and any discussion of age as a
criterion for setting priorities in health care is likely to stir up intense public debate. In this paper, I provide
an overview of the range of ideas that have been used to defend the relevance of age.
Is Disability Mere Difference?
Journal of Medical Ethics 42 (2016), 46–49.
Some philosophers and disability advocates argue that disability is not bad for you. Rather
than treated as a harm, it should be considered and even celebrated as just another manifestation of human diversity.
Disability is mere difference. To most of us, these are extraordinary claims. Can they be defended?
Fair Innings
Bioethics 29 (2015), 251–261.
In many societies, the aging of the population is becoming a major public policy problem. On
what is known as the fair innings view, it is not impermissible to give lower priority to policies that
primarily benefit the elderly. Philosophers have tried to justify this view on various grounds. In this paper, I
argue that all of these justifications have implausible implications. I end by outlining a different kind of
justification that avoids those implications and corresponds better to our considered moral judgments.
QALYs, DALYs, and Their Critics
In John D. Arras, Elizabeth Fenton, and Rebecca Kukla (eds.), The Routledge Companion to Bioethics.
Routledge, 2015, 44–55.
This paper provides an introduction to evaluative measures of health,
including quality-adjusted life years (QALYs) and disability-adjusted life years (DALYs). It also
discusses some of the ethical issues that arise for their application.
Empirical and Armchair Ethics
Utilitas 24 (2012), 467–482.
In a recent paper, Michael Otsuka and Alex Voorhoeve present a novel argument against
prioritarianism ["Why It Matters that Some are Worse Off than Others: An Argument against the Priority
View," Philosophy and Public Affairs 37 (2009), 171–199]. The argument takes its starting point from
empirical surveys on people's preferences in health care resource allocation problems. In this article, I first
question whether the empirical findings support their argument, and then I make some general points about the use of
"empirical ethics" in ethical theory.
Enhancement and Equality
Ethical Perspectives 19 (2012), 11–32.
Opponents of genetic enhancement technologies often argue that the pursuit of these
technologies will lead to self-defeating collective outcomes, massive social inequalities, or other forms of
collective harm. They assume that these harms will outweigh individual benefits. Defenders of genetic enhancement
technologies counter that individual benefits will outweigh collective harms and there will be no conflict between
individual and collective interests. The present contribution tries to advance the debate by providing a more detailed
discussion of the conditions under which individual and collective interests may conflict. It presents a simple model
that clarifies the conditions in which the use of genetic enhancement technologies may lead to self-defeating
collective outcomes and social inequalities. It argues that given current inequalities, these conditions might indeed
obtain as new genetic knowledge leads to a transition in population health. If they do, then genetic enhancement will
steepen the social gradient in health. Thus, regulating access to enhancement technologies should be a matter of
social justice.
Can the Maximin Principle Serve as a Basis for Climate Change
Policy?
The Monist 94 (2011), 329–348.
The precautionary approach has been widely considered reasonable for many issues in
environmental policy, including climate change. It has also been recognized, however, that standard formulations of
the precautionary principle suffer from many difficulties. An influential strategy to avoid these difficulties is to
formulate a narrow version of the principle on the basis of the maximin rule. Rawls proposed that following the
maximin rule can be rational under certain conditions. Defenders of this strategy argue that these conditions are
approximated when it comes to issues like climate change. In the first part of this paper, I argue that the Rawlsian
conditions do not establish the unique rationality of the maximin rule, hence the precautionary principle cannot be
defended on its basis. When the Rawlsian conditions are approximated, other principles can also lead to reasonable
choices. In particular, a prioritarian principle can capture the precautionary approach and serve a useful role in
climate change policy. I develop this proposal in the second part.
Impartiality and Disability Discrimination
Kennedy Institute of Ethics Journal 21 (2011), 1–23.
Cost-effectiveness analysis is the standard analytical tool for evaluating the aggregate health
benefits of treatments and health programs. According to a common objection, however, its use may lead to unfair
discrimination against people with disabilities. Since the disability discrimination objection is seldom articulated
in a precise way, I first provide a formulation that avoids some implausible implications. Then I turn to the
standard defense of cost-effectiveness analysis and argue that it does not succeed. But this does not settle the
question of whether the use of cost-effectiveness analysis leads to unfair discrimination. Rather, it shows that the
controversy should be approached in a different way.
Does Cost Effectiveness Analysis Unfairly
Discriminate Against People with Disabilities?
Journal of Applied Philosophy 27 (2010), 394–408.
Cost-effectiveness analysis is a tool for evaluating the aggregate benefits of medical
treatments, health care services, and public health programs. Its opponents often claim that its use leads to unfair
discrimination against people with disabilities. My aim in this paper is to clarify the conditions under which this
might be so. I present some ways in which the use of cost effectiveness analysis can lead to discrimination and
suggest why these forms of discrimination may be unfair. I also discuss some proposals for avoiding discrimination
without rejecting cost effectiveness analysis altogether. I argue that none of these proposals is ultimately
convincing. I describe a different approach to the problem and conclude by answering the question in the
title.
Saving Lives and Respecting Persons
Co-written with Samuel J. Kerstein.
Journal of Ethics & Social Philosophy 5 (2010), 1–20.
In the distribution of resources, persons must be respected, or so many philosophers contend.
Unfortunately, they often leave it unclear why a certain allocation would respect persons, while another would not.
In this paper, we explore what it means to respect persons in the distribution of scarce, life-saving resources. We
begin by presenting two kinds of cases. In different age cases, we have a drug that we must use either to save a
young person who would live for many more years or an old person who would only live for a few. In different numbers
cases, we must save either one person or many persons from certain death. We argue that two familiar accounts of
respect for persons—an equal worth account, suggested by Jeff McMahan, and a Kantian account, inspired by the Formula
of Humanity—have implausible implications in such cases. We develop a new, "three-tiered" account: one that, we
claim, generates results in such cases that accord better with many people's considered judgments than those produced
by its rivals.
Authentic Happiness
Utilitas 22 (2010), 272–284.
This article discusses L. W. Sumner's theory of well-being as authentic happiness. I
distinguish between extreme and moderate versions of subjectivism and argue that Sumner's characterization of the
conditions of authenticity leads him to an extreme subjective theory. More generally, I also criticize Sumner's
argument for the subjectivity of welfare. I conclude by addressing some of the implications of my arguments for
theories of well-being in philosophy and welfare measurement in the social sciences.
Complete Lives in the Balance
Co-written with Samuel J. Kerstein.
The American Journal of Bioethics 10 (2010), 37–45.
The allocation of scarce health care resources such as flu treatment or organs for transplant
presents stark problems of distributive justice. Persad, Wertheimer, and Emanuel have recently proposed a novel
system for such allocation. Their "complete lives system" incorporates several principles, including ones that
prescribe saving the most lives, preserving the most life-years, and giving priority to persons between 15 and 40
years old. This paper argues that the system lacks adequate moral foundations. Persad and colleagues' defense of
giving priority to those between 15 and 40 leaves them open to the charge that they discriminate unfairly against
children. Second, the paper contends that the complete lives system fails to provide meaningful practical guidance in
central cases, since it contains no method for balancing its principles when they conflict. Finally, the paper
proposes a new method for balancing principles of saving the most lives and maximizing life-years.
Quality of Life: Subjective or Objective?
In Jean-François Ravaud, Isabelle Ville and Serge Poiraudeau (eds.), Handicap et Qualité de Vie.
GMsanté, 2010, 17–24. [French translation]
In the last several decades, quality of life research has become an extensive and diverse
field. Governments, public policy institutes and other organizations have developed various indexes to measure the
quality of life. But there remain unsettled issues and deep disagreements between researchers. Perhaps the most
important debate concerns the use of objective and subjective indicators of quality of life. This paper attempts to
sort out the various ambiguities and misunderstandings in the debate.
Welfare Judgments and Risk
In Lotte Asveld and Sabine Roeser (eds.), The Ethics of Technological Risk. Earthscan, 2009, 144–160.
This paper begins by distinguishing between theories of welfare and models of welfare
judgments. Then it introduces the ideal advisor model of welfare judgments: on this model, welfare judgments are made
by appealing to what a person, were she fully informed and ideally rational, would prefer. I argue that this model is
often implicit in discussions of well-being and our ordinary practice of making welfare judgments. I go on to develop
an argument against the model, showing that it needs to be amended, at least for a certain class of welfare
judgments. The amendment takes the form of a substantive account of reasonable and unreasonable risks.
Age-Weighting
Economics and Philosophy 24 (2008), 167–189.
Some empirical findings seem to show that people value health benefits differently depending on
the age of the beneficiary. Health economists and philosophers have offered justifications for these preferences on
grounds of both efficiency and equity. In this paper, I examine the most prominent examples of both sorts of
justification: the defence of age-weighting in the WHO’s global burden of disease studies and the fair innings
argument. I argue that neither sort of justification has been worked out in satisfactory form: age should not be
taken into account in the framework of the burden of disease measure, and on the most promising formulations of the
fair innings argument, it turns out to be merely an indicator of some other factor. I conclude by describing the role
of age in theories of justice of healthcare resource allocation.
Well-Being and Health
Health Care Analysis 16 (2008), 97–113.
One way of evaluating health is in terms of its impact on well-being. It has been shown,
however, that evaluating health this way runs into difficulties, since health and other aspects of well-being are not
separable. At the same time, the practical implications of the inseparability problem remain unclear. This paper
assesses these implications by considering the relations between theories, components, and indicators of
well-being.
The Concept of Quality of Life
Social Theory & Practice 31 (2005), 561–580.
Quality of life research aims to develop and apply indices for the measurement of human
welfare. It is an increasingly important field within the social sciences and its results are an important resource
for policy making and evaluation. This paper explores the conceptual background of quality of life research. It
focuses on its single most important issue: the controversy between the use of "objective social indicators" and the
use of people's "subjective evaluations" as proxies for welfare. Most quality of life researchers today argue that
people's own evaluations have an indispensable role in quality of life measurement. I argue that their position must
be defended on philosophical grounds, because their use of evaluations commits them to some particular theories of
welfare. I explore the connections between theories of welfare in philosophy and the use of evaluations in quality of
life research. I conclude that even though evaluations may have a role in particular applications, they are unlikely
to have a role in all applications.
The Ethics of Health Care Rationing, our book
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