Does Cost Effectiveness Analysis Unfairly Discriminate against People with Disabilities?

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.     

The disappearing agent objection to event-causal libertarianism

The question I raise is whether Mark Balaguer’s event-causal libertarianism can withstand the disappearing agent objection. The concern is that with the causal role of the events antecedent to a decision already given, nothing settles whether the decision occurs, and so the agent does not settle whether the decision occurs. Thus it would seem that in this view the agent will not have the control in making decisions required for moral responsibility. I examine whether Balaguer’s position has the resources to answer this objection.     

Asymmetry and Incoherence: A Reply to Cyr

In defense of the Deprivation Approach to the badness of death against the Lucretian objection that death is relevantly similar to prenatal nonexistence, John Martin Fischer and Anthony L. Brueckner have suggested that whereas death deprives us of things that it is rational for us to care about, prenatal nonexistence does not. I have argued that this suggestion, even if correct, does not make for a successful defense of the Deprivation Approach against the Lucretian objection. My criticism involved a thought experiment in which a person avoids being tortured. Recently, Taylor Cyr has defended Fischer and Brueckner’s approach, arguing that my thought experiment is incoherent. In this response, I question both the truth and relevance of Cyr’s incoherence claim.     

On the Incoherence Objection to Rule-Utilitarianism

For a long time many philosophers felt the incoherence objection was a decisive objection to rule-consequentialism, but that position has recently become less secure, because Brad Hooker has offered a clever new way for rule-consequentialists to avoid the incoherence objection. Hooker’s response defeats traditional forms of the incoherence objection, but this paper argues that another version of the problem remains. Several possible solutions fail. One other does not, but it introduces other problems into the theory. I conclude that the new incoherence objection still poses a major challenge to rule-consequentialism, though not for the reasons usually assumed. It does not constitute a fatal objection to rule-consequentialism but instead highlights a theoretical drawback in the theory which must be taken into account during a more holistic evaluation of rule-consequentialism and its rivals.     

Does the Demographic Objection to Epistocracy Succeed?

In most, if not all, forms of epistocracy, we can expect (at least in the near future) that the more advantaged demographic groups would have higher rates of representation than less advantaged groups. The Demographic Objection to Epistocracy holds that this means epistocracy is unjust. One version of the Demographic Objection holds that the unequal representation is inherently unfair. I show that this argument fails, as proceduralist concern for fairness does not get us to universal equal suffrage at all. A second version holds that by giving some kinds of people more power than others, epistocracy will tend to help the advantaged and harm the already disadvantaged. In contrast, I argue that certain forms of epistocracy escape this objection altogether. For the others, though, this version of the objection relies on questionable empirical assumptions. In the end, neither version of the Demographic Objection succeeds. The Demographic Objection to epistocracy is much weaker than it seems.     

Asymmetry in Action

In The Elm and The Expert (Fodor 1994), Jerry Fodor claims that in order to solve the mind/body problem (consciousness excluded), a computational psychology needs to be combined with a naturalistic theory of content such as the asymmetric dependence theory put forward in 'A Theory of Content II' (in Fodor 1990, pp. 89-136). However, since this theory was first proposed, it has been reproached for a number of failings, perhaps the most significant of which is the objection that it simply begs the question. In this paper I provide an outline of the story so far, covering Fodor's objectives, the theory he proposes to meet them and the objection in question, before going on to argue that a promising attempt to answer this objection will not bear fruit given the way in which Fodor tackles the original problems. I then argue that the seeming intractability of this objection is due to Fodor's striving to solve all the problems that a naturalistic theory presents in one fell swoop, and conclude by suggesting how, given a careful choice of targets and a well organised methodology, asymmetric dependence might yet prove to be an attractive theory of content.     

Is Having Pets Morally Permissible?

In this article, I consider the question of whether having pets is morally permissible. However, I do so indirectly by considering three objections to the practice of having pets — what I shall call the ‘restriction of freedom objection’, the ‘property objection’, and the ‘dependency objection’. The restriction of freedom objection is dismissed relatively easily. The property objection also fails to show that having pets is morally impermissible. However, my consideration of this second objection does lead to the conclusion that we ought to aim at changing existing legal systems and the majority of people's attitudes towards pets such that they (pets) are no longer considered to be the personal property of the humans in whose homes they are kept. But, while it is clear that we ought to aim at ending the practice of owning pets, it is not clear whether we ought to aim at ending the practice of keeping pets. Indeed, I do not to reach a definitive conclusion about the cogency of the dependency objection. However, I argue that this lack of clarity is of little concern at this time as our present moral obligations to pets are quite clear.     

In Defense of the Phenomenal Concept Strategy1

Section 1 articulates a genus‐species claim: that knowledge is a kind of success from ability. Equivalently: In cases of knowledge, S’s success in believing the truth is attributable to S’s ability. That idea is then applied to questions about the nature and value of knowledge. Section 2 asks what it would take to turn the genus‐species claim into a proper theory of knowledge; that is, into informative, necessary and sufficient conditions. That question is raised in the context of an important line of objection against even the genus‐species claim; namely, that there is no way to understand the attribution relation so that it does all the work that it is supposed to do. Section 3 reviews several extant proposals for understanding the attribution relation, and argues that none of them are adequate for answering the objection. Section 4 proposes a different way of understanding the relation, and shows how the resulting view does resolve the objection. Section 5 completes the new account by proposing a way to understand intellectual abilities. Section 6 briefly addresses Barn Façade cases and lottery propositions. Section 7 briefly addresses a question about the scope of knowledge; in particular, it shows how the new view allows a neo‐Moorean response to skepticism.     

Conventions and Moral Norms: The Legacy of Lewis

David Lewis’ Convention has been a major source of inspiration for philosophers and social scientists alike for the analysis of norms. In this essay, I demonstrate its usefulness for the analysis of some moral norms. At the same time, conventionalism with regards to moral norms has attracted sustained criticism. I discuss three major strands of criticism and propose how these can be met. First, I discuss the criticism that Lewis conventions analyze norms in situations with no conflict of interest, whereas most, if not all, moral norms deal with situations with conflicting interests. This criticism can be answered by showing that conventions can emerge in those contexts as well. Secondly, I discuss the objection that this type of conventionalism, inspired by Lewis, presents moral norms as fundamentally contingent, whereas most, if not all, moral norms are not. However, such critics fail to appreciate that conventions are not radically contingent. Moreover, if one distinguishes the question as to why an individual should comply with a norm from the question whether the norm in question itself can be justified, a core element of the complaint of contingency disappears. The third objection to conventionalism concerns the way in which conventionalists justify norms. I argue that reflection upon the way in which according to Lewis norms are justified reveals a fundamental tension in his theory. Possible solutions to this tension all have in common that the complaint of contingency returns in some form. Therefore, this third complaint cannot be avoided altogether.     

Inequality in Political Philosophy and in Epidemiology: A Remarriage

In political philosophy and in economics, unfair inequality is usually assessed between individuals, nowadays often on luck‐egalitarian grounds. You have more than I do (through no fault of my own) and that's unfair. By contrast, in epidemiology and sociology, unfair inequality is traditionally assessed between groups. More is concentrated among people of your class or race than among people of mine, and that's unfair. I shall call this difference the egalitarian ‘divorce’. Epidemiologists, and their ‘divorce lawyers’ Paula Braveman, Norman Daniels, and Iris Marion Young, explain that not every inequality between individuals is an inequity. Only inequality between social status groups is unfair. Only such inequality stems from problems like partiality, discrimination, oppression, inequality‐related population health problems, and unfair distribution of prospects. And it alone is actionable. By contrast, inequality between individuals, e.g. in longevity, is natural, inevitable, less important, or otherwise less informative — not unjust. In ‘divorce trial’ mode, I respond to epidemiologists that group inequalities lack the intrinsic disvalue that they ascribe them. They may be instrumentally or contingently bad or wrong, not essentially so. I then shift to ‘remarriage’: although group inequalities lack intrinsic badness or wrongness, for multiple reasons they remain useful to measure.     

What's So Egalitarian About Luck Egalitarianism?

Luck egalitarians typically hold that it is bad for some to be worse off than others through no fault or choice of their own. In this paper I want to address two complaints against standard luck egalitarianism that do not question responsibility‐sensitivity (or ‘luck‐ism’). The first objection says that equality itself lacks inherent non‐instrumental value, and so the luckist component ought to be attached to a different pattern, say prioritarianism (thus producing ‘luck‐prioritarianism’). The second objection also endorses luckism but worries that luck egalitarianism as conventionally formulated is committed in fact to neutralizing not just brute luck but also option luck. And this would mean, among other things, compensating unsuccessful gamblers, which is something many egalitarians find counterintuitive. My aim is to show that there is a way for luck egalitarianism to meet both criticisms; that it can maintain its egalitarian credentials while avoiding the counterintuitive consequences of compensating unsuccessful gamblers. To do so, I propose, we ought to understand luck egalitarianism as resting on the disvalue of being arbitrarily worse off compared to others. In addition, I suggest, the badness of luck egalitarian inequality – that of arbitrary disadvantage – has both an inter‐personal and an intra‐personal dimension.     

Excluded middle and bivalence

I consider two related objections to the claim that the law of excluded middle does not imply bivalence. One objection claims that the truth predicate captured by supervaluation semantics is not properly motivated. The second objection says that even if it is, LEM still implies bivalence. I show that LEM does not imply bivalence in a supervaluational language. I also argue that considering supertruth as truth can be reasonably motivated.     

Skeptical theism and value judgments

One of the most prominent objections to skeptical theism in recent literature is that the skeptical theist is forced to deny our competency in making judgments about the all-things-considered value of any natural event. Some skeptical theists accept that their view has this implication, but argue that it is not problematic. I think that there is reason to question the implication itself. I begin by explaining the objection to skeptical theism and the standard response to it. I then identify an assumption that is prevalent in much of the literature concerning the problem of evil, and show that it is a factor in motivating commitment to the implication I mean to question. I argue that the assumption is false, and that once it is rejected there is room to endorse the skeptical theist’s strategy in responding to some arguments from evil without endorsing the putative implication that objectors find unacceptable.     

Actual Utility, The Objection from Impracticality, and the Move to Expected Utility

Utilitarians are attracted to the idea that an act is morally right iff it leads to the best outcome. But critics have pointed out that in many cases we cannot determine which of our alternatives in fact would lead to the best outcome. So we can’t use the classic principle to determine what we should do. It’s not “practical”; it’s not “action-guiding”. Some take this to be a serious objection to utilitarianism, since they think a moral theory ought to be practical and action-guiding. In response, some utilitarians propose to modify utilitarianism by replacing talk of actual utility with talk of expected utility. Others propose to leave the original utilitarian principle in place, but to combine it with a decision procedure involving expected utility. What all these philosophers have in common is this: they move toward expected utility in order to defend utilitarianism against the impracticality objection. My aim in this paper is to cast doubt on this way of replying to the objection. My central claim is that if utilitarians are worried about the impracticality objection, they should not turn to expected utility utilitarianism. That theory does not provide the basis for a cogent reply to the objection. Originally presented at the 2004 Bellingham Summer Philosophy Conference, Bellingham Washington, August 2, 2004, with comments by Gustaf Arrhenius and Elizabeth Harman. I am grateful to Arrhenius and Harman for their challenging criticism, as well as to Chris Heathwood, Michael Zimmerman, Owen McLeod, Elinor Mason, Eric Moore and other participants at the Bellingham Conference for comments and suggestions. In October, 2004 I discovered Mark Strasser’s ‘Actual Versus Probable Utilitarianism’. I see that in that paper Strasser anticipates a number of the points I make here.     

Health care and human rights: against the split duty gambit

There are various grounds on which one may wish to distinguish a right to health care from a right to health. In this article, I review some old grounds before introducing some new grounds. But my central task is to argue that separating a right to health care from a right to health has objectionable consequences. I offer two main objections. The domestic objection is that separating the two rights prevents the state from fulfilling its duty to maximise the health it provides each citizen from its fixed health budget. The international objection is that separating a human right to health care fails the moral requirement that, for any given moral human right, the substance to which any two right-holders are entitled be of an equal standard.     

From Volitionalism to the Dual Aspect Theory of Action

Volitionalism is a theory of action motivated by certain shortcomings in the standard causal theory of action. However, volitionalism is vulnerable to the objection that it distorts the phenomenology of embodied agency. Arguments for volitionalism typically proceed by attempting to establish three claims: (1) that whenever an agent acts, she tries or wills to act, (2) that it is possible for volitions to occur even in the absence of bodily movement, and (3) that in cases of successful bodily actions the relation between volition and bodily movement is causal. I defend an argument for the second of these claims from an objection by Thor Grünbaum, but I show that several volitionalist arguments for the third are not compelling. I then argue that the dual aspect theory of action provides a better account of the relationship between an agent’s volition and the bodily movements she makes when she acts, insofar as it has the same advantages over the standard story as volitionalism without being open to the phenomenological objection. I also defend the dual aspect theory from an objection by A.D. Smith. Finally, I show why the dual aspect theory of action is a better alternative to volitionalism than the theory of action recently put forward by Adrian Haddock. In order to avoid the phenomenological objection Haddock suggests a disjunctive account of bodily movements. While disjunctivism should be taken seriously in the philosophy of action, on the dual aspect theory it is the category of volition, rather than bodily movement, that should receive a disjunctive analysis.     

How to Overcome Strawson’s Point: Defending a Value-Oriented Foundation for Contractualism

In The Second Person Standpoint, Darwall charges that all value-oriented foundations for ethics make a category mistake. Calling it Strawson’s point, he argues these foundations explain moral authority, which concerns whether someone has standing to hold another accountable, in terms of a value, which essentially concerns what makes the world go best. However, whether it would be good for me to blame you simply asks a different question than whether I have standing to blame you. I defend a valueoriented foundation for contractualism by identifying one way to overcome Strawson’s point. At bottom, Darwall’s objection relies on the assumption that all values are worldregarding. I argue that another class of values exists: second-personal values. Grounding morality in one of these values does not make the category mistake at the heart of Strawson’s point. In particular, I argue that grounding morality on one secondpersonal value, the ideal of acting justifiably towards others, better captures traditional contractualist ideals than Darwall’s formal foundation.     

The Instability of Vague Terms

Timothy Williamson's response to the question why we cannot know where the sharp boundaries marked by vague terms lie involves the claim that vague terms are unstable. Several theorists would not accept this claim, and it is tempting to think that this gives them a good objection to Williamson. By clarifying the structure of Williamson's response to the title question, I show that this objection is wrong-headed, and reveal a new line of attack.     

Fine-tuning and the infrared bull’s-eye

I argue that the standard way of formalizing the fine-tuning argument for design is flawed, and I present an alternative formalization. On the alternative formalization, the existence of life is not treated as the evidence that confirms design; instead it is treated as part of the background knowledge, while the fact that fine tuning is required for life serves as the evidence. I argue that the alternative better captures the informal line of thought that gives the fine-tuning argument its intuitive plausibility, and I show that the alternative formalization avoids all of the most prominent objections to the fine-tuning argument, including the objection from observation selection effects, the problem of old evidence, the problem of non-normalizable probability measures and a further objection due to Monton. I conclude that the alternative formalization is the one that attention should be focused on.     

THE CHARACTER OF VIRTUE: ANSWERING THE SITUATIONIST CHALLENGE TO VIRTUE ETHICS

Neo‐Aristotelian virtue ethics makes essential reference to the notion of a stable, robust character‐trait. It also claims to be constrained by at least a minimal degree of psychological realism. Recent developments in empirical psychology have drawn into question the evidence for the existence of such robust traits, arguing that it rests on what has been called a ‘fundamental attribution error’. Virtue ethics has thus seemingly been made vulnerable to criticisms that it is essentially dependent on an erroneous, folk‐psychological, notion of character and, so, must either abandon their characteristic notion of virtue or forego any pretensions to psychological realism. I develop a two‐pronged response to this objection. First, I argue that there is reason to question much of the empirical evidence and that such evidence as does exist can easily be accommodated by virtue ethics. Next, I argue that even if we allow that neo‐Aristotelian virtue ethical theories does sometimes presuppose a stronger conception of character‐traits than is warranted by the evidence, this does not significantly undermine the virtue ethicist's project.