Future ethics: risk,care and non-reciprocal responsibility

As the number of intrinsically unknowable technologically produced risks global society faces continues to grow, it is evident that the question of our responsibilities towards future people is of urgent importance. However, the concepts with which this question is generally approached are, it is argued, deficient in comprehending the nature of these risks. In particular, the individualistic language of rights presents severe difficulties. An alternative understanding of responsibility is required, which, it is argued, can be developed from phenomenological and feminist concepts of care. Such concepts privilege an understanding of human beings that is primarily relational rather than individualistic, and show that responsibility is, in the first place, about connection rather than respecting separation. Care, by opening up for us an understanding of the diversity of values that are constitutive of a worthwhile life, also connects us to the future as the future of care. As such, it provides us with ethical resources that can guide us in the face of uncertainty, including general principles of action and the desire for institutions that can articulate them.     

Health care need: three interpretations

The argument that scarce health care resources should be distributed so that patients in 'need' are given priority for treatment is rarely contested. In this paper, we argue that if need is to play a significant role in distributive decisions it is crucial that what is meant by need can be precisely articulated. Following a discussion of the general features of health care need, we propose three principal interpretations of need, each of which focuses on separate intuitions. Although this account may not be a completely exhaustive reflection of what people mean when they refer to need, the three interpretations provide a starting-point for further debate of what the concept means in its specific application. We discuss combined interpretations, the meaning of grading needs, and compare needs-based priority setting to social welfare maximisation.     

Health care and the prospective Pareto principle

Issues of social justice in access to health care are examined from the standpoint of the "prospective," or "ex ante," Pareto principle, an ethical principle which holds that one policy is to be preferred over another if it betters the prospects of some persons while the alternative betters no one's prospects. It is suggested that this principle may validate a form of utilitarianism in health policy decisions, with equity demanding that everyone have access to a decent minimum of care but not necessarily to all highly expensive treatments.     

Insanity and responsibility

This paper attempts to set forth, in the context of Anglo‐U.S. criminal law, the meaning of the concept of insanity, its necessary relation to absence of responsibility, and its bearing on some relevant psychiatric concepts and legal controversies. Irrationality is a distinctive and necessary (but not sufficient) condition for insanity. Irrationality consists in failure even to grasp the relevance of what is ‘essentially’ relevant. To that extent there obviously can be no responsibility. A mental makeup which renders one (who would not normally be so) substantially incapable of rational conduct constitutes insanity, and in that respect renders the person non‐responsible. Much more broadly and roughly speaking, the mind that is ill is the mind that is irrational (and hence in that respect non‐responsible).     

Assigning vicarious responsibility

An experiment tested three hypotheses about the conditions under which someone can be held vicariously responsible for the actions of another. Two of the hypotheses received empirical support: that the vicariously responsible person is in a superior relationship to the person who caused the damage and is able to control that person's causing of the damage. A third hypotheis, that a person is held vicariously responsible because of a relatively greater ability to pay compensation to the victim, was not supported.     

Beliefs and responsibility

I am grateful to R.S. Downie and Elizabeth Telfer for their comments on an earlier draft of this paper.