Research
I am currently working on issues related to personal responsibility in healthcare provision, as part of a Wellcome Trust funded project. This includes work on the role of health monitoring devices, and interactions between the demands of responsibility and other normative issues, such as egalitarian justice.
My central research focus outside this project is inter-generational justice in health care. You can hear me talk about some of the issues involved as part of KCL's Health & Society podcast series (2016) here.
My central research focus outside this project is inter-generational justice in health care. You can hear me talk about some of the issues involved as part of KCL's Health & Society podcast series (2016) here.
Publications
Forthcoming (Available online) Bursting bubbles: QALYs and discrimination Utilitas. DOI: 10.1017/S0953820818000249
Quality-adjusted life years are a measure of effectiveness in healthcare. But they are often criticised as discriminating against disability. Toby Ord and Nick Beckstead claim that although QALYs are discriminatory, there is no way to avoid this without giving up either a preference for larger benefits, a commitment to autonomy, or rational consistency. I note that the inconsistency Ord and Beckstead identify can in fact be generated only by a commitment to benefit size and autonomy. As such, there is no good reason to abandon a commitment to avoiding discrimination.
Preprint
Forthcoming (Available online) Ageing and terminal illness: Problems for Rawlsian Justice Journal of Applied Philosophy. DOI: 10.1111/japp.12265
This paper considers attempts to address the issue of intergenerational justice in healthcare provision through a Rawlsian framework. It first considers Norman Daniels’ Prudential Lifespan Account, which reduces intergenerational questions to issues of intrapersonal prudence from behind a Rawslian veil of ignorance. This approach faces several problems of idealisation, including those raised by Hugh Lazenby, because it must assume that everyone will live to the same age; this undermines its status as a prudential calculation. I then assess Lazenby’s own account, which applies Rawls’ general theory of justice more directly to healthcare. Lazenby suggests that we should apply Rawls’ difference principle – which claims that any inequalities in social goods must benefit the worst off – to conclude that we should significantly prioritise treatment of young patients. I argue that a strict application of the difference principle in the case of health care leads to rather more extreme conclusions, given the existence of very young patients whose situation cannot be improved. Moreover, the prudential calculations on which Lazenby relies are not warranted from within the Rawlsian framework. I conclude that age and terminal illness present significant problems for any comprehensive Rawlsian account of justice.
Preprint
2018 John Rawls' 'A Theory of Justice' 1000-Word Philosophy
A brief overview of some central themes in John Rawls' book, A Theory of Justice, intended as a study and teaching aid.
2017 Paternalism and evaluative shift. Moral Philosophy and Politics 4(2): 325-347
Many people feel that respecting a person’s autonomy is not sufficiently important to obligate us to stay out of their affairs in all cases; but if the agent herself has all the information we have, it can be rather hard to see the liberal ground for interference. Indeed, such ground may often turn out to be a hunch that the agent cannot really be competent, or cannot really be in full cognisance of the what her decision implies; for if she were both of these things, surely she would not make such a foolish decision. But this is not a liberal response at all. This paper suggests a justification of paternalism that avoids the suggestion that the target of paternalistic interference has made some mistake about what is in her interests. I suggest that in cases where we can predict that the agent will undergo a significantly alteration in their evaluative outlook – an ‘evaluative shift’ – many otherwise persuasive objections to paternalism lose their force. I then suggest that we can extend this argument to some cases where evaluative alteration is not predictable, but where the risk and harm are both significant. In such cases, paternalism is justified.
Preprint
2017 Enhancement and the Conservative Bias Philosophy and Technology 30(3): 339-356
Nicholas Agar argues that we should avoid certain ‘radical’ enhancement technologies. One reason for this is that they will alienate us from current sources of value by altering our evaluative outlooks. We should avoid this, even if enhancing will provide us with novel, objectively better sources of value. After noting the parallel between Agar’s views and G. A. Cohen’s work on the ‘conservative bias’, I explore Agar’s suggestion in relation to two kinds of radical enhancement: cognitive and anti-ageing. With regard to both, there are reasons to doubt Agar’s empirical predictions about the severity of the evaluative changes we will undergo. Nonetheless, there is some force to the argument as applied to cognitive enhancement; in particular, radical cognitive enhancement may endanger our current valuable relationships with our loved ones. However, even if we find this a plausible worry for radical cognitive enhancement, it is not plausible for even radical anti-ageing enhancement, because the change Agar predicts will not affect our core motivations in the way that cognitive enhancement threatens to.
Preprint
2017 (with Giulia Felappi) Publish or Perish Metaphilosophy 48(5): 745-761
Funds and positions in philosophy should be awarded through systems that are reliable, objective, and efficient. One question usually taken to be relevant is how many publications people have in a group of well-respected journals. However, in the context of significant competition for jobs and funding, relying on publication quantity creates a serious downside: the oft-lamented demand that we publish or perish. We offer a systematic review of the problems involved in contemporary academic philosophy, and argue that the resulting situation is bad not just for individual philosophers, but for philosophy itself: we are not working as a discipline to as high a standard as we might. We then suggest some potential solutions, including some more detailed considerations around what seems to us a particularly promising option: a professional code of conduct for philosophers.
2016 Utilitarianism and animal cruelty: Further doubts De Ethica 3(3). 5-19. (Open access)
Utilitarianism has an apparent pedigree when it comes to animal welfare. It supports the view that animal welfare matters just as much as human welfare. And many utilitarians support and oppose various practices in line with more mainstream concern over animal welfare, such as that we should not kill animals for food or other use, and that we ought not to torture animals for fun.
This relationship has come under tension from many directions. The aim of this article is to add further considerations in support of that tension. I suggest three ways in which utilitarianism comes significantly apart from mainstream concerns with animal welfare. First, utilitarianism opposes animal cruelty only when it offers an inefficient ratio of pleasure to pain; while this may be true of eating animal products, it is not obviously true of other abuses. Second, utilitarianism faces a familiar problem of the inefficacy of individual decisions; I consider a common response to this worry, and offer further concerns. Finally, the common utilitarian argument against animal cruelty ignores various pleasures that humans may get from the superior status that a structure supporting exploitation confers.
2016 Fair innings and time-relative claims. Bioethics 30(6). 462-468
Greg Bognar has recently offered a prioritarian justification for ‘fair innings’ distributive principles that would ration access to healthcare on the basis of patients’ age. In this article, I agree that Bognar’s principle is among the strongest arguments for age-based rationing. However, I argue that this position is incomplete because of the possibility of ‘time-relative’ egalitarian principles that could complement the kind of lifetime egalitarianism that Bognar adopts. After outlining Bognar’s position, and explaining the attraction of time-relative egalitarianism, I suggest various ways in which these two kinds of principle could interact. Since various options have very different implications for age-based rationing, proponents of such a rationing scheme must take a position on time-relative egalitarianism to complement a lifetime prioritarian view like Bognar’s.
Preprint
2015 Review of Dennis McKerlie's Justice Between the Young and the Old. Czech Sociological Review 51(3). 562-565
Quality-adjusted life years are a measure of effectiveness in healthcare. But they are often criticised as discriminating against disability. Toby Ord and Nick Beckstead claim that although QALYs are discriminatory, there is no way to avoid this without giving up either a preference for larger benefits, a commitment to autonomy, or rational consistency. I note that the inconsistency Ord and Beckstead identify can in fact be generated only by a commitment to benefit size and autonomy. As such, there is no good reason to abandon a commitment to avoiding discrimination.
Preprint
Forthcoming (Available online) Ageing and terminal illness: Problems for Rawlsian Justice Journal of Applied Philosophy. DOI: 10.1111/japp.12265
This paper considers attempts to address the issue of intergenerational justice in healthcare provision through a Rawlsian framework. It first considers Norman Daniels’ Prudential Lifespan Account, which reduces intergenerational questions to issues of intrapersonal prudence from behind a Rawslian veil of ignorance. This approach faces several problems of idealisation, including those raised by Hugh Lazenby, because it must assume that everyone will live to the same age; this undermines its status as a prudential calculation. I then assess Lazenby’s own account, which applies Rawls’ general theory of justice more directly to healthcare. Lazenby suggests that we should apply Rawls’ difference principle – which claims that any inequalities in social goods must benefit the worst off – to conclude that we should significantly prioritise treatment of young patients. I argue that a strict application of the difference principle in the case of health care leads to rather more extreme conclusions, given the existence of very young patients whose situation cannot be improved. Moreover, the prudential calculations on which Lazenby relies are not warranted from within the Rawlsian framework. I conclude that age and terminal illness present significant problems for any comprehensive Rawlsian account of justice.
Preprint
2018 John Rawls' 'A Theory of Justice' 1000-Word Philosophy
A brief overview of some central themes in John Rawls' book, A Theory of Justice, intended as a study and teaching aid.
2017 Paternalism and evaluative shift. Moral Philosophy and Politics 4(2): 325-347
Many people feel that respecting a person’s autonomy is not sufficiently important to obligate us to stay out of their affairs in all cases; but if the agent herself has all the information we have, it can be rather hard to see the liberal ground for interference. Indeed, such ground may often turn out to be a hunch that the agent cannot really be competent, or cannot really be in full cognisance of the what her decision implies; for if she were both of these things, surely she would not make such a foolish decision. But this is not a liberal response at all. This paper suggests a justification of paternalism that avoids the suggestion that the target of paternalistic interference has made some mistake about what is in her interests. I suggest that in cases where we can predict that the agent will undergo a significantly alteration in their evaluative outlook – an ‘evaluative shift’ – many otherwise persuasive objections to paternalism lose their force. I then suggest that we can extend this argument to some cases where evaluative alteration is not predictable, but where the risk and harm are both significant. In such cases, paternalism is justified.
Preprint
2017 Enhancement and the Conservative Bias Philosophy and Technology 30(3): 339-356
Nicholas Agar argues that we should avoid certain ‘radical’ enhancement technologies. One reason for this is that they will alienate us from current sources of value by altering our evaluative outlooks. We should avoid this, even if enhancing will provide us with novel, objectively better sources of value. After noting the parallel between Agar’s views and G. A. Cohen’s work on the ‘conservative bias’, I explore Agar’s suggestion in relation to two kinds of radical enhancement: cognitive and anti-ageing. With regard to both, there are reasons to doubt Agar’s empirical predictions about the severity of the evaluative changes we will undergo. Nonetheless, there is some force to the argument as applied to cognitive enhancement; in particular, radical cognitive enhancement may endanger our current valuable relationships with our loved ones. However, even if we find this a plausible worry for radical cognitive enhancement, it is not plausible for even radical anti-ageing enhancement, because the change Agar predicts will not affect our core motivations in the way that cognitive enhancement threatens to.
Preprint
2017 (with Giulia Felappi) Publish or Perish Metaphilosophy 48(5): 745-761
Funds and positions in philosophy should be awarded through systems that are reliable, objective, and efficient. One question usually taken to be relevant is how many publications people have in a group of well-respected journals. However, in the context of significant competition for jobs and funding, relying on publication quantity creates a serious downside: the oft-lamented demand that we publish or perish. We offer a systematic review of the problems involved in contemporary academic philosophy, and argue that the resulting situation is bad not just for individual philosophers, but for philosophy itself: we are not working as a discipline to as high a standard as we might. We then suggest some potential solutions, including some more detailed considerations around what seems to us a particularly promising option: a professional code of conduct for philosophers.
2016 Utilitarianism and animal cruelty: Further doubts De Ethica 3(3). 5-19. (Open access)
Utilitarianism has an apparent pedigree when it comes to animal welfare. It supports the view that animal welfare matters just as much as human welfare. And many utilitarians support and oppose various practices in line with more mainstream concern over animal welfare, such as that we should not kill animals for food or other use, and that we ought not to torture animals for fun.
This relationship has come under tension from many directions. The aim of this article is to add further considerations in support of that tension. I suggest three ways in which utilitarianism comes significantly apart from mainstream concerns with animal welfare. First, utilitarianism opposes animal cruelty only when it offers an inefficient ratio of pleasure to pain; while this may be true of eating animal products, it is not obviously true of other abuses. Second, utilitarianism faces a familiar problem of the inefficacy of individual decisions; I consider a common response to this worry, and offer further concerns. Finally, the common utilitarian argument against animal cruelty ignores various pleasures that humans may get from the superior status that a structure supporting exploitation confers.
2016 Fair innings and time-relative claims. Bioethics 30(6). 462-468
Greg Bognar has recently offered a prioritarian justification for ‘fair innings’ distributive principles that would ration access to healthcare on the basis of patients’ age. In this article, I agree that Bognar’s principle is among the strongest arguments for age-based rationing. However, I argue that this position is incomplete because of the possibility of ‘time-relative’ egalitarian principles that could complement the kind of lifetime egalitarianism that Bognar adopts. After outlining Bognar’s position, and explaining the attraction of time-relative egalitarianism, I suggest various ways in which these two kinds of principle could interact. Since various options have very different implications for age-based rationing, proponents of such a rationing scheme must take a position on time-relative egalitarianism to complement a lifetime prioritarian view like Bognar’s.
Preprint
2015 Review of Dennis McKerlie's Justice Between the Young and the Old. Czech Sociological Review 51(3). 562-565
Work in progress
Comments are very welcome on the following drafts. Please do not reference without permission.
Bringing the myth to life: Three prima facie cases of optional war
War is a morally serious undertaking, and hence requires the threat of severe harm to justify it. Kieran Oberman uses this fact to argue that wars cannot be morally 'optional' (morally permissible, but not required). Oberman considers two traditional grounds of war's optionality (a humanitarian war that will impose great costs on the war-going nation's people; and a self-defensive war that can be refused on the grounds of self-determination) and argues convincingly against them. In particular, the humanitarian case is rejected on the grounds of what Oberman calls the 'Cost Principle': if citizens do not have a humanitarian duty to bear a cost to resolve a humanitarian crisis, the state may not permissibly impose that cost on them. However, I suggest that even if Oberman's arguments are sound, they do not prove that the optional war is a "myth" as he claims. Using humanitarian wars as my focus, I suggest three scenarios that might be grounds for optional war: a state's obligation to incentivise its citizens towards privately supporting a war ('The Private War'); a scenario where it is uncertain whether the war will exceed the principle established by the Cost Principle ('The Forever War'); and a scenario where a state faces two or more interventions, which would individually fall below the threshold, but which collectively exceeds it ('The Multi-War'). While there are ways to resist these conclusions, they require significantly more argument or assumption than Oberman provides.
Cows, crickets and clams: On the alleged 'vegan' obligation to eat different kinds of meat (currently under consideration)
Some people think that the logic behind veganism implies an obligation to eat certain kinds of meat - different authors have defended this claim with regard to animals as complex as cows, to as simple as insects and shellfish. I take cows, crickets and clams to stand for three different animal categories: animals that can definitely suffer; animals that might be able to suffer, and animals who are as likely to suffer as are plants. I then note that the primary principle behind defences of 'vegan' meat-eating depend on the 'least harm' principle (LHP). But LHP is implausible, and not the only possible motivator for veganism. I consider the implications of the primary alternative to LHP - a deontological theory of rights - for the alleged obligation(s) to eat certain kinds of meat.
In defence of welfare subjectivism
Subjectivist theories of welfare base individual welfare on particular mental attitudes. Bradley suggests that all such theories generate paradoxical results in cases where the subject has the relevant positive attitude towards their life going badly. One view that apparently circumvents this paradox, suggested by Dorsey, is a view that bases welfare on the individual’s judgments that something is good or bad for them. However, Lin argues that subjectivist views cannot account for infant welfare. This suggests that subjectivists should adopt a far simpler attitude as grounding welfare than in Dorsey's theory.
I argue that subjectivists must respond to these twin worries with a disjunctive theory. Your welfare is determined by judgement subjectivism, unless you cannot make the relevant judgements. Then, your welfare is determined by your desires. I defend this view against objections from Lin, and the charge that it is ad hoc.
The Universe doesn't care - Against the rationalist defence of moral realism (Currently under consideration)
Evolutionary debunking accounts claim that the evolutionary origins of our moral beliefs provide a problem for moral realists because evolutionary explanations of our moral beliefs have more plausibility than realist accounts. A certain kind of response, which I term ‘rationalist’ offers a dual response to evolutionary debunking. First, they offer a supposedly plausible account of how we acquire objective moral knowledge through use of our rationality. Second, they claim that certain moral beliefs are not amenable to evolutionary explanation. I argue that neither of these putative advantages survives further scrutiny. An appeal to ‘rational insight’, although it makes reference to a somewhat familiar faculty, gives no useful explanation of how we come to know moral facts. Moreover, the supposedly problematic moral beliefs are in fact amenable to evolutionary explanation. As such, rationalist accounts are, like other realist accounts, on the wrong side of the balance of justification against evolutionary debunking.
Egalitarianism and healthcare: the time-relative view (Currently under consideration)
Egalitarianism about healthcare need to have something to say about what Dennis McKerlie calls the 'temporal subject': the question of whether egalitarian principles apply solely across lifetimes, or at shorter times too. I outline the importance of this question, and defend a broadly sufficientarian view of 'time-relative' justice with respect to health.
Sufficiency and responsibility in healthcare
According to many people, responsibility should play some role in healthcare entitlements. Applied in a simplistic fashion, this principle seems to lead us to excessively harsh claims, familiar from discussions around 'luck egalitarianism', where people who bear responsibility for their health burdens are abandoned, no matter how serious those burdens are. Several authors have argued that the solution to this problem is a sufficientarian approach, where responsibility applies only if holding you responsible would not leave you below a threshold of health or welfare. This paper extends that project in two directions, firstly by outlining how such a view might use a more limited form of responsibility to decide between people below this threshold and, secondly, by considering the question of whether sufficiency applies across lifetimes, at particular times, or both.
The doctor as appointed fiduciary
According to common wisdom, medicine has moved from the bad old days, where doctors were paternalistic, to the good days where doctors are mere providers of empirical information. The impetus for this move has been an increase in the importance attached to patient autonomy. While patient autonomy is certainly important, I note that autonomy - and the responsibility that comes with it - can also be a burden. I outline a model of the doctor as the patient's 'appointed fiduciary', i.e. as someone charged to make decisions in the patient's best interest. This model is not supposed to replace the current model, but to supplement it. Since patients choose whether to appoint a fiduciary, I argue that it is consistent with respect for patient autonomy.
Bringing the myth to life: Three prima facie cases of optional war
War is a morally serious undertaking, and hence requires the threat of severe harm to justify it. Kieran Oberman uses this fact to argue that wars cannot be morally 'optional' (morally permissible, but not required). Oberman considers two traditional grounds of war's optionality (a humanitarian war that will impose great costs on the war-going nation's people; and a self-defensive war that can be refused on the grounds of self-determination) and argues convincingly against them. In particular, the humanitarian case is rejected on the grounds of what Oberman calls the 'Cost Principle': if citizens do not have a humanitarian duty to bear a cost to resolve a humanitarian crisis, the state may not permissibly impose that cost on them. However, I suggest that even if Oberman's arguments are sound, they do not prove that the optional war is a "myth" as he claims. Using humanitarian wars as my focus, I suggest three scenarios that might be grounds for optional war: a state's obligation to incentivise its citizens towards privately supporting a war ('The Private War'); a scenario where it is uncertain whether the war will exceed the principle established by the Cost Principle ('The Forever War'); and a scenario where a state faces two or more interventions, which would individually fall below the threshold, but which collectively exceeds it ('The Multi-War'). While there are ways to resist these conclusions, they require significantly more argument or assumption than Oberman provides.
Cows, crickets and clams: On the alleged 'vegan' obligation to eat different kinds of meat (currently under consideration)
Some people think that the logic behind veganism implies an obligation to eat certain kinds of meat - different authors have defended this claim with regard to animals as complex as cows, to as simple as insects and shellfish. I take cows, crickets and clams to stand for three different animal categories: animals that can definitely suffer; animals that might be able to suffer, and animals who are as likely to suffer as are plants. I then note that the primary principle behind defences of 'vegan' meat-eating depend on the 'least harm' principle (LHP). But LHP is implausible, and not the only possible motivator for veganism. I consider the implications of the primary alternative to LHP - a deontological theory of rights - for the alleged obligation(s) to eat certain kinds of meat.
In defence of welfare subjectivism
Subjectivist theories of welfare base individual welfare on particular mental attitudes. Bradley suggests that all such theories generate paradoxical results in cases where the subject has the relevant positive attitude towards their life going badly. One view that apparently circumvents this paradox, suggested by Dorsey, is a view that bases welfare on the individual’s judgments that something is good or bad for them. However, Lin argues that subjectivist views cannot account for infant welfare. This suggests that subjectivists should adopt a far simpler attitude as grounding welfare than in Dorsey's theory.
I argue that subjectivists must respond to these twin worries with a disjunctive theory. Your welfare is determined by judgement subjectivism, unless you cannot make the relevant judgements. Then, your welfare is determined by your desires. I defend this view against objections from Lin, and the charge that it is ad hoc.
The Universe doesn't care - Against the rationalist defence of moral realism (Currently under consideration)
Evolutionary debunking accounts claim that the evolutionary origins of our moral beliefs provide a problem for moral realists because evolutionary explanations of our moral beliefs have more plausibility than realist accounts. A certain kind of response, which I term ‘rationalist’ offers a dual response to evolutionary debunking. First, they offer a supposedly plausible account of how we acquire objective moral knowledge through use of our rationality. Second, they claim that certain moral beliefs are not amenable to evolutionary explanation. I argue that neither of these putative advantages survives further scrutiny. An appeal to ‘rational insight’, although it makes reference to a somewhat familiar faculty, gives no useful explanation of how we come to know moral facts. Moreover, the supposedly problematic moral beliefs are in fact amenable to evolutionary explanation. As such, rationalist accounts are, like other realist accounts, on the wrong side of the balance of justification against evolutionary debunking.
Egalitarianism and healthcare: the time-relative view (Currently under consideration)
Egalitarianism about healthcare need to have something to say about what Dennis McKerlie calls the 'temporal subject': the question of whether egalitarian principles apply solely across lifetimes, or at shorter times too. I outline the importance of this question, and defend a broadly sufficientarian view of 'time-relative' justice with respect to health.
Sufficiency and responsibility in healthcare
According to many people, responsibility should play some role in healthcare entitlements. Applied in a simplistic fashion, this principle seems to lead us to excessively harsh claims, familiar from discussions around 'luck egalitarianism', where people who bear responsibility for their health burdens are abandoned, no matter how serious those burdens are. Several authors have argued that the solution to this problem is a sufficientarian approach, where responsibility applies only if holding you responsible would not leave you below a threshold of health or welfare. This paper extends that project in two directions, firstly by outlining how such a view might use a more limited form of responsibility to decide between people below this threshold and, secondly, by considering the question of whether sufficiency applies across lifetimes, at particular times, or both.
The doctor as appointed fiduciary
According to common wisdom, medicine has moved from the bad old days, where doctors were paternalistic, to the good days where doctors are mere providers of empirical information. The impetus for this move has been an increase in the importance attached to patient autonomy. While patient autonomy is certainly important, I note that autonomy - and the responsibility that comes with it - can also be a burden. I outline a model of the doctor as the patient's 'appointed fiduciary', i.e. as someone charged to make decisions in the patient's best interest. This model is not supposed to replace the current model, but to supplement it. Since patients choose whether to appoint a fiduciary, I argue that it is consistent with respect for patient autonomy.
