Research
I am currently working on issues related to the idea of sufficiency in healthcare decision-making, as part of a Wellcome Research Fellowship on the project 'From best interests to sufficient benefit: The ethics of hard decisions in healthcare". The project aims to bring recent developments in sufficientarian political philosophy to bear on two central questions of health justice: the distribution of resources, and the disagreements over the treatment of critically ill infants and neonates.
My central research focus outside this project is inter-generational justice in health care: this includes thinking about how the passage of time affects our justice-related entitlements, and has in the past included work - including my PhD - on anti-ageing enhancement. You can hear me talk about some of the issues involved as part of KCL's Health & Society podcast series (2016) here. I also have interests in broader issues of justice in healthcare (particularly related to discrimination).
Other than this, my research interests are in:
(1) animal ethics, particularly deontological constraints on our relationships with animals;
(2) professional ethics: my current focus here has been on professional ethics in medicine, but I plan to expand this area of research to other aspects of professional ethics;
(3) autonomy, paternalism and prudence: as with my interest in inter-generational justice, I think about these issues mostly through the lens of the passage of time: how should we think about autonomy and prudential value, for instance, when we can reasonably predict that our minds will change significantly over time?
My central research focus outside this project is inter-generational justice in health care: this includes thinking about how the passage of time affects our justice-related entitlements, and has in the past included work - including my PhD - on anti-ageing enhancement. You can hear me talk about some of the issues involved as part of KCL's Health & Society podcast series (2016) here. I also have interests in broader issues of justice in healthcare (particularly related to discrimination).
Other than this, my research interests are in:
(1) animal ethics, particularly deontological constraints on our relationships with animals;
(2) professional ethics: my current focus here has been on professional ethics in medicine, but I plan to expand this area of research to other aspects of professional ethics;
(3) autonomy, paternalism and prudence: as with my interest in inter-generational justice, I think about these issues mostly through the lens of the passage of time: how should we think about autonomy and prudential value, for instance, when we can reasonably predict that our minds will change significantly over time?
Publications
Edited collections
Forthcoming. B. Davies, G. De Marco, N. Levy and J. Savulescu (eds.) Responsibility and Healthcare. Oxford University Press
Edited collection with chapters on a range of topics related to responsibility and health care, including the responsibilities of institutions, medical professionals and patients.
Book chapters
25. 2022. (with Tom Douglas). Learning to Discriminate: The Perfect Proxy Problem in Artificially Intelligent Criminal Sentencing. In J Roberts, J Ryberg (eds), Principled Sentencing and Artificial Intelligence. OUP.
Machine learning tools used for criminal sentencing can seemingly avoid direct racial discrimination by having race excluded from their training data. However, ML tools might learn associations between other factors and recidivism that form a proxy, perhaps even a perfect proxy, for race; this might be, for instance, because of associations between race and factors such as social deprivation, and further links between social deprivation and recidivism. This chapter explores what this means on several prominent theories of the wrongness of discrimination. One conclusion is that avoiding the wrongness of discrimination is likely not to be as simple a matter as excluding some material from explicit training data.
24. Forthcoming (with Joshua Parker). Physician, heal thyself? Do doctors have a responsibility to practice self-care? In Responsibility and Healthcare (Forthcoming, OUP).
A common response to burnout among medical professionals, especially in the NHS, has been to emphasise strategies of self-care, focusing on what the individual can do to avoid burnout and the impact of burnout on their professional responsibilities. This chapter critiques this individualist and instrumentalist focus, arguing that it is both ethically exploitative, and pragmatically self-defeating.
Journal articles
23. Forthcoming. Healthcare priorities: The 'young' and the 'old'. Cambridge Quarterly of Healthcare Ethics (Open access)
One argument for using age as an allocation criterion in healthcare in fairness: ‘old’ patients have had either more of a relevant good than ‘young’ people, or enough of that good, and so have weaker claims to treatment. This paper first notes that discussions of age-based priority that focus on old and young patients are indeterminate between two claims: that patients classified as old should have a low priority, and that patients classified as young should have high priority. Drawing on work by Christine Overall, it then argues that while equity cannot justify giving ‘old’ patients low priority, there might be limited role for age-based prioritisation in the context of infant and childhood death, since those who die in childhood are always, and uncontroversially, among the worst off.
22. 2022. (with Hazem Zohny and Dominic Wilkinson). Affirmative action in healthcare resource allocation: Vaccines, ventilators and race. Bioethics 36(9): 970-977. (Open access).
Considers arguments for and against Affirmative Action (AA) in the context of two pandemic-related healthcare resources: vaccinations and ventillators, and ways in which an AA in this area - Affirmative Action in healthcare Resource Allocation (AARA) - could be implemented, and considers some challenges for AARA.
21. 2022. The prospects for 'prospect utilitarianism'. Utilitas 34(3): 335-343,
Reply to Hun Chung's article, 'Prospect utilitarianism: A better alternative to sufficientarianism. Chung argues that sufficientarianism faces fatal problems in giving inappropriate answers to 'lifeboat cases', and in failing to respect the axiom of continuity. He proposes a novel view - 'prospect utilitarianism' - which retains sufficientarianism's advantages while avoiding its problems, and which draws support from empirical work. I argue that sufficientarianism has the conceptual resources to avoid Chung's criticisms, and raise problems for prospect utilitarianism, including its supposed empirical support.
Preprint
20. Forthcoming (with Julian Savulescu). Institutional Responsibility is Prior to Personal Responsibility in a Pandemic. The Journal of Value Inquiry (Open access). Institutional responsibility is prior to personal responsibility in a pandemic.
Develops a theory of pandemic responsibility in light of the Covid pandemic, particularly focusing on the decision-making of the UK government, Argues that failures of institutional responsibility constrain, but do not fully eliminate, personal responsibility of individual citizens.
19. 2022 (with Joshua Parker) Doctors as appointed fiduciaries: A supplemental model for medical decision-making Cambridge Quarterly of Healthcare Ethics 31(1): 23-33. (Open access).
Existing models of the doctor-patient relationship either fail to cater well for patients who do not want the responsibility of medical decision-making, or place too much control in doctors' hands as a default. We outline an alternative model, where patients are offered the chance of a formal, but limited, transfer of decision-making responsibility to their doctor.
18. 2022. Responsibility and the recursion problem. Ratio 35(2): 112-122 (Open access)
Debates around using responsibility as an allocation criterion in healthcare tend to focus on one-off decisions, and narrowly on impacts on people's health. But there is a two–way relationship between health and other social goods: deficits in health typically undermine one's abilities to secure advantage in other areas, which in turn often have further negative effects on health. This relationship exacerbates an existing problem for proponents of responsibilisation (the ‘harshness objection’) in ways that standard responses to this objection cannot address. Placing significant conditions on healthcare access because of a person's prior responsibility risks trapping them in, or worsening, negative cycles where poor health and associated lack of opportunity reinforce one another, making further poor yet ultimately responsible choices more likely.
17. 2021. 'Personal Health Surveillance': The use of mHealth in Healthcare Responsibilisation Public Health Ethics 14(3): 268-280. (Open access)
'mHealth' or mobile health technologies allow patients to self-monitor behaviours and outcomes in new ways. Some may see mHealth as offering a solution to problems which plague attempts to hold patients responsible for their own health: fairness of burdens and reliance on self-reporting. After noting that these would only really be solved by unacceptably comprehensive forms of personal health surveillance, I suggest a more plausible model is to use personal health surveillance as a 'last resort' for patients who would otherwise independently qualify for responsibility-based penalties. However, I note that there are still a number of ethical and practical problems that such a policy would need to overcome. The prospects of mHealth enabling a fair, genuinely cost-saving policy of patient responsibility are slim.
16. 2021 (with Julian Savulescu) The Right Not to Know: some steps towards a compromise Ethical Theory and Moral Practice 24(1): 137-150 (Open access).
Opponents and proponents of the 'right not to know' (see paper 12 below) tend to fall into two opposing camps with respect to autonomy. Proponents typically defend a 'liberty' conception, where autonomy involves freedom to act as one wishes; opponents often advocate a 'duty' conception, where autonomy involves the duty to become informed. We suggest that neither position is tenable in its extreme version, and offer some suggestions for compromise. While the two positions remain distinct, this paper tries to point towards a middle ground.
15. 2020 (with Julian Savulescu). From sufficient health to sufficient responsibility. Journal of Bioethical Inquiry 17(3): 423-33. (Open access).
While many sufficientarians see the threshold of sufficiency as marking a point below which responsibility cannot be taken into account, this paper outlines a 'responsibility-sensitive' sufficientarian view for healthcare: responsibility can be taken into account, but only (i) between individuals who are in similar positions with respect to sufficiency, and (ii) when they have shown sufficient responsibility.
14. 2020 (with Joshua Parker). No blame, no gain? From a No Blame culture to a responsibility culture in medicine Journal of Applied Philosophy 37(4): 646-60. (Open access)
Many health systems adopt a 'no blame culture' in response to medical errors, which eschews individual blame in favour of a focus on systems. We argue that the no blame culture fails to distinguish between blame and responsibility, and outline an approach which keeps the positives of (mostly) avoiding blame without ignoring individual responsibility altogether.
This paper was also the subject of an invited post on the blog Justice Everywhere.
13. 2020. Responsibility and the limits of patient choice Bioethics 34(5) 459-66 (Open access).
Discusses how we should determine limits on the choices patients are able to make with respect to their treatment, and considers how we should respond to patients who nonetheless persist with treatments outside this range, or who refuse institutionally accepted forms of care.
12. 2020. The right not to know and the obligation to know (open access). Journal of Medical Ethics 46(5): 300-3 (Open access).
The 'right not to know' is a putative right in healthcare for patients to refuse medically relevant informaiton. I extend an existing argument, based on the burdens placed on others by exercising the right not to know, that suggests that in many cases patients have a moral obligation to know. However, I note that - contrary to the dominant treatment of this issue by Rosamond Rhodes - this does not mean that patients lack a right not to know. Patients can have the right to do what is morally wrong, and it is important to have an institutional protection of patient control over access to information even if some patients will fail moral obligations in exercising this right.
JME Feature Article, commentaries from Benjamin Berkman, Aisha Deslandes, Lisa Dive and Ainsley Newson, and John Harris
(See 'Replies and commentaries' below for my response).
11. 2019 (with Julian Savulescu Solidarity and responsibility in health care Public Health Ethics 12(2): 133-44. (Open access)
Argues that healthcare services founded in solidarity can, in some cases, hold patients substantively responsible.
10. 2019 Bursting bubbles: QALYs and discrimination Utilitas 31(2): 191-202.
Reply to Nick Beckstead and Toby Ord's 'Bubbles under the wallpaper' Beckstead and Ord argue that even if QALYs are discriminatory against people with disabilities, our only alternative is to abandon a more fundamental commitment. I show that the tensions they use to ground this view occur even without a commitment to avoiding disability discrimination.
9. 2018 Health(care) and the temporal subject The Ethics Forum 13(3): 38-64
Defends “momentary sufficientarianism,” as being an important element of healthcare justice: it is a fundamental demand of justice that people are sufficiently well off not across their lives, but at all moments in their lives. Also considers how a pluralist approach, which engages both with people’s lives as a whole and with their states at particular moments, can reconcile the potentially competing claims in healthcare that emerge from these two perspectives.
Preprint
8. 2018 Ageing and terminal illness: Problems for Rawlsian justice Journal of Applied Philosophy 35(4): 775-89
Critical appraisal of two prominent extensions of John Rawls's theory of justice to health care. A strict application of the difference principle in the case of health care leads to extreme conclusions, given the existence of very young patients whose situation cannot be improved. I also show that the prudential calculations on which one of these views - Hugh Lazenby's - relies are not warranted from within the Rawlsian framework. Age and terminal illness are significant problems for any Rawlsian account of health justice.
Preprint
7. 2017 Paternalism and evaluative shift Moral Philosophy and Politics 4(2): 325-47
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. In cases where we can predict that an agent will undergo a significant alteration in their evaluative outlook - an 'evaluative shift' - many otherwise persuasive objections to paternalism lose their force.
Preprint
6. 2017 Enhancement and the conservative bias Philosophy and Technology 30 (3): 339-56
Explores Nicholas Agar’s view that we should avoid 'radical' enhancement in relation to two kinds of radical enhancement: cognitive and anti-ageing. While Agar's worries have some plausibility with respect to radical cognitive enhancement, it is not plausible for radical anti-ageing enhancement.
Preprint
5. 2017 (with Giulia Felappi) Publish or perish Metaphilosophy 48(5): 745-61
Offers a systematic review of the problems involved in reliance on publication numbers in contemporary academic philosophy, and argue that the resulting situation is bad not just for individual philosophers, but for philosophy itself. Suggests potential solutions, including a professional code of conduct for philosophers.
4. 2016 Utilitarianism and animal cruelty De Ethica 3(3). 5-19. (Open access)
Adds further considerations in support of a tension between utilitarianism and concern for animal welfare. Suggests three ways in which utilitarianism comes significantly apart from mainstream concerns with animal welfare. a) It opposes animal cruelty only when it offers an inefficient ratio of pleasure to pain, which is not obviously true of abuses not related to food consumption; b) it faces the problem of the inefficacy of individual decisions; c) the it ignores various pleasures that humans may get from the superior status that a structure supporting exploitation confers.
3. 2016 Fair innings and time-relative claims Bioethics 30(6). 462-8
Greg Bognar offers a prioritarian justification for ‘fair innings’ distributive principles that ration healthcare by age. This article argues 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.
Preprint
Replies and commentaries
2. 2021. Grow the pie, or the resource shuffle? Journal of Medical Ethics 47: 98–99.
Invited commentary on an article by Christian Munthe, Davide Fumagalli and Erik Malmqvist.
1. 2020. The right not to know and the obligation to know, response to commentaries. Journal of Medical Ethics 46(5): 309-310.
Preprint
Forthcoming. B. Davies, G. De Marco, N. Levy and J. Savulescu (eds.) Responsibility and Healthcare. Oxford University Press
Edited collection with chapters on a range of topics related to responsibility and health care, including the responsibilities of institutions, medical professionals and patients.
Book chapters
25. 2022. (with Tom Douglas). Learning to Discriminate: The Perfect Proxy Problem in Artificially Intelligent Criminal Sentencing. In J Roberts, J Ryberg (eds), Principled Sentencing and Artificial Intelligence. OUP.
Machine learning tools used for criminal sentencing can seemingly avoid direct racial discrimination by having race excluded from their training data. However, ML tools might learn associations between other factors and recidivism that form a proxy, perhaps even a perfect proxy, for race; this might be, for instance, because of associations between race and factors such as social deprivation, and further links between social deprivation and recidivism. This chapter explores what this means on several prominent theories of the wrongness of discrimination. One conclusion is that avoiding the wrongness of discrimination is likely not to be as simple a matter as excluding some material from explicit training data.
24. Forthcoming (with Joshua Parker). Physician, heal thyself? Do doctors have a responsibility to practice self-care? In Responsibility and Healthcare (Forthcoming, OUP).
A common response to burnout among medical professionals, especially in the NHS, has been to emphasise strategies of self-care, focusing on what the individual can do to avoid burnout and the impact of burnout on their professional responsibilities. This chapter critiques this individualist and instrumentalist focus, arguing that it is both ethically exploitative, and pragmatically self-defeating.
Journal articles
23. Forthcoming. Healthcare priorities: The 'young' and the 'old'. Cambridge Quarterly of Healthcare Ethics (Open access)
One argument for using age as an allocation criterion in healthcare in fairness: ‘old’ patients have had either more of a relevant good than ‘young’ people, or enough of that good, and so have weaker claims to treatment. This paper first notes that discussions of age-based priority that focus on old and young patients are indeterminate between two claims: that patients classified as old should have a low priority, and that patients classified as young should have high priority. Drawing on work by Christine Overall, it then argues that while equity cannot justify giving ‘old’ patients low priority, there might be limited role for age-based prioritisation in the context of infant and childhood death, since those who die in childhood are always, and uncontroversially, among the worst off.
22. 2022. (with Hazem Zohny and Dominic Wilkinson). Affirmative action in healthcare resource allocation: Vaccines, ventilators and race. Bioethics 36(9): 970-977. (Open access).
Considers arguments for and against Affirmative Action (AA) in the context of two pandemic-related healthcare resources: vaccinations and ventillators, and ways in which an AA in this area - Affirmative Action in healthcare Resource Allocation (AARA) - could be implemented, and considers some challenges for AARA.
21. 2022. The prospects for 'prospect utilitarianism'. Utilitas 34(3): 335-343,
Reply to Hun Chung's article, 'Prospect utilitarianism: A better alternative to sufficientarianism. Chung argues that sufficientarianism faces fatal problems in giving inappropriate answers to 'lifeboat cases', and in failing to respect the axiom of continuity. He proposes a novel view - 'prospect utilitarianism' - which retains sufficientarianism's advantages while avoiding its problems, and which draws support from empirical work. I argue that sufficientarianism has the conceptual resources to avoid Chung's criticisms, and raise problems for prospect utilitarianism, including its supposed empirical support.
Preprint
20. Forthcoming (with Julian Savulescu). Institutional Responsibility is Prior to Personal Responsibility in a Pandemic. The Journal of Value Inquiry (Open access). Institutional responsibility is prior to personal responsibility in a pandemic.
Develops a theory of pandemic responsibility in light of the Covid pandemic, particularly focusing on the decision-making of the UK government, Argues that failures of institutional responsibility constrain, but do not fully eliminate, personal responsibility of individual citizens.
19. 2022 (with Joshua Parker) Doctors as appointed fiduciaries: A supplemental model for medical decision-making Cambridge Quarterly of Healthcare Ethics 31(1): 23-33. (Open access).
Existing models of the doctor-patient relationship either fail to cater well for patients who do not want the responsibility of medical decision-making, or place too much control in doctors' hands as a default. We outline an alternative model, where patients are offered the chance of a formal, but limited, transfer of decision-making responsibility to their doctor.
18. 2022. Responsibility and the recursion problem. Ratio 35(2): 112-122 (Open access)
Debates around using responsibility as an allocation criterion in healthcare tend to focus on one-off decisions, and narrowly on impacts on people's health. But there is a two–way relationship between health and other social goods: deficits in health typically undermine one's abilities to secure advantage in other areas, which in turn often have further negative effects on health. This relationship exacerbates an existing problem for proponents of responsibilisation (the ‘harshness objection’) in ways that standard responses to this objection cannot address. Placing significant conditions on healthcare access because of a person's prior responsibility risks trapping them in, or worsening, negative cycles where poor health and associated lack of opportunity reinforce one another, making further poor yet ultimately responsible choices more likely.
17. 2021. 'Personal Health Surveillance': The use of mHealth in Healthcare Responsibilisation Public Health Ethics 14(3): 268-280. (Open access)
'mHealth' or mobile health technologies allow patients to self-monitor behaviours and outcomes in new ways. Some may see mHealth as offering a solution to problems which plague attempts to hold patients responsible for their own health: fairness of burdens and reliance on self-reporting. After noting that these would only really be solved by unacceptably comprehensive forms of personal health surveillance, I suggest a more plausible model is to use personal health surveillance as a 'last resort' for patients who would otherwise independently qualify for responsibility-based penalties. However, I note that there are still a number of ethical and practical problems that such a policy would need to overcome. The prospects of mHealth enabling a fair, genuinely cost-saving policy of patient responsibility are slim.
16. 2021 (with Julian Savulescu) The Right Not to Know: some steps towards a compromise Ethical Theory and Moral Practice 24(1): 137-150 (Open access).
Opponents and proponents of the 'right not to know' (see paper 12 below) tend to fall into two opposing camps with respect to autonomy. Proponents typically defend a 'liberty' conception, where autonomy involves freedom to act as one wishes; opponents often advocate a 'duty' conception, where autonomy involves the duty to become informed. We suggest that neither position is tenable in its extreme version, and offer some suggestions for compromise. While the two positions remain distinct, this paper tries to point towards a middle ground.
15. 2020 (with Julian Savulescu). From sufficient health to sufficient responsibility. Journal of Bioethical Inquiry 17(3): 423-33. (Open access).
While many sufficientarians see the threshold of sufficiency as marking a point below which responsibility cannot be taken into account, this paper outlines a 'responsibility-sensitive' sufficientarian view for healthcare: responsibility can be taken into account, but only (i) between individuals who are in similar positions with respect to sufficiency, and (ii) when they have shown sufficient responsibility.
14. 2020 (with Joshua Parker). No blame, no gain? From a No Blame culture to a responsibility culture in medicine Journal of Applied Philosophy 37(4): 646-60. (Open access)
Many health systems adopt a 'no blame culture' in response to medical errors, which eschews individual blame in favour of a focus on systems. We argue that the no blame culture fails to distinguish between blame and responsibility, and outline an approach which keeps the positives of (mostly) avoiding blame without ignoring individual responsibility altogether.
This paper was also the subject of an invited post on the blog Justice Everywhere.
13. 2020. Responsibility and the limits of patient choice Bioethics 34(5) 459-66 (Open access).
Discusses how we should determine limits on the choices patients are able to make with respect to their treatment, and considers how we should respond to patients who nonetheless persist with treatments outside this range, or who refuse institutionally accepted forms of care.
12. 2020. The right not to know and the obligation to know (open access). Journal of Medical Ethics 46(5): 300-3 (Open access).
The 'right not to know' is a putative right in healthcare for patients to refuse medically relevant informaiton. I extend an existing argument, based on the burdens placed on others by exercising the right not to know, that suggests that in many cases patients have a moral obligation to know. However, I note that - contrary to the dominant treatment of this issue by Rosamond Rhodes - this does not mean that patients lack a right not to know. Patients can have the right to do what is morally wrong, and it is important to have an institutional protection of patient control over access to information even if some patients will fail moral obligations in exercising this right.
JME Feature Article, commentaries from Benjamin Berkman, Aisha Deslandes, Lisa Dive and Ainsley Newson, and John Harris
(See 'Replies and commentaries' below for my response).
11. 2019 (with Julian Savulescu Solidarity and responsibility in health care Public Health Ethics 12(2): 133-44. (Open access)
Argues that healthcare services founded in solidarity can, in some cases, hold patients substantively responsible.
10. 2019 Bursting bubbles: QALYs and discrimination Utilitas 31(2): 191-202.
Reply to Nick Beckstead and Toby Ord's 'Bubbles under the wallpaper' Beckstead and Ord argue that even if QALYs are discriminatory against people with disabilities, our only alternative is to abandon a more fundamental commitment. I show that the tensions they use to ground this view occur even without a commitment to avoiding disability discrimination.
9. 2018 Health(care) and the temporal subject The Ethics Forum 13(3): 38-64
Defends “momentary sufficientarianism,” as being an important element of healthcare justice: it is a fundamental demand of justice that people are sufficiently well off not across their lives, but at all moments in their lives. Also considers how a pluralist approach, which engages both with people’s lives as a whole and with their states at particular moments, can reconcile the potentially competing claims in healthcare that emerge from these two perspectives.
Preprint
8. 2018 Ageing and terminal illness: Problems for Rawlsian justice Journal of Applied Philosophy 35(4): 775-89
Critical appraisal of two prominent extensions of John Rawls's theory of justice to health care. A strict application of the difference principle in the case of health care leads to extreme conclusions, given the existence of very young patients whose situation cannot be improved. I also show that the prudential calculations on which one of these views - Hugh Lazenby's - relies are not warranted from within the Rawlsian framework. Age and terminal illness are significant problems for any Rawlsian account of health justice.
Preprint
7. 2017 Paternalism and evaluative shift Moral Philosophy and Politics 4(2): 325-47
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. In cases where we can predict that an agent will undergo a significant alteration in their evaluative outlook - an 'evaluative shift' - many otherwise persuasive objections to paternalism lose their force.
Preprint
6. 2017 Enhancement and the conservative bias Philosophy and Technology 30 (3): 339-56
Explores Nicholas Agar’s view that we should avoid 'radical' enhancement in relation to two kinds of radical enhancement: cognitive and anti-ageing. While Agar's worries have some plausibility with respect to radical cognitive enhancement, it is not plausible for radical anti-ageing enhancement.
Preprint
5. 2017 (with Giulia Felappi) Publish or perish Metaphilosophy 48(5): 745-61
Offers a systematic review of the problems involved in reliance on publication numbers in contemporary academic philosophy, and argue that the resulting situation is bad not just for individual philosophers, but for philosophy itself. Suggests potential solutions, including a professional code of conduct for philosophers.
4. 2016 Utilitarianism and animal cruelty De Ethica 3(3). 5-19. (Open access)
Adds further considerations in support of a tension between utilitarianism and concern for animal welfare. Suggests three ways in which utilitarianism comes significantly apart from mainstream concerns with animal welfare. a) It opposes animal cruelty only when it offers an inefficient ratio of pleasure to pain, which is not obviously true of abuses not related to food consumption; b) it faces the problem of the inefficacy of individual decisions; c) the it ignores various pleasures that humans may get from the superior status that a structure supporting exploitation confers.
3. 2016 Fair innings and time-relative claims Bioethics 30(6). 462-8
Greg Bognar offers a prioritarian justification for ‘fair innings’ distributive principles that ration healthcare by age. This article argues 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.
Preprint
Replies and commentaries
2. 2021. Grow the pie, or the resource shuffle? Journal of Medical Ethics 47: 98–99.
Invited commentary on an article by Christian Munthe, Davide Fumagalli and Erik Malmqvist.
1. 2020. The right not to know and the obligation to know, response to commentaries. Journal of Medical Ethics 46(5): 309-310.
Preprint
Other publications
2019 John Rawls and the 'Veil of Ignorance' in (Noah Levin, ed.) Introduction to Ethics: An Open Educational Resource pp.92-97
A short chapter in an open-access textbook on Rawls's use of the 'Veil of Ignorance'.
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.
Book reviews
2020 Thinking Through Utilitarianism by Andrew T. Forcehimes and Luke Semrau. Teaching Philosophy 43(2): 201-4
2015 Justice Between the Young and the Old by Dennis McKerlie. Czech Sociological Review 51(3). 562-5
2019 John Rawls and the 'Veil of Ignorance' in (Noah Levin, ed.) Introduction to Ethics: An Open Educational Resource pp.92-97
A short chapter in an open-access textbook on Rawls's use of the 'Veil of Ignorance'.
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.
Book reviews
2020 Thinking Through Utilitarianism by Andrew T. Forcehimes and Luke Semrau. Teaching Philosophy 43(2): 201-4
2015 Justice Between the Young and the Old by Dennis McKerlie. Czech Sociological Review 51(3). 562-5
Work in progress
- 'Health capital' as a currency of justice (with Thomas Schramme)
- Whether we should always 'treat like cases alike'.
- The role of 'basic needs' in health care.
- The best interests standard in paediatric clinical decision-making
- The ethics of infant feeding recommendations (with Clare Moriarty)
- The attitudes medical professionals should take to ethics guidance (with Josh Parker). Submitted.
- The ethics of ‘intimate examinations’ (with Michael Power and Kevork Hopayian). Submitted
Older drafts with no current home
Comments are very welcome on drafts where these are available.
8. 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.
9. Cows, crickets and clams: On the alleged 'vegan' obligation to eat different kinds of meat 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.
10. 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.
11. The Universe doesn't care: Against the rationalist defence of moral realism
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.
8. 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.
9. Cows, crickets and clams: On the alleged 'vegan' obligation to eat different kinds of meat 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.
10. 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.
11. The Universe doesn't care: Against the rationalist defence of moral realism
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.
