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
Peer-reviewed publications
12. Forthcoming. The right not to know and the obligation to know. Journal of Medical Ethics.
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.
11. Forthcoming (with Joshua Parker) Doctors as appointed fiduciaries: A supplemental model for medical decision-making. Cambridge Quarterly of Healthcare Ethics
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.
10. Forthcoming. Responsibility and the limits of patient choice Bioethics (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.
9. 2019 (With Julian Savulescu Solidarity and responsibility in health care Public Health Ethics 12(2): 133-144. (Open access)
Argues that healthcare services founded in solidarity can, in some cases, hold patients substantively responsible.
8. 2019 Bursting bubbles: QALYs and discrimination Utilitas 31(2): 191-20
A response 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.
Preprint
7. 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
6. 2018 Ageing and terminal illness: Problems for Rawlsian justice Journal of Applied Philosophy 35(4): 775-789
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
5. 2017 Paternalism and evaluative shift Moral Philosophy and Politics 4(2): 325-347
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
4. 2017 Enhancement and the conservative bias Philosophy and Technology 30 (3): 339-356
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
3. 2017 (With Giulia Felappi) Publish or perish Metaphilosophy 48(5): 745-761
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.
2. 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.
1. 2016 Fair innings and time-relative claims Bioethics 30(6). 462-468
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
12. Forthcoming. The right not to know and the obligation to know. Journal of Medical Ethics.
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.
11. Forthcoming (with Joshua Parker) Doctors as appointed fiduciaries: A supplemental model for medical decision-making. Cambridge Quarterly of Healthcare Ethics
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.
10. Forthcoming. Responsibility and the limits of patient choice Bioethics (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.
9. 2019 (With Julian Savulescu Solidarity and responsibility in health care Public Health Ethics 12(2): 133-144. (Open access)
Argues that healthcare services founded in solidarity can, in some cases, hold patients substantively responsible.
8. 2019 Bursting bubbles: QALYs and discrimination Utilitas 31(2): 191-20
A response 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.
Preprint
7. 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
6. 2018 Ageing and terminal illness: Problems for Rawlsian justice Journal of Applied Philosophy 35(4): 775-789
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
5. 2017 Paternalism and evaluative shift Moral Philosophy and Politics 4(2): 325-347
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
4. 2017 Enhancement and the conservative bias Philosophy and Technology 30 (3): 339-356
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
3. 2017 (With Giulia Felappi) Publish or perish Metaphilosophy 48(5): 745-761
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.
2. 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.
1. 2016 Fair innings and time-relative claims Bioethics 30(6). 462-468
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
Other publications
2019 John Rawls and the 'Veil of Ignorance' in (Noah Levin, ed.) Introduction to Ethics: An Open Educational Resource pp92-97
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
2015 Review of Dennis McKerlie's Justice Between the Young and the Old. Czech Sociological Review 51(3). 562-565
2019 John Rawls and the 'Veil of Ignorance' in (Noah Levin, ed.) Introduction to Ethics: An Open Educational Resource pp92-97
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
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.
Rights of refusal in healthcare - The challenge from responsibilisation
Patients are usually thought to have at least two 'rights of refusal': the right to refuse medically optimal treatment (including the right to refuse treatment altogether) and the right to refuse medically relevant information. I suggest the free enjoyment of these rights is often in conflict with the widespread belief, that those who are responsible for their poor health can (sometimes) legitimately be penalised, e.g. by lower priority treatment. This tension can be resolved in one of three ways. First, rights of refusal might be removed or severely circumscribed in scope. Second, rights of refusal might be made more burdensome by allowing those who exercise them to be penalised. Third, responsibility might have to have a much weaker influence to allow full, unburdened exercise of refusal rights.
From sufficient health to sufficient responsibility
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 considers some further questions that sufficientarians must answer to offer a complete view of how we should approach responsibility.
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
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
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.
Rights of refusal in healthcare - The challenge from responsibilisation
Patients are usually thought to have at least two 'rights of refusal': the right to refuse medically optimal treatment (including the right to refuse treatment altogether) and the right to refuse medically relevant information. I suggest the free enjoyment of these rights is often in conflict with the widespread belief, that those who are responsible for their poor health can (sometimes) legitimately be penalised, e.g. by lower priority treatment. This tension can be resolved in one of three ways. First, rights of refusal might be removed or severely circumscribed in scope. Second, rights of refusal might be made more burdensome by allowing those who exercise them to be penalised. Third, responsibility might have to have a much weaker influence to allow full, unburdened exercise of refusal rights.
From sufficient health to sufficient responsibility
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 considers some further questions that sufficientarians must answer to offer a complete view of how we should approach responsibility.
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
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
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.
