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I discuss the comments from Professor Piotr Lichacz on my book, Setting Health-Care Priorities. What Ethical Theories Tell Us (New York: OUP, 2019). The idea that our reluctance to let go of life and abstain from marginal life extension is irrational is defended against his criticism. The methodology used in the book—urging us to rely in our testing on ethical theories on the content of our considered moral intuitions—is explained at length and the notion of cognitive psychotherapy involved in it is defended.

The article provides answers to comments in this journal on my recent book, Setting Health-Care Priorities. What Ethical Theories Tell Us (Oxford University Press, 2019). Did I address all of the relevant theories? Yes, I did. Was my argument underdeveloped in any respects? Yes, at least in one as I should perhaps have discussed contractual ethical thinking more carefully. I do so in this response. Moreover, the critical comments raised have helped me to clarify my argument in many ways, for which I thank my critics.

All conservatives have something in common, a particular argument, even if they disagree about the rationale behind this argument. The conservative argument can be stated thus: Some orders ought to be maintained because they are existing and well established. The reason given by conservatives why orders that are existing and well established ought to be maintained is varied. Typically, it has to do with pessimism with regard to the human moral nature or human rationality, or it has to do with pessimism with regard to rational argumentation combined with optimism about what has evolved historically speaking. The reasoning, then, is instrumental and pragmatic. However, there are also conservatives who claim that an existing and well-established order, such as a nation, a Volk, a species, or some cherished institution, has final value.

Assume that neuro-doping is safe and efficient. This means that the use of it, and similar future safe methods of enhancement in sport, may help those who are naturally weak to catch up with those who are naturally strong and sometimes even defeat them. The rationale behind anti-doping measures seem to presuppose that this is unfair. But the idea that those who are naturally strong should defeat those who are naturally weak rests on a fascistoid ideology that sport had better leave behind. Neuro-doping may be seen as a means to undermine the fascistoid notion of fairness. The conjecture is that, given that society adopts what will be characterized as a policy of biological egalitarianism, this will happen. Then people will compete in society in general and in sport in particular on more equal biological terms. The fascination with natural strength, and the cheering for the winners, can then go away. Instead we see a liberated sport where we take part in it for the sheer fun of doing so. Neuro-doping, and similar techniques, may be a means that helps to liberate elite sport from its perverse view of fairness.

Total views imply what Derek Parfit has called ‘the repugnant conclusion’. There are several strategies aimed at debunking the intuition that this implication is repugnant. In particular, it goes away when we consider the principle of unrestricted instantiation, according to which any instantiation of the repugnant conclusion must appear repugnant if we should be warranted in relying on it as evidence against total theories. However, there are instantiations of the conclusion where it doesn't seem to be at all repugnant. Hence there is nothing repugnant about the repugnant conclusion as such. The faults with total views have nothing to do with large numbers or with the conclusion as such. It is possible, if you like, to correct these putative faults even if you adopt some total view (different from utilitarianism).

This is a short reply to Professor Reichlin’s comment on my book Setting Health-Care Priorities. What Ethical Theories Tell Us. The version of prioritarianism I rely on in the book is defended as the most plausible one. The general claim that there is convergence between all plausible theories on distributive justice is also defended with regard to assisted reproduction, disability, and enhancement.

The Repugnant Conclusion is an implication of some approaches to population ethics. It states, in Derek Parfit's original formulation, For any possible population of at least ten billion people, all with a very high quality of life, there must be some much larger imaginable population whose existence, if other things are equal, would be better, even though its members have lives that are barely worth living. (Parfit 1984: 388)

(1998). Is Our Admiration for Sports Heroes Fascistoid? Journal of the Philosophy of Sport: Vol. 25, No. 1, pp. 23-34.

From dawn till dusk. Bioethical insights into the beginning and the end of life : Evangelos D. Protopapadakis. Logos: Berlin, 2019

Utilitarianism and prioritarianism are compared. It may seem that only prioritarianism takes suffering seriously enough. Even if utilitarianism is more sensitive to suffering than is the maximin/theory or egalitarianism, it does not take suffering seriously enough. According to prioritarianism, we should help a person in deep distress rather than improving the situation of a very happy person, even if this means some waste of happiness (the person in distress gains fewer hedons that the happy person would do if instead we tended to her needs). The prioritarian needs to tell us exactly how much weight should be given to momentary suffering and happiness, however. They need to specify the relevant function. This has been shown to be a difficult task to undertake. Moreover, according to prioritarianism a life with a net surplus of happiness may be worth not living. Some may give up on prioritarianism because of this implication of the theory. Others may stick to the rationale behind it, bite the bullet, and amend utilitarianism with prioritarianism. Both moves are considered justifiable.

Time has come to apply the theories in the real world. We have seen that in the metaphysical laboratory, where we put them to crucial tests in our thought experiments, the theories conflict. Now time has come to investigate their implications in real life and to tease out their implications for priority-setting in health care. This task has to be accomplished in steps, however. It is important to distinguish between their implications for priority setting under the assumption of strict compliance (with one or another of the theories), and a realistic situation where it is expected that even people who accept one of the theories will, once their turn to carry the costs has come, try and bend the rules in their favour. Here a simplified notion of ideal and nonideal theory will be developed and put to use. And I will start by looking into the implications of the theories under the assumption of strict compliance (ideal theory), only later to turn to the problems associated with noncompliance (nonideal theory). All this prepares room for a discussion about the normative significance of noncompliance to be undertaken later in this book. The question then is whether the fact that noncompliance with the theories is to be expected spells problems for the theories as such. Does it count against their plausibility that people are not prepared to act in accordance with them?

The idea that it is bad for a person when someone else is better off is presented. If taken seriously, this means that one should maximize not the sum total of happiness but a weighed sum where the weights for each person are given with reference to a position in relation to others with regard to happiness. This is egalitarianism. The egalitarian idea presupposes that interpersonal comparisons of happiness are possible and it takes for granted the distinction between persons. Yet, while it acknowledges that compensation within lives is morally unproblematic, and accepts some compensation between lives, the latter kind of compensation comes with a moral price whenever it means that increments fall on those who are better off rather on those who are worse off (comparatively speaking). Since compensation within lives is considered morally acceptable it is maintained that when we assess how badly off a person is, in relation to others, we focus on their entire lives rather than on time-slice of them.

Presented in this chapter is the Rawlsian idea that one should take seriously the distinction between (and integrity of) persons. This distinction between, and integrity of, persons, is the metaphysical rationale behind the normative idea here discussed to the effect that absolute priority should be given to the person who is worst off. This is the maximin idea. Once the needs of those who are worst off have been catered to, we ought to tend to the needs of those who come next in line. This is the leximin idea. In the defence of these normative ideas it is taken for granted that interpersonal comparisons of happiness are possible and that compensation within lives but not between lives is permissible. This idea is contrasted with the utilitarian maxim that we ought to maximize the sum total of happiness. It is argued that the metaphysical rationale behind the maximin/leximin idea is consistent with utilitarianism so the choice between the maximin/leximin and utilitarianism relies in the final analysis on normative, not metaphysical, considerations.

The rationale behind prioritarianism is the idea that suffering has a special moral importance. This means that a person who momentarily suffers has a special moral claim for improvement of her hedonic situation. It is the other way around with happiness. Prioritarianism is seen as a possible amendment to utilitarianism. Since suffering takes place at a definite time, momentary suffering, not suffering within an entire life, is what matters, according to prioritarianism. While the maximin/leximin theory gives absolute priority to those who are worst off prioritarinism presents a more nuanced view. Some special weight is given to an amount of happiness/unhappiness depending on where it falls, on a happy or on a miserable moment. There are many ideas, however, about how to specify the exact weight which should be given to an instant of happiness/unhappiness depending on where it appears on the hedonistic scale. This means that prioritarianism presents us with a family of theories rather than with one theory in particular. They all agree on the claim, however, that what should be maximized is a weighted sum of happiness rather than the sum total of happiness.

Utilitarianism, the maximin/leximin theory, egalitarianism, and prioritarianism all come with, on the face of it, plausible rationales. However, these theories are inconsistent with one another, so they cannot all be true. It is of note, also, that each of them comes with some problematic implications. In particular, according to utilitarianism there are fewer reasons to extend the life of an unhappy person than the life of a happy person. Hence it has been thought to discriminate against disability. On the maximin/leximin theory, on the other hand, those who are worst off may seem to have a morally legitimate claim on all the good things in life (they become what is here nicknamed as ‘utility thieves’). Egalitarianism implies that levelling down to a situation where everyone is on the same low level of happiness means, at least in one respect, an improvement. Moreover, egalitarianism is insensitive in relation to momentary suffering. Prioritarianism does take suffering seriously, but apart from this it shares the standard problems with utilitarianism, which is only to be expected, since it is here seen as a mere amendment to utilitarianism.

The three most promising theories of distributive justice are discussed in the context of population ethics. They all allow for what has been called the repugnant conclusion (i.e. the conclusion that some world, the Z-world, with an enormous population of persons living a life just worth living, is preferable to a world with ten billion extremely happy persons (the A-world). Utilitarianism implies the repugnant conclusion. It urges us to move from the A-world to the Z-world. It is different with the maximin/leximin theory and egalitarianism. They are person-affecting moralities. They refer to actual persons. These theories do not urge us to move to from the A-world to the Z-world but they allow for such a move. Does this spell problem for the theories? It does not, it is argued. The repugnant conclusion is after all acceptable. It is shown how the intuition that the Z world is worse than the A world tends to go away when submitted to cognitive psycho-therapy. It is typically not replaced by an intuition to the opposite effect, but there exists a sound argument to the effect that the Z-world is indeed better than the A-world.

In situations of mass casualty there is a need to tend to the medical supply side. We must contemplate whether, by saving one person rather than another, we affect the medical resources available to us. Should medical personnel be tended to first if this means that those who are saved first can go on to save other lives? When resources are scare, should younger patients be treated rather than old ones? The unexpectedly similar implications of the three theories of distributive justice in situations of mass casualty are presented. Here a discussion is also undertaken about equity and the idea that we should save as many lives as possible. Does it make sense to flip a coin when you decide about priority setting in a triage situation? Could saving as many lives as possible work as a proxy for utilitarian thinking? Both the equity view and the idea that one should save as many lives as possible are rejected. It is argued that we should rely on our favoured theories: utilitarianism (with or without a prioritarian amendment), the maximin/leximin theory, and egalitarianism.

Even if according to all plausible theories of distributive justice, spending more on the care and cure of patients suffering from mental illness should be a priority rather than on marginal life extension, this will not happen. The reason has to do with fear of death and human irrationality. Does the fact that we will not abide by any one of the theories, even if we are convinced that it is true, mean that there is something wrong with it? Does our reluctance to act on the theories mean that they must be false? I think not. Here I avail myself in my argument of moral realism. If there is a truth in the matter, there is no reason to believe that the correct moral theory must be such that we abide by it, once we accept it (theoretically speaking) as true. This means that our unwillingness to live according to the theories does not show that they are unreasonable. The problem lies not with the theories themselves but rather with our unwillingness to abide by them. We are to blame, not abstract moral theory.

Three theories of distributive justice are introduced: the maximin/leximin theory, egalitarianism, and utilitarianism (with or without a prioritarian amendment). A methodology for assessing their plausibility is adumbrated: applied ethics turned upside down. This means arranging with crucial thought experiments where we reach conflicting verdicts from the theories. We confront the verdicts with the content of our considered intuitions. Roughly speaking, an intuition is taken to be ‘considered’ if it has survived cognitive psychotherapy, where we have learnt all we can about its causal origin. The theory that provides the best explanation of the content of our considered intuition gains support from the experiment. A nice aspect of thought experiments, it is noted, is that we are all capable of repeating them for ourselves.

There exist existential global problems we cannot solve unless we resort to a world government. It is desirable that such a government can be held responsible by a democratically elected world parliament. Hence, global democracy is desirable. However, the road to global democracy is blocked by similar problems that render it necessary in the first place: collective decision problems of a different but related sort. And time is short. In particular we face an emergent need to tend to problems to do with global warming. This means that we have to investigate the possibility and desirability of a last resort to global despotism.

The COVID-19 pandemic has engendered unprecedented drastic and costly measures to obviate the threat. Will something similar happen in relation to global heating? No, this is not likely. Mainly this has to do with a difference in the nature of collective action. Nation states protect their respective populations against the virus. With regard to global heating, we are facing the tragedy of the commons. No global government assumes responsibility for our common future. However, there may be another and further explanation lurking behind political inaction: many people, including our politicians, think that it does not matter if humanity goes extinct. It does matter, however. Strangely enough, the view that it matters is questioned by many important philosophers in the past and in the present, and it is hence controversial. Yet, it should be our common-sense stance to the problem. It is of the utmost importance that there will be sentient happy life on the globe for an indefinite time. Theoretically speaking, in order to recognize this, we need to accept some “total” view, implying what has been called the repugnant conclusion. Practically speaking, we should go to great length to rescue our human civilisation, even if this means that, for a while, we must endure all sorts of hardships such as a global enlightened despotism, or worse—a situation of life boat ethics.

The notion of moral exchangeability is scrutinized and its proper place in neonatal care is examined. On influential moral outlooks, the neonate is morally exchangeable. On these views, if the parents are prepared to let go of the neonate with a poor prognosis and opt instead for another child who is healthy, this may be the morally right thing for them to do, and neonatal care ought to ease their choice. The notion of moral exchangeability has a different place in different moral theories. Three theories are examined: deontological ethics (insisting on the sanctity of innocent human life), according to which there is no place for the replacement of 1 child for another. It is different, however, with utilitarianism and in the moral rights theory based on self-ownership. According to utilitarianism, we are all replaceable. According to the moral rights theory, neonates are replaceable to the extent that they have not developed personhood. Even a deontological ethicist of a Kantian bent would concur here with the moral rights theory. Because influential moral theories imply that the neonate is morally exchangeable, it is reasonable within neonatal care, as a general rule, to grant the parents a veto against any attempts to save a child with a poor prognosis. In particular, if the parents are prepared instead to have another, healthy child, this is to be recommended. However, this rule cannot be strict. In rare cases, it is necessary to yield to parents who insist that their neonate be saved despite a poor prognosis.

A simple hedonistic theory allowing for interpersonal comparisons of happiness is taken for granted in this article. The hedonistic theory is used to compare utilitarianism, urging us to maximize the sum total of happiness, with prioritarianism, urging us to maximize a sum total of weighed happiness. It is argued with reference to a few thought experiments that utilitarianism is, intuitively speaking, more plausible than prioritarianism. The problem with prioritarianism surfaces when prudence and morality come apart.

A member of Jehovah’s Witnesses agreed to receive blood when alone, but rejected it once the elders were present. She insisted that the elders should stay, they were allowed to do so, and she bled ...

Many moral theories incorporate the idea that when an action is wrong, it is wrong because there was something else that the agent could and should have done instead. Most notable among these are consequentialist theories. Relatively little attention has been given to the question of how to understand the meaning of 'could have' in this specific context. However, without an answer to this question, consequentialist theories fail to yield determinate verdicts about the deontic status of actions in real scenarios. It is here argued that a conditional analysis provides the required answer and gives us the most plausible version of consequentialism. Such a conditional analysis has been universally rejected as an analysis of the general meaning of 'could have,' but we show that in the specific context of specifying the meaning of 'could have' in a criterion of right and wrong action, all the stan­dard objections to it fail.

If there is such a thing as objectively existing prescriptivity, as the moral realist claims, then we can also explain why — and we need not deny that — strong (conceptual) internalism is true. Strong conceptual internalism is true, not because of any belief in any magnetic force thought to be inherent in moral properties themselves, as Mackie argued, but because we do not allow that anyone has (in the practical sense) ‘accepted’ a normative claim, unless she is prepared to some extent to act on it (to see to it that it is satisfied).

Aims The aim of this study was to examine if it is plausible to interpret the appearance of shame in a Swedish healthcare setting as a reaction to having one9s honour wronged. Methods Using a questionnaire, we studied answers from a sample of long-term sick-listed patients who had experienced negative encounters (n=1628) and of these 64% also felt wronged. We used feeling wronged to examine emotional reactions such as feeling ashamed and made the assumption that feeling shame could be associated with having one9s honour wronged. In statistical analyses relative risks (RRs) were computed, adjusting for age, sex, disease-labelling, educational levels, as well as their 95% CI. Results Approximately half of those who had been wronged stated that they also felt shame and of those who felt shame, 93% (CI 91 to 95) felt that they had been wronged. The RR was 4.5 (CI 3.0 to 6.8) for shame when wronged. This can be compared with the other emotional reactions where the RRs were between 1.1 (CI 0.9 to 1.3)–1.4 (CI 1.2 to 1.7). We found no association between country of birth and feeling shame after having experienced negative encounters. Conclusions We found that the RR of feeling shame when wronged was significantly higher compared with other feelings. Along with theoretical considerations, and the specific types of negative encounters associated with shame, the results indicate that our research hypothesis might be plausible. We think that the results deserve to be used as point of departure for future research.

A set of moral problems known as The Trolley Dilemmas was presented to 3000 randomly selected inhabitants of the USA, Russia and China. It is shown that Chinese are significantly less prone to supp ...

According to estimates more than 400 biobanks currently operate across Europe. The term 'biobank' indicates a specific field of genetic study that has quietly developed without any significant critical reflection across European societies. Although scientists now routinely use this phrase, the wider public is still confused when the word 'bank' is being connected with the collection of their biological samples. There is a striking lack of knowledge of this field. In the recent Eurobarometer survey it was demonstrated that even in 2010 two-thirds of the respondents had never even heard about biobanks. The term gives the impression that a systematic collection of biological samples can constitute a 'bank' of considerable financial worth, where the biological samples, which are insignificant in isolation but are valuable as a collection, can be preserved, analysed and put to 'profitable use'. By studying the practices of the numerous already existing biobanks, the authors address the following questions: to what extent does the term 'biobank' reflect the normative concept of using biological samples for the purposes of biomedical research? Furthermore, is it in harmony with the so far agreed legal-ethical consensus in Europe or does it deliberately pull science to the territory of a new, ambiguous commercial field? In other words, do biobanks constitute a medico-legal fiction or are they substantively different from other biomedical research protocols on human tissues?

Given a reasonable coherentist view of justification in ethics, applied ethics, as here conceived of, cannot only guide us, in our practical decisions, but also provide moral understanding through explanation of our moral obligations. Furthermore, applied ethics can contribute to the growth of knowledge in ethics as such. We put moral hypotheses to crucial test in individual cases. This claim is defended against the challenges from moral intuitionism and particularism.

Why should we respect the privacy of donors of biological material? The question is answered in the present article in general philosophical terms from the point of view of an ethics of honour, a libertarian theory of rights, a view of respect for privacy based on the idea that autonomy is of value in itself, and utilitarianism respectively. For different reasons the ethics of honour and the idea of the value of autonomy are set to one side. It surfaces that the moral rights theory and utilitarianism present conflicting answers to the question. The main thrust of the argument is that there is no way of finding an overlapping consensus, so politicians have to take decisions that are bound to be controversial in that they can be questioned on reasonable philosophical grounds. TissEU. Tiss.EU stands for ‘Evaluation of Legislation and Related Guidelines on the Procurement, Storage and Transfer of Human Tissues and Cells in the European Union—an Evidence- Based Impact Analysis.’ The project has been funded by the European Commission as part of the 7th Framework Programme

Ought we to enhance our cognitive capacities beyond the normal human range? There is no denying that it might be a good idea to level out differences between people with respect to cognitive capacities, and there is no denying that some persons' reaching beyond normal capacities may have some good side-effects on society at large (but also bad side-effects, of course). But is there any direct gain to be made by having ones cognitive capacities enhanced? Will this as such make our lives go better? No, I argue, or, at least, there doesn't seem to exist any evidence suggesting that it would. And it doesn't matter whether we consider the question from a narrow hedonistic perspective, from a more refined hedonistic perspective, from a desire-satisfaction view, or if we adopt some reasonable objective list view of what makes a life go well. Only on an extremely perfectionist — and implausible —view of what makes our lives go well could any direct value in cognitive enhancement find support. Finally, there are no good reasons to do with our sense of identity to enhance even our capacity to remember. So, cognitive enhancement as such would not make our lives go any better.

Church, A. 2009. Referee reports on Fitch's 'A definition of value'. In New Essays on the Knowability Paradox, ed. J. Salerno, 13-20. Oxford: Oxford University Press. Dummett, M. 1975. Wang's paradox. Synthese 30: 301-4. Dummett, M. 1978. Truth and Other Enigmas. London: Duckworth. Dummett, M. 1994. Reply to Prawitz. In The Philosophy of Michael Dummett, eds. D. Prawitz and G. Olivieri, 292-99. Dordrecht: Kluwer. Dummett, M. 2001. Victor's error. Analysis 61: 1-2. Dummett, M. 2007. Reply to Wolfgang Kiinne. In The Philosophy of Michael Dummett, eds. R.E. Auxier and L.E. Hahn, 345-50. Chicago: Open Court. Edgington, D. 1985. The paradox of knowability. Mind 94: 557-68. Fitch, F. 1963. A logical analysis of some value concepts. Journal of Philosophical Logic 28: 135-42.

There exists a derived negative right to procreative freedom, including a right to in vitro fertilisation (IVF) and to the exercise of selective techniques such as preimplantation genetic diagnosis. This is an extensive freedom, including not only the right to the exercise of a responsible parenthood, but also, in rare cases, to wrong decisions. It includes also a right for less than perfect parents to the use of IVF, and for IVF doctors to assist them, if they want and can agree about the terms.

Peter Unger, Living High and Letting Die. Our Illusion of Innocence (Oxford and New York Oxford University Press, 1996

The expressivist theory of truth (TETT) is stated and defended. According to TETT, to state such things as that it is true that snow is white is to express one's assent to the proposition that snow is white. In contexts where we refer to propositions with the aid of definite descriptions (“What Peter said”) or quantify over them (“Everything Peter says”), in order to say that they are “true”, the word “true” is essential, however. But it does not stand for any genuine property. According to TETT, as here understood, it expresses our readiness or willingness to assent to these propositions. It is argued that TETT, even if still more of a reseach program than a full-fledged theory, means an improvement over more elaborate minimalist theories of truth put forward by Crispin Wright and Paul Horwich.

The repugnant conclusion is acceptable from the point of view of total utilitarianism. Total utilitarians do not seem to be bothered with it. They feel that it is in no way repugnant. To me, a hard-nosed total utilitarian, this settles the case. However, if, sometimes, I doubt that total utilitarianism has the final say in ethics, and tend to think that there may be something to some objection to it or another, it is the objection to it brought forward from egalitarian thought that first comes to mind. But if my argument in this article is correct, then it is clear that the repugnant conclusion should be equally acceptable to egalitarians of various different bents as it is to total utilitarians.

In morality, as in science, we seek understanding through explanation. While old fashioned non-naturalistic moral realism renders such explanation available to us, neither moral irrealism nor moral naturalism does. This does not prove any of these theories wrong, of course. It does indicate, however, that, if we feel that we have to resort to them, there is a high intellectual price to be paid.