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A notorious problem that has recently received increased attention in axiology, normative theory and population ethics is the apparent ubiquity of what can be generally called nondeterminacy. This paper illustrates how nondeterminacy can spawn cyclical rankings. So, accepting that practical reasons can admit of nondeterminacy challenges the widely held idea that ‘better than’ is transitive. As a r
This article shows that introducing the positive comparative relation parity only helps one block so-called “Spectrum Arguments” in order to avoid their unsavoury implications if one specifies parity in a specific way with respect to its persistence. The article illustrates how parity must both admit of persistency and be weakly non-persistent for parity to block Spectrum Arguments, and identifies
This paper introduces a condition for rational choice that states that accepting decision methods and normative theories that sometimes entail that the act of choosing a maximal alternative renders this alternative non-maximal is irrational. The paper illustrates how certain distributive theories that ascribe importance to what the status quo is violate this condition and argues that they thereby
This paper argues that decision problems and money-pump arguments should not be a deciding factor against accepting non-transitive better than relations. If the reasons to accept normative standpoints that entail a non-transitive better than relation are compelling enough, we ought to revise our decision method rather than the normative standpoints. The paper introduces the most common argument in
This article analyzes approaches to nondeterminacy (e.g., incommensurability, indeterminacy, parity) that suggest that one can make justified choices when primary criteria fail to fully determine a best alternative by introducing a secondary criterion. It is shown that these approaches (in the article called “two-step models”) risk violating Basic Contraction Consistency. Some ways of adjusting tw
How should states and international organizations allocate global health resources? This paper examines proposals for distributing these resources in the literature. First, we look at the literature on the metrics for measuring what matters and consider how they might be modified to avoid some common objections—e.g., that these measures discriminate against the disabled or fail to give due weight
In this paper, I argue that sufficientarian principles are indispensable in the set of principles that have bearing on issues in distributive ethics. I provide two arguments in favor of this claim. First, I argue that sufficientarianism is the only framework that allows us to appropriately analyze what sort of obligations we have toward individuals who are badly off due to their own faults and cho
This present contribution presents an approach to making rational choices in face of cluelessness, focusing on effective altruism. I begin by illustrating how effective altruism faces the challenge of cluelessness, which implies a particular kind of incompleteness I call practical incompleteness. I then argue that this is not a reason for proponents of effective altruists to become skeptics, but r
It is a common view that benefits to the worse off should be given priority when health benefits are distributed. This paper addresses how to understand who is worse off in this context when individuals are differently well off at different times. The paper argues that the view that this judgment about who is worse off should be based solely on how well off individuals are when their complete live
This article argues that values that apply to health care allocation entail the possibility of “spectrum arguments,” and that it is plausible that they often fail to determine a best alternative. In order to deal with this problem, a two-step process is suggested. First, we should identify the Strongly Uncovered Set that excludes all alternatives that are worse than some alternatives and not bette
Lifetime quality-adjusted life-year (QALY) prioritarianism has recently been defended as a reasonable specification of the prioritarian view that benefits to the worse off should be given priority in health-related priority setting. This paper argues against this view with reference to how it relies on implausible assumptions. By referring to lifetime QALY as the basis for judgments about who is w
This article addresses the prioritization questions that arise when people attempt to institutionalize reasonable ethical principles and create guidelines for microlevel decisions. I propose that this instantiates an incommensurability problem, and suggest two different kinds of practical solutions for dealing with this issue.
Background: High-dose haemodiafiltration has been shown, in a randomised clinical trial, to result in a 23% lower risk of mortality for patients with kidney failure when compared with conventional high-flux haemodialysis. Nevertheless, whether treatment effects differ across subgroups, whether a dose–response relationship with convection volume exists, and the effects on cause-specific mortality r
This article provides a new argument and a new value-theoretical ground for person-centered care and shared decision making that ascribes to it the role of enabling rational choice in situations involving clinical choice. Rather than referring to good health outcomes and/or ethical grounds such as patient autonomy, it argues that a plausible justification and ground for person-centered care and sh
Recent research indicates that there is a gap in life expectancy between the rich and the poor. This raises the question: should we on egalitarian grounds use income-based equity weights when we assess benefits of alternative benevolent interventions, so that health benefits to the poor count for more? This article provides three egalitarian arguments for using income-based equity weights under ce
Normative criteria for evaluations of economic and social outcomes are often formulated in terms of social welfare functions which are essentially and importantly non-satiable. However, there are good reasons to consider certain normative criteria and many policy objectives to be capped, i.e. bounded, and thus satiable provided sufficient resources are made available for their satisfaction. Inspir
The principle of need—the idea that resources should be allocated according to need—is often invoked in priority setting in the health care sector. In this article, I argue that a reasonable principle of need must be indeterminate, and examine three different ways that this can be dealt with: appendicizing the principle with further principles, imposing determinacy, or empowering decision makers.
A notorious debate in the ethics of healthcare rationing concerns whether to address rationing decisions with substantial principles or with a procedural approach. One major argument in favour of procedural approaches is that substantial principles are indeterminate so that we can reasonably disagree about how to apply them. To deal with indeterminacy, we need a just decision process. In this pape
This article argues that standard models of person-centred care (PCC) and shared decision making (SDM)rely on simplistic, often unrealistic assumptions of patient capacities that entail that PCC/SDM mighthave detrimental effects in many applications. We suggest a complementary PCC/SDM approach toensure that patients are able to execute rational decisions taken jointly with care professionals whenp
Much research aimed at developing measures for normative criteria to guide the assessment of healthcare resource allocation decisions has focused on health maximization, equity concerns and more recently approaches based on health capabilities. However, a widely embraced idea is that health resources should be allocated to meet health needs. Little attention has been given to the principle of need
