Many economic measures are structured to reflect ethical values. I describe three attitudes towards this: maximalism, according to which we should aim to build all relevant values into measures; minimalism, according to which we should aim to keep values out of measures; and an intermediate view. I argue the intermediate view is likely correct, but existing versions are inadequate. In particular, economists have strong reason to structure measures to reflect fixed, as opposed to user-assessable, values. I conclude by arguing that, despite disagreement about how to do so, economists should standardly adjust QALYs and DALYs to reflect egalitarian values.
Wellbeing, Opportunity, and Selecting for Disability. Forthcoming in the Journal of Ethics and Social Philosophy.
In this paper I look at the much-discussed case of disabled parents seeking to conceive (or "selecting for") disabled children. I argue that the permissibility of selecting for disability does not depend on the precise impact the disability will have on the child's wellbeing, as most assume, but rather on the impact that disability will have on the child's future opportunities. Nearly all bioethicists who have approached the issue in this way have argued that disabilities like deafness unacceptably constrain a child's opportunities. I argue, however, that this conclusion is premature for several reasons. Most importantly, we don't have a good way of comparing opportunity sets. I conclude by suggesting that bioethicists and philosophers of disability need to more carefully consider the relationship between disability and opportunity.
Is consistency overrated? Journal of Medical Ethics 44(3), 2018.
Solberg, Norheim, and Barra have recently argued that there is a serious problem with the way disability-adjusted life years (DALYs) are calculated. Morbidity is measured in YLDs in a way quite unlike the way mortality is measured in YLLs. This potentially renders them incommensurable, like apples and oranges, and makes their aggregate - DALYs - conceptually unsound. I argue, however, that DALYs are best interpreted as an index (rather than as a measure), and that it can be perfectly reasonable to add apples to oranges in an index. That said, there can be instrumental reasons to prefer that an index/measure stick to commensurable quantities. I conclude by identifying some of these, and note how tehy have influenced the construction of the DALY.
Using Democratic Values in Science: an Objection and (Partial) Response. Philosophy of Science 84(5), 2017. (uncorrected draft).
Many philosophers of science have argued that social and ethical values have a significant role to play in core parts of the scientific process. A question that naturally arises is: when such value choices need to be made, which or whose values should be used? A common answer to this question turns to political values -- i.e., the values of the public or its representatives. In this paper, I argue that this imposes a morally significant burden on some scientists, effectively requiring them to advocate for policy positions they strongly disagree with. I conclude by discussing under what conditions this burden might be justified.
Consequentializing and Its Consequences. Philosophical Studies 174(6), 2017. (uncorrected draft)
Recently, a number of philosophers have argued that we can and should "consequentialize" non-consequentialist moral theories, putting them into a consequentialist framework. I argue that these philosophers, often treated as a group, in fact offer three separate arguments, two of which are incompatible. I show that none represent significant threats to a committed non-consequentialist, and that the literature has suffered due to a failure to distinguish these arguments. I conclude by showing that the failure of the consequentializers' arguments has implications for disciplines, such as economics, logic, decision theory, and linguistics, which sometimes use a consequentialist structure to represent non-consequentialist ethical theories.
The public vs. private value of health, and their relationship. Journal of Economic Methodology 24(3), 2017. (uncorrected draft)
A review of Daniel Hausman's recent book, Valuing Health: Well-Being, Freedom, and Suffering. I outline the book's content, and then suggest that, if Hausman's argument is correct, the consequences for work in health measurement are more significant than the book describes.
Value Choices in Summary Measures of Population Health. Public Health Ethics 10(2), 2017. (free access via link)
Summary measures of health, such as the QALY and DALY, have long been known to incorporate a number of value choices. In this paper, though, I show that the value choices in the construction of such measures extend far beyond what is generally recognized. In showing this, I hope both to improve the understanding of those measures by epidemiologists, health economists, and policy-makers, and also to contribute to the general debate about the extent to which such measures should be adjusted to reflect ethical values.
Health, Disability, and Well-Being. In The Routledge Handbook of Philosophy of Well-Being (ed. Fletcher), 2016. (uncorrected draft)
Much academic work (in philosophy, economics, law, etc.), as well as common sense, assumes that ill health reduces well-being. It is bad for a person to become sick, injured, disabled, etc. Empirical research, however, shows that people living with health problems report surprisingly high levels of well-being - in some cases as high as the self-reported well-being of healthy people. In this chapter, I explore the relationship between health and well-being. I argue that although we have good reason to believe that health problems causing pain and death typically do reduce well-being, health problems that limit capabilities probably don't reduce well-being nearly as much as most people suppose. I then briefly explore the consequences of this conclusion for political philosophy and ethics. If many health problems don't significantly reduce well-being, why should governments go to great expense to prevent or treat them? Why should parents be obliged to ensure the health of their children?
Basic Ethical Principles. In Case Files: Ethics and Professionalism (ed. Cochrane, Toy, and Raines), McGraw-Hill, 2015.
In this chapter, the first case in a medical ethics textbook, I introduce a number of core ethical ideas through a case study.
Imperfect Duties as Group Obligations. Journal of Moral Philosophy 11(5), 2014. (uncorrected draft)
There is virtually no philosophical consensus on what, exactly, imperfect duties are. In this paper, I lay out three criteria which I argue any adequate account of imperfect duties should satisfy. Using beneficence as a leading example, I suggest that existing accounts of imperfect duties will have trouble meeting those criteria. I then propose a new approach: thinking of imperfect duties as duties held by groups, rather than individuals. I show, again using the example of beneficence, that this proposal can satisfy the three criteria, explaining how something can both have the necessity characteristic of duty, while also allowing agents the latitude which seems to attach to imperfect duties.
Rethinking Health: Healthy or Healthier Than? British Journal for Philosophy of Science 64(1), 2013. (uncorrected draft)
Some gradable concepts are more naturally analyzed in terms of their comparative form. Taller than, for example, seems more basic than tall, since we can define the latter in terms of the former: to be tall is to be taller than a sufficient number of objects in some comparison class. For other concepts it's the reverse: straight is plausibly more basic than straighter than, since we can formulate the idea of perfect straightness, which is then the basis for assessing relative straightness. Without argument, theorists of health have assumed that (or at least acted as if) health should be put in the latter category. I argue, though, that there is good reason to think that it should be grouped with the former: healthier than is more basic than healthy. I show that this apparently minor shift in focus has important consequences for debates in the philosophy of medicine, bioethics, and for the measurement of health.
Incidence, Prevalence, and Hybrid Approaches to Calculating DALYs. Population Health Metrics 10(19), 2012. (open access)
When disability-adjusted life years (DALYs) are used to measure the burden of disease on a population in a time interval, they can be calculated in several different ways: from an incidence, pure prevalence, or hybrid perspective. I show that these calculation methods are not equivalent and discuss some of the formal difficulties each method faces. I show that if we don't discount the value of future health, there is a sense in which the choice of calculation method is a mere question of accounting. Such questions can be important, but they don't raise deep theoretical concerns. If we do discount, however, choice of calculation method can change the relative burden attributed to different conditions over time. I conclude by recommending that studies involving disability-adjusted life years be explicit in noting what calculation method is being employed and in explaining why that calculation method has been chosen.
You Don't Have to Do What's Best! (A problem for consequentialists and other teleologists). Oxford Studies in Normative Ethics, vol. 1, ed. Mark Timmons, Oxford University Press, 2011. (uncorrected draft)
Define teleology as the view that requirements hold in virtue of facts about value or goodness. Teleological views are quite popular, and in fact some philosophers (e.g. Dreier, Smith) argue that all (plausible) moral theories can be understood teleologically. I argue, however, that certain well-known cases show that the teleologist must at minimum assume that there are certain facts that an agent ought to know, and that this means that requirements can't, in general, hold in virtue of facts about value or goodness. I then show that even if we grant those 'ought's teleology still runs into problems. A positive justification of teleology looks like it will require an argument of this form: O(X); if X, then O(Y); therefore O(Y). But this form of argument isn't in general valid. I conclude by offering two positive suggestions for those attracted to a teleological outlook.
Works in Progress
Drafts of some of these papers may be available. Please contact me if you'd like to see one. Also, see my C.V. for a list of recent presentations.
Ethical Dimensions of the Global Burden of Disease (with CJL Murray)
Communicating Complex Scientific Results to Policy-Makers
A Better Foundation for Public Trust in Science
A Disability-Positive Interpretation of QALYs
A short monograph on disability, opportunity, and wellbeing