Pub Date : 2019-08-29DOI: 10.1093/OSO/9780190946883.003.0010
T. Tännsjö
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.
{"title":"Triage in Situations of Mass Casualty","authors":"T. Tännsjö","doi":"10.1093/OSO/9780190946883.003.0010","DOIUrl":"https://doi.org/10.1093/OSO/9780190946883.003.0010","url":null,"abstract":"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.","PeriodicalId":422224,"journal":{"name":"Setting Health-Care Priorities","volume":"153 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"121777367","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-08-29DOI: 10.1093/OSO/9780190946883.003.0006
T. Tännsjö
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.
{"title":"Some Controversial Implications of the Three Theories","authors":"T. Tännsjö","doi":"10.1093/OSO/9780190946883.003.0006","DOIUrl":"https://doi.org/10.1093/OSO/9780190946883.003.0006","url":null,"abstract":"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.","PeriodicalId":422224,"journal":{"name":"Setting Health-Care Priorities","volume":"53 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130908018","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-07-18DOI: 10.1093/oso/9780190946883.003.0013
T. Tännsjö
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.
{"title":"Conclusion","authors":"T. Tännsjö","doi":"10.1093/oso/9780190946883.003.0013","DOIUrl":"https://doi.org/10.1093/oso/9780190946883.003.0013","url":null,"abstract":"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.","PeriodicalId":422224,"journal":{"name":"Setting Health-Care Priorities","volume":"21 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134013216","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-07-18DOI: 10.1093/oso/9780190946883.003.0005
T. Tännsjö
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.
{"title":"Prioritarianism","authors":"T. Tännsjö","doi":"10.1093/oso/9780190946883.003.0005","DOIUrl":"https://doi.org/10.1093/oso/9780190946883.003.0005","url":null,"abstract":"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.","PeriodicalId":422224,"journal":{"name":"Setting Health-Care Priorities","volume":"40 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126300361","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-07-18DOI: 10.1093/OSO/9780190946883.003.0009
T. Tännsjö
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?
{"title":"Ideal and Nonideal Theory","authors":"T. Tännsjö","doi":"10.1093/OSO/9780190946883.003.0009","DOIUrl":"https://doi.org/10.1093/OSO/9780190946883.003.0009","url":null,"abstract":"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?","PeriodicalId":422224,"journal":{"name":"Setting Health-Care Priorities","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133307095","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-07-18DOI: 10.1093/oso/9780190946883.003.0007
T. Tännsjö
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.
{"title":"Population Ethics","authors":"T. Tännsjö","doi":"10.1093/oso/9780190946883.003.0007","DOIUrl":"https://doi.org/10.1093/oso/9780190946883.003.0007","url":null,"abstract":"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.","PeriodicalId":422224,"journal":{"name":"Setting Health-Care Priorities","volume":"1995 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125563884","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-07-18DOI: 10.1093/oso/9780190946883.003.0004
T. Tännsjö
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.
{"title":"Egalitarianism","authors":"T. Tännsjö","doi":"10.1093/oso/9780190946883.003.0004","DOIUrl":"https://doi.org/10.1093/oso/9780190946883.003.0004","url":null,"abstract":"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.","PeriodicalId":422224,"journal":{"name":"Setting Health-Care Priorities","volume":"33 9 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126036081","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-07-18DOI: 10.1093/OSO/9780190946883.003.0011
T. Tännsjö
The maximin/leximin theory is applied in real medical life. The general result, in relation to any welfare state assuming its global obligations, is that more resources ought to be directed to the care and cure of people suffering from mental illness; less should be spent on marginal life extension (especially among elderly patients).The urgency of mental health, when the matter is assessed from the point of view of the maximin/leximin theory, has to do with the fact that people often suffer for very long time from mental disease rendering it plausible to assume that many people in this category garner throughout their lives a net deficit in terms of happiness. Hence they are the patients who are worst off. The problem with marginal life extension among elderly patients has to do with the fact that many among them have throughout their long lives already garnered a lot of happiness. Now these people have to stand back when there is fierce competition for available medical resources.
{"title":"The Maximin/Leximin Theory","authors":"T. Tännsjö","doi":"10.1093/OSO/9780190946883.003.0011","DOIUrl":"https://doi.org/10.1093/OSO/9780190946883.003.0011","url":null,"abstract":"The maximin/leximin theory is applied in real medical life. The general result, in relation to any welfare state assuming its global obligations, is that more resources ought to be directed to the care and cure of people suffering from mental illness; less should be spent on marginal life extension (especially among elderly patients).The urgency of mental health, when the matter is assessed from the point of view of the maximin/leximin theory, has to do with the fact that people often suffer for very long time from mental disease rendering it plausible to assume that many people in this category garner throughout their lives a net deficit in terms of happiness. Hence they are the patients who are worst off. The problem with marginal life extension among elderly patients has to do with the fact that many among them have throughout their long lives already garnered a lot of happiness. Now these people have to stand back when there is fierce competition for available medical resources.","PeriodicalId":422224,"journal":{"name":"Setting Health-Care Priorities","volume":"46 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130957488","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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