Drafts by Benedict Rumbold
This note outlines a set of ethical principles to be used in prioritisation of different patient ... more This note outlines a set of ethical principles to be used in prioritisation of different patient groups, specifically with respect to the admission of patients into ICU and withdrawal of treatment. The principles are designed for specific use during the present pandemic, and not at other times/in other cases.
Lead author: Benedict Rumbold (University of Nottingham), with input from the UCL/KCL Social Values Group.
In this paper I assess two possible challenges to citizen lobbying: first, that it poses a direct... more In this paper I assess two possible challenges to citizen lobbying: first, that it poses a direct threat to political equality; second, that it is undemocratic. In the end, I conclude that neither challenge suggests lobbying is necessarily morally impermissible and that there is a feasible political world in which lobbying would be permissible, one which isn't so hard to reach from where we are now, and one which we might think is somewhat attractive.
In this article, I offer a new justification of the specialness thesis about healthcare (STHC), o... more In this article, I offer a new justification of the specialness thesis about healthcare (STHC), one which I take to be immune from objections that have undercut other defences. Notably, unlike previous utility- and opportunity-based theories, I argue that we can find normative justification for STHC in what I term our special duty to assist those unable to help themselves. It is this duty, I argue, that ultimately gives us reason to treat health care differently from other sorts of goods (even other goods meeting health needs), and to distribute it independently of individuals’ ability to pay.
Before presenting his own account of value in the Ethics, Spinoza spends much of EIAppendix and E... more Before presenting his own account of value in the Ethics, Spinoza spends much of EIAppendix and EIVPreface attempting to refute a series of axiological ‘prejudices’ that he takes to have taken root in the minds of his readership. In doing so, Spinoza adopts what might be termed a ‘genealogical’ argumentative strategy. That is, he tries to establish the falsity of imagined readership’s prejudices about good and bad, perfection and imperfection, by first showing that the ideas from which they have arisen are themselves false. Many elements of this genealogy, however, remain unclear. First, both the nature of the metaethical prejudices Spinoza believes we have been labouring under, and the metaphysical prejudices that he takes to have given rise to them, continue to attract widespread disagreement. Although much less commented on, it is also not entirely obvious why Spinoza takes the one to have engendered the other. In this article, I attempt to clarify Spinoza’s reasoning in both of these respects, ultimately concluding that Spinoza offers us two accounts of how this process has occurred, the first beginning from an anthropocentric doctrine of divine providence, the second from more secular, perhaps more purely Aristotelian metaphysical tradition.
Papers by Benedict Rumbold
Philosophical Foundations of Medical Law, Nov 21, 2019
The justification for the judicial review of priority-setting decisions in the NHS is premised up... more The justification for the judicial review of priority-setting decisions in the NHS is premised upon a distinction between substantive policy decisions and matters of procedural fairness, with courts themselves perceiving their function as restricted primarily to assessments of procedure. This approach finds normative ground in the ‘procedural turn’ in the philosophical literature on justice in health, in particular in the influential idea of ‘Accountability for Reasonableness’. However, this chapter will argue that relying on the substance/procedure distinction to identify the appropriate role for the courts in the control of allocative decisions in health care will attract to judicial review a series of concerns raised in the philosophical literature with regard to the idea of securing just priority setting through procedural means.
Ethical Theory and Moral Practice, 2019
One rationale policy-makers sometimes give for declining to fund a service or intervention is on ... more One rationale policy-makers sometimes give for declining to fund a service or intervention is on the grounds that it would be ‘unaffordable’, which is to say, that the total cost of providing the service or intervention for all eligible recipients would exceed the budget limit. But does the mere fact that a service or intervention is unaffordable present a reason not to fund it? Thus far, the philosophical literature has remained largely silent on this issue. However, in this article, we consider this kind of thinking in depth. Albeit with certain important caveats, we argue that the use of affordability criteria in matters of public financing commits what Parfit might have called a ‘mistake in moral mathematics’. First, it fails to abide by what we term a principle of ‘non-perfectionism’ in moral action: the mere fact that it is practically impossible for you to do all the good that you have reason to do does not present a reason not to do whatever good you can do. And second, when used as a means of arbitrating between which services to fund, affordability criteria can lead to a kind of ‘numerical discrimination’. Various attendant issues around fairness and lotteries are also discussed.
Journal of Political Philosophy, 2018
Res Publica, 2018
For all their various disagreements, one point upon which rights theorists often agree is that it... more For all their various disagreements, one point upon which rights theorists often agree is that it is simply part of the nature of rights that they tend to override, outweigh or exclude competing considerations in moral reasoning, that they have 'peremptory force' (Raz in The Morality of Freedom, Oxford University Press, Oxford, 1986, p. 192), making 'powerful demands' that can only be overridden in 'exceptional circumstances' (Miller, in Cruft, Liao, Renzo (eds), Philosophical Foundations of Human Rights, Oxford University Press, Oxford, 2016, p. 240). In this article I challenge this thought. My aim here is not to prove that the traditional view of rights' stringency is necessarily false, nor even that we have no good reason to believe it is true. Rather, my aim is only to show that we have good reason to think that the foundation of the traditional position is less stable than we might have otherwise supposed and that an alternative conception of rights—one which takes the stringency of any given right as particular to the kind of right it is—is both viable and attractive. In short, to begin to move us towards a more 'particularist' conception of rights' standing in moral reasoning and judgement.
Human Rights and Justice, 2018
In this chapter, I seek to assess critically another (apparently) necessary condition of moral hu... more In this chapter, I seek to assess critically another (apparently) necessary condition of moral human rights, what I shall refer to here as the test of moral feasibility. This is the requirement that if a stipulated moral human right is to make a valid claim upon us as duty-bearers, the demands it makes must not conflict with certain other normative demands we face as moral agents. According to the most prevalent species of this claim, moral human rights only make a valid claim on our action insofar as they are compossible, or simultaneously realisable, with the demands of every other moral human right.
In what follows, I contest this and other species of the moral feasibility requirement. Against what might reasonably be characterised as the orthodox position, I argue that we have no good reason for thinking that the validity of moral human rights turns on their moral feasibility and, indeed, that our moral theory is better served by freeing them from such a condition.
Intellectual History Review, 2017
Among Spinoza’s principal projects in the Ethics is his effort to “remove” certain metaethical pr... more Among Spinoza’s principal projects in the Ethics is his effort to “remove” certain metaethical prejudices from the minds of his readers, to “expose” them, as he has similar misconceptions about other matters, by submitting them to the “scrutiny of reason”. In this article, I consider the argumentative strategy Spinoza uses here – and its intellectual history – in depth. I argue that Spinoza’s method is best characterised as a genealogical analysis. As I recount, by Spinoza’s time of writing, these kinds of arguments already had a long and illustrious history. However, I also argue that, in his adoption of such strategies, we have good reason to think Spinoza’s primary influence was Gersonides. Elucidating this aspect of Spinoza’s critique of his contemporaries’ axiologies brings a number of explicatory and historical boons. However, regrettably, it also comes at a cost, revealing a significant flaw in Spinoza’s reasoning. Towards the end of this article, I consider the nature of this flaw, whether Spinoza can avoid it and its ramifications for Spinoza’s wider philosophical project.
Kennedy Institute of Ethics Journal, 2017
Health systems that aim to secure universal patient access through a scheme of prepayments—whethe... more Health systems that aim to secure universal patient access through a scheme of prepayments—whether through taxes, social insurance, or a combination of the two—need to make decisions on the scope of coverage that they guarantee: such tasks often falling to a priority-setting agency. This article analyzes the decision-making processes at one such agency in particular—the UK's National Institute for Health and Care Excellence (NICE)—and appraises their ethical justifiability. In particular, we consider the extent to which NICE's model can be justified on the basis of Rawls's conception of " reasonableness. " This test shares certain features with the well-known Accountability for Reasonableness (AfR) model but also offers an alternative to it, being concerned with how far the values used by priority-setting agencies such as NICE meet substantive conditions of reasonableness irrespective of their procedural virtues. We find that while there are areas in which NICE's processes may be improved, NICE's overall approach to evaluating health technologies and setting priorities for health-care coverage is a reasonable one, making it an exemplar for other health-care systems facing similar coverage dilemmas. In so doing we offer both a framework for analysing the ethical justifiability of NICE's processes and one that might be used to evaluate others.
Bioethics, 2017
In this article I seek to establish what, if anything, might be morally troubling about morally e... more In this article I seek to establish what, if anything, might be morally troubling about morally enhancing oneself through biomedical means. Building on arguments by Harris, while simultaneously acknowledging several valid counter-arguments that have been put forth by his critics, I argue that taking BMEs necessarily incurs at least one moral cost in the restrictions they impose on our freedom. This does not necessarily entail that the use of BMEs cannot be overall justified, nor that, in certain cases, their costs may not be forestalled. It does show, however, that their use is not morally neutral. There is a cost to such technologies and, as such, the onus will always be on their defenders to show that these costs can compensated for.
Journal of Medical Ethics, 2017
To say health is 'special' is to say that it has a moral significance that differentiates it from... more To say health is 'special' is to say that it has a moral significance that differentiates it from other goods (cars, say or radios) and, as a matter of justice, warrants distributing it separately. In this essay, I critique a new justification for the specialness thesis about healthcare (STHC) recently put forth by Engster. I argue that, regrettably, Engster's justification of STHC ultimately fails and fails on much the same grounds as have previous justifications of STHC. However, I also argue that Engster's argument still adds something valuable to the debate around STHC insofar as it reminds us that the moral significance of healthcare may be wider than simply its effect on the incidence of disability and disease: one further reason we may think healthcare is morally significant is because it concerns the treatment and care of those who are already unwell.
Critical Review of International Social and Political Philosophy, 2015
British Journal for the History of Philosophy, 2015
Health economics, policy, and law, Jan 10, 2015
In this article we consider the conclusions and recommendations of the World Health Organisation&... more In this article we consider the conclusions and recommendations of the World Health Organisation's report Making Fair Choices from a philosophical perspective. In particular we reflect on the report's return to substantive claims about justice in the allocation of health care resources and its argument that certain trade-offs are…
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Drafts by Benedict Rumbold
Lead author: Benedict Rumbold (University of Nottingham), with input from the UCL/KCL Social Values Group.
Papers by Benedict Rumbold
In what follows, I contest this and other species of the moral feasibility requirement. Against what might reasonably be characterised as the orthodox position, I argue that we have no good reason for thinking that the validity of moral human rights turns on their moral feasibility and, indeed, that our moral theory is better served by freeing them from such a condition.
Lead author: Benedict Rumbold (University of Nottingham), with input from the UCL/KCL Social Values Group.
In what follows, I contest this and other species of the moral feasibility requirement. Against what might reasonably be characterised as the orthodox position, I argue that we have no good reason for thinking that the validity of moral human rights turns on their moral feasibility and, indeed, that our moral theory is better served by freeing them from such a condition.