At the W. Maurice Young Centre for Applied Ethics, UBC, I have started critical analysis of the role of ethical principles in applied ethics, e.g. research ethics and clinical ethics. I also continue work on analyzing the results of deliberative assessments of cognitive enhancement with Peter Danielson. I coordinated the research project 'Applied Ethics: Technology and Governance of Health and Natural Resources' at NTNU Programme for Applied Ethics, IFR. For my PhD in Philosophy I published on the limits of rationing healthcare in extreme scarcity. My postdoctoral project is on cultural conflicts and ethics of new and emerging technologies. I published on the place of culture-based reasons in public debates about new technologies. I have worked on the relation between cultural diversity and deliberation on controversial ethical issues, especially on the moral status of future generations affected by current practices.
The question of how society should deal with social conflicts arising from cultural differences p... more The question of how society should deal with social conflicts arising from cultural differences persists. Should we adopt an exclusivist approach by excluding reasons based on specific cultural traditions (culture-based reasons) from public debates about social policy, especially because these reasons do not appeal to the public at large? Or should we resort to an inclusivist approach by including reasons based on cultural traditions in public debate to give recognition to the diverse cultural identities of those who practice these traditions? While these two approaches assign different roles to cultural traditions in public debate, both seem to welcome compromise between conflicting parties. This paper reviews contending normative approaches for dealing with conflicts in multicultural societies and explores the place of culture-based reasons in public debates designed to resolve conflicts.
Asian Bioethics Review, Volume 5, Issue 4, Dec 2013
‘Corporate greed' has recently been denounced in several protest demonstrations in different part... more ‘Corporate greed' has recently been denounced in several protest demonstrations in different parts of the world. In those demonstrations corporations are called to put an end to their being too selfish and greedy for profit and to start caring for the interests of others, especially the many who are poor and unemployed. While such protest movements seem to attract less support in Asian countries than in their Western counterparts this does not mean that people there are necessarily indifferent to denouncing ‘greed'. There is even a familiar quote attributed to Lao Tzu that says that there is no greater disaster than greed (or lavish desires). This may be a different kind of greed than what global protesters are denouncing. But even if people have different conceptions of what should be considered greed and how to denounce it, we could at least agree that we should not only be concerned about our own interests. In certain ways it may also be beneficial for us to consider how others are faring.
Ethical beliefs may vary across cultures but there are things that must be valued as precondition... more Ethical beliefs may vary across cultures but there are things that must be valued as preconditions to any cultural practice. Physical and mental abilities vital to believing, valuing and practising a culture are such preconditions and it is always important to protect them. If one is to practise a distinct culture, she must at least have these basic abilities. Access to basic healthcare is one way to ensure that vital abilities are protected. John Rawls argued that access to all-purpose primary goods must be ensured. Amartya Sen and Martha Nussbaum claim that universal capabilities are what resources are meant to enable. Len Doyal and Ian Gough identify physical health and autonomy as basic needs of every person in every culture. When we disagree on what to prioritize, when resources to satisfy competing demands are scarce, our common needs can provide a point of normative convergence. Need-based rationing, however, has been criticized for being too indeterminate to give guidance for deciding which healthcare services to prioritize and for tending to create a bottomless-pit problem. But there is a difference between needing something (first-order need) and needing to have the ability to need (second-order need). Even if we disagree about which first-order need to prioritize, we must accept the importance of satisfying our second-order need to have the ability to value things. We all have a second-order need for basic healthcare as a means to protect our vital abilities even if we differ in what our cultures consider to be particular first-order needs.
The problem of allocating scarce healthcare resources remains difficult to solve and there are se... more The problem of allocating scarce healthcare resources remains difficult to solve and there are several contending approaches. This is compounded by the often neglected fact that standard approaches to rationing, developed in view of moderate scarcity in more affluent settings, would yield more tragic results if applied directly to low-income countries where extreme scarcity is often prevalent. I will briefly mention the failures of some main approaches and focus on the relevance of vital needs and vital abilities in discussing the problem of
allocating healthcare resources in situations of extreme scarcity. I will highlight the inconsistency of the idea that rationing decisions that result in depriving citizens of basic enabling healthcare could be accepted if they conform to certain ideals (e.g. equality, fairness, efficiency) that decision-makers adopt. Simply put, I will try to show why it is inconsistent for society to obligate citizens to fulfill their role as citizens without insisting on society’s corresponding duty to provide citizens sufficient means to fulfill their obligations.
Application of egalitarian and prioritarian accounts of health resource allocation in low-income ... more Application of egalitarian and prioritarian accounts of health resource allocation in low-income countries have both been criticized for implying distribution outcomes that allow decreasing/undermining health gains and for tolerating unacceptable standards of health care and health status that result from such allocation schemes. Insufficient health care and severe deprivation of health resources are difficult to accept even when justified by aggregative efficiency or legitimized by fair deliberative process in pursuing equality and priority oriented outcomes. I affirm the sufficientarian argument that, given extreme scarcity of public health resources in low-income countries, neither health status equality between populations nor priority for the worse off is normatively adequate. Nevertheless, the threshold norm alone need not be the sole consideration when a country's total health budget is extremely scarce. Threshold considerations are necessary in developing a theory of fair distribution of health resources that is sensitive to the lexically prior norm of sufficiency. Based on the intuition that shares must not be taken away from those who barely achieve a minimal level of health, I argue that assessments based on standards of minimal physical/mental health must be developed to evaluate the sufficiency of the total resources of health systems in low-income countries prior to pursuing equality, priority, and efficiency based resource allocation. I also begin to examine how threshold sensitive health resource assessment could be used in the Philippines.
The discussion on ethical issues, it is said, should not be confined to experts but should be ext... more The discussion on ethical issues, it is said, should not be confined to experts but should be extended to patients and local communities, because of the real need to engage stakeholders and non-stakeholders alike not only in carrying out any biomedical research project, but also in the drafting and legislation of bioethics instruments. Several local and inter-country consultations have already been conducted in furtherance of this goal, but there is much left to be desired in them. The consultations may have helped in articulating local principles, but not in making the instruments embody these principles. As such, instruments turn incompossible, i.e. the principles and actions they legitimate are not performable. In an ethnographic study conducted in the Philippines, for example, paragraphs 29 and 30 of the Declaration of Helsinki and CIOMS guidelines 8 and 15 are construed as not only contradictory to one another but also to local principles. This problem can be solved by taking deliberate steps to ensure that consultations are grounded in ethnographic data about local principles, which the instruments would embody. A steering committee can be of help in gathering ethnographic data, in conducting consultations at the local level, and in providing a venue for discourse on various bioethical issues.
Rational justification of claims with empirical content calls for empirical and not only normativ... more Rational justification of claims with empirical content calls for empirical and not only normative philosophical investigation. Empirical approaches to bioethics are epistemically valuable, i.e., such methods may be necessary in providing and verifying basic knowledge about cultural values and norms. Our assumptions in moral reasoning can be verified or corrected using these methods. Moral arguments can be initiated or adjudicated by data drawn from empirical investigation. One may argue that individualistic informed consent, for example, is not compatible with the Asian communitarian orientation. But this normative claim uses an empirical assumption that may be contrary to the fact that some Asians do value and argue for informed consent. Is it necessary and factual to neatly characterize some cultures as individualistic and some as communitarian? Empirical investigation can provide a reasonable way to inform such generalizations. In a multi-cultural context, such as in the Philippines, there is a need to investigate the nature of the local ethos before making any appeal to authenticity. Otherwise we may succumb to the same ethical imperialism we are trying hard to resist. Normative claims that involve empirical premises cannot be reasonably verified or evaluated without utilizing empirical methods along with philosophical reflection. The integration of empirical methods to the standard normative approach to moral reasoning should be reasonably guided by the epistemic demands of claims arising from cross-cultural discourse in bioethics.
How should national societies build legitimate and inclusive collective identities amidst prolifi... more How should national societies build legitimate and inclusive collective identities amidst prolific multiculturalism and linguistic diversity? We argue that cultural ownership of particular ways of framing ethics should be part of this collective identity building process. We should avoid unfair domination of minority cultural identities, but how do we do this when ethical discourses themselves tend to be shaped by particular dominant identities? We look into the case of the challenges that a particular multicultural society, the Philippines, faces in its ongoing collective identity building project on three levels: (1) ethnic and linguistic differences (e.g. differences between Tagalog, Cebuano, Maranao, etc.), (2) the historical layers of foreign culture (e.g. Islamic, Spanish, and American) that have each influenced these distinct cultural identities in different degrees, and (3) the apparent domination of Tagalog linguistic culture over others. Our answer to the question of legitimate and inclusive collective identity comes from an inter-linguistic dialogue that can be effected between cultures by harnessing similarities of ethical concepts, without compromising cultural differences. We present three different possible approaches under the following headings: (1) Pilipino ethics, (2) Filipino ethics and (3) Philippine ethics, each representing a particular stance to the dominant Tagalog linguistic culture. We argue for the third option, which is the most inclusive because of how it equalizes the status of all participating cultures in the dialogue. We also draw from the possibilities afforded by the phenomena of Scandinavian semicommunication (Haugen 1966) and what this practice offers in making collective identity building more inclusive.
The question of how society should deal with social conflicts arising from cultural differences p... more The question of how society should deal with social conflicts arising from cultural differences persists. Should we adopt an exclusivist approach by excluding reasons based on specific cultural traditions (culture-based reasons) from public debates about social policy, especially because these reasons do not appeal to the public at large? Or should we resort to an inclusivist approach by including reasons based on cultural traditions in public debate to give recognition to the diverse cultural identities of those who practice these traditions? While these two approaches assign different roles to cultural traditions in public debate, both seem to welcome compromise between conflicting parties. This paper reviews contending normative approaches for dealing with conflicts in multicultural societies and explores the place of culture-based reasons in public debates designed to resolve conflicts.
Asian Bioethics Review, Volume 5, Issue 4, Dec 2013
‘Corporate greed' has recently been denounced in several protest demonstrations in different part... more ‘Corporate greed' has recently been denounced in several protest demonstrations in different parts of the world. In those demonstrations corporations are called to put an end to their being too selfish and greedy for profit and to start caring for the interests of others, especially the many who are poor and unemployed. While such protest movements seem to attract less support in Asian countries than in their Western counterparts this does not mean that people there are necessarily indifferent to denouncing ‘greed'. There is even a familiar quote attributed to Lao Tzu that says that there is no greater disaster than greed (or lavish desires). This may be a different kind of greed than what global protesters are denouncing. But even if people have different conceptions of what should be considered greed and how to denounce it, we could at least agree that we should not only be concerned about our own interests. In certain ways it may also be beneficial for us to consider how others are faring.
Ethical beliefs may vary across cultures but there are things that must be valued as precondition... more Ethical beliefs may vary across cultures but there are things that must be valued as preconditions to any cultural practice. Physical and mental abilities vital to believing, valuing and practising a culture are such preconditions and it is always important to protect them. If one is to practise a distinct culture, she must at least have these basic abilities. Access to basic healthcare is one way to ensure that vital abilities are protected. John Rawls argued that access to all-purpose primary goods must be ensured. Amartya Sen and Martha Nussbaum claim that universal capabilities are what resources are meant to enable. Len Doyal and Ian Gough identify physical health and autonomy as basic needs of every person in every culture. When we disagree on what to prioritize, when resources to satisfy competing demands are scarce, our common needs can provide a point of normative convergence. Need-based rationing, however, has been criticized for being too indeterminate to give guidance for deciding which healthcare services to prioritize and for tending to create a bottomless-pit problem. But there is a difference between needing something (first-order need) and needing to have the ability to need (second-order need). Even if we disagree about which first-order need to prioritize, we must accept the importance of satisfying our second-order need to have the ability to value things. We all have a second-order need for basic healthcare as a means to protect our vital abilities even if we differ in what our cultures consider to be particular first-order needs.
The problem of allocating scarce healthcare resources remains difficult to solve and there are se... more The problem of allocating scarce healthcare resources remains difficult to solve and there are several contending approaches. This is compounded by the often neglected fact that standard approaches to rationing, developed in view of moderate scarcity in more affluent settings, would yield more tragic results if applied directly to low-income countries where extreme scarcity is often prevalent. I will briefly mention the failures of some main approaches and focus on the relevance of vital needs and vital abilities in discussing the problem of
allocating healthcare resources in situations of extreme scarcity. I will highlight the inconsistency of the idea that rationing decisions that result in depriving citizens of basic enabling healthcare could be accepted if they conform to certain ideals (e.g. equality, fairness, efficiency) that decision-makers adopt. Simply put, I will try to show why it is inconsistent for society to obligate citizens to fulfill their role as citizens without insisting on society’s corresponding duty to provide citizens sufficient means to fulfill their obligations.
Application of egalitarian and prioritarian accounts of health resource allocation in low-income ... more Application of egalitarian and prioritarian accounts of health resource allocation in low-income countries have both been criticized for implying distribution outcomes that allow decreasing/undermining health gains and for tolerating unacceptable standards of health care and health status that result from such allocation schemes. Insufficient health care and severe deprivation of health resources are difficult to accept even when justified by aggregative efficiency or legitimized by fair deliberative process in pursuing equality and priority oriented outcomes. I affirm the sufficientarian argument that, given extreme scarcity of public health resources in low-income countries, neither health status equality between populations nor priority for the worse off is normatively adequate. Nevertheless, the threshold norm alone need not be the sole consideration when a country's total health budget is extremely scarce. Threshold considerations are necessary in developing a theory of fair distribution of health resources that is sensitive to the lexically prior norm of sufficiency. Based on the intuition that shares must not be taken away from those who barely achieve a minimal level of health, I argue that assessments based on standards of minimal physical/mental health must be developed to evaluate the sufficiency of the total resources of health systems in low-income countries prior to pursuing equality, priority, and efficiency based resource allocation. I also begin to examine how threshold sensitive health resource assessment could be used in the Philippines.
The discussion on ethical issues, it is said, should not be confined to experts but should be ext... more The discussion on ethical issues, it is said, should not be confined to experts but should be extended to patients and local communities, because of the real need to engage stakeholders and non-stakeholders alike not only in carrying out any biomedical research project, but also in the drafting and legislation of bioethics instruments. Several local and inter-country consultations have already been conducted in furtherance of this goal, but there is much left to be desired in them. The consultations may have helped in articulating local principles, but not in making the instruments embody these principles. As such, instruments turn incompossible, i.e. the principles and actions they legitimate are not performable. In an ethnographic study conducted in the Philippines, for example, paragraphs 29 and 30 of the Declaration of Helsinki and CIOMS guidelines 8 and 15 are construed as not only contradictory to one another but also to local principles. This problem can be solved by taking deliberate steps to ensure that consultations are grounded in ethnographic data about local principles, which the instruments would embody. A steering committee can be of help in gathering ethnographic data, in conducting consultations at the local level, and in providing a venue for discourse on various bioethical issues.
Rational justification of claims with empirical content calls for empirical and not only normativ... more Rational justification of claims with empirical content calls for empirical and not only normative philosophical investigation. Empirical approaches to bioethics are epistemically valuable, i.e., such methods may be necessary in providing and verifying basic knowledge about cultural values and norms. Our assumptions in moral reasoning can be verified or corrected using these methods. Moral arguments can be initiated or adjudicated by data drawn from empirical investigation. One may argue that individualistic informed consent, for example, is not compatible with the Asian communitarian orientation. But this normative claim uses an empirical assumption that may be contrary to the fact that some Asians do value and argue for informed consent. Is it necessary and factual to neatly characterize some cultures as individualistic and some as communitarian? Empirical investigation can provide a reasonable way to inform such generalizations. In a multi-cultural context, such as in the Philippines, there is a need to investigate the nature of the local ethos before making any appeal to authenticity. Otherwise we may succumb to the same ethical imperialism we are trying hard to resist. Normative claims that involve empirical premises cannot be reasonably verified or evaluated without utilizing empirical methods along with philosophical reflection. The integration of empirical methods to the standard normative approach to moral reasoning should be reasonably guided by the epistemic demands of claims arising from cross-cultural discourse in bioethics.
How should national societies build legitimate and inclusive collective identities amidst prolifi... more How should national societies build legitimate and inclusive collective identities amidst prolific multiculturalism and linguistic diversity? We argue that cultural ownership of particular ways of framing ethics should be part of this collective identity building process. We should avoid unfair domination of minority cultural identities, but how do we do this when ethical discourses themselves tend to be shaped by particular dominant identities? We look into the case of the challenges that a particular multicultural society, the Philippines, faces in its ongoing collective identity building project on three levels: (1) ethnic and linguistic differences (e.g. differences between Tagalog, Cebuano, Maranao, etc.), (2) the historical layers of foreign culture (e.g. Islamic, Spanish, and American) that have each influenced these distinct cultural identities in different degrees, and (3) the apparent domination of Tagalog linguistic culture over others. Our answer to the question of legitimate and inclusive collective identity comes from an inter-linguistic dialogue that can be effected between cultures by harnessing similarities of ethical concepts, without compromising cultural differences. We present three different possible approaches under the following headings: (1) Pilipino ethics, (2) Filipino ethics and (3) Philippine ethics, each representing a particular stance to the dominant Tagalog linguistic culture. We argue for the third option, which is the most inclusive because of how it equalizes the status of all participating cultures in the dialogue. We also draw from the possibilities afforded by the phenomena of Scandinavian semicommunication (Haugen 1966) and what this practice offers in making collective identity building more inclusive.
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Papers by Allen Alvarez
allocating healthcare resources in situations of extreme scarcity. I will highlight the inconsistency of the idea that rationing decisions that result in depriving citizens of basic enabling healthcare could be accepted if they conform to certain ideals (e.g. equality, fairness, efficiency) that decision-makers adopt. Simply put, I will try to show why it is inconsistent for society to obligate citizens to fulfill their role as citizens without insisting on society’s corresponding duty to provide citizens sufficient means to fulfill their obligations.
Journal Articles by Allen Alvarez
allocating healthcare resources in situations of extreme scarcity. I will highlight the inconsistency of the idea that rationing decisions that result in depriving citizens of basic enabling healthcare could be accepted if they conform to certain ideals (e.g. equality, fairness, efficiency) that decision-makers adopt. Simply put, I will try to show why it is inconsistent for society to obligate citizens to fulfill their role as citizens without insisting on society’s corresponding duty to provide citizens sufficient means to fulfill their obligations.