Rebuilding society from the ground up: Contextual justice, fellow citizenship, and United States welfare policy.

In this dissertation I develop and explore a contextual approach to political philosophy that focuses on actual, concrete problems currently faced in the public sphere. This sort of contextual approach is minimalist, in that it involves addressing large theoretical questions of justice only as necessary to solve the problem at hand. This is an alternative to more typical approaches to political philosophy in which the central task is to develop an account of the ideally just state or formulate a set of principles of justice that can later be applied to particular problems. On the approach I advocate, the primary aim is to identify ways to improve the current situation. The resulting conclusions are therefore incremental; once the recommended changes are implemented they may give rise to further instances of injustice, some of which may have been difficult or impossible to foresee, which will then require additional improvements and modifications. After describing my preferred approach and defending it from several theoretical objections, I spend the remainder of the dissertation investigating welfare policy in the United States. I argue that the recent set of welfare reforms are best understood as growing out of an implicit commitment to an ideal of fellow citizenship. I go on to defend the obligations of reciprocity owed between fellow citizens as a sound basis for welfare policy in the United States, although I claim that careful attention to these obligations reveals significant shortcomings in our current policies. For instance, although I support the use of work requirements, I argue that publicly funded jobs of last resort ought to be available to potential welfare recipients, that time limits on the receipt of welfare benefits ought to be eliminated, and that total benefits from welfare and other earnings support programs ought to be high enough to ensure that all who fulfill their obligations of fellow citizenship are able to earn a socially recognized sufficient income. I close by pointing out that any success I have had in my contextual analysis of welfare policy vindicates the contextualist approach to political philosophy advocated in the beginning of the dissertation.Ph.D.PhilosophyPhilosophy, Religion and TheologyPublic administrationPublic policySocial SciencesUniversity of Michigan, Horace H. Rackham School of Graduate Studieshttp://deepblue.lib.umich.edu/bitstream/2027.42/125338/2/3192616.pd

Why do we want the right to die? A systematic review of the international literature on the views of patients, carers and the public on assisted dying

Background: Assisted dying is legal in four European countries and three American states. Elsewhere, particularly in more affluent or mainly Protestant countries, it remains controversial. Dominant headlines feature professional (medical, legal, religious) arguments versus celebrity campaigners; ordinary people are less clearly represented. Aim: To synthesise the international evidence of people’s views and attitudes towards assisted dying in order to inform current debate about this controversial issue. Design: Systematic review and mixed method synthesis of qualitative and survey data Data sources: Eleven electronic databases from inception to October 2011; bibliographies of included studies Review Methods: Two reviewers independently screened papers and appraised quality. Qualitative results were extracted verbatim; survey results were summarised in a table. Qualitative data were synthesised using framework methods and survey results integrated where they supported, contrasted or added to the themes identified. Results: Sixteen qualitative studies and 94 surveys were included; many participants considered the immediate relevance of assisted dying for them. Themes related to poor quality of life, a good quality of death, potential abuse of assisted dying and the importance of individual stance. People valued autonomy in death as much as in life. Attitudes were diverse, complex and related to definitions of unbearable suffering including physical, psycho-social and existential factors and were consistent regardless of social, economic, legal and health-care contexts. Conclusion: Our review sheds light on ordinary people’s perspectives about assisted dying, when they are ill or disabled. Unbearable suffering is a key construct, and common factors are revealed that lead people to ask for help to die. The consistency of international views indicates a mandate for legislative and medical systems worldwide to listen and understand this