What to do when there isn't enough: the fair distribution of scarce goods

My DPhil submission consists of a series of papers on related topics on the moral philosophy of scarce benefit distribution. It focuses on two types of scarce benefit distribution case. The first type occurs when which all potential beneficiaries of a good each have an equally strong moral claim on an equal benefit from the resource but scarcity or indivisibility prevents us from benefiting all potential beneficiaries. Call these cases equal conflict cases. In 'Anti-Majoritarianism', I argue against the view defended by both utilitarians and non-utilitarians that in equal conflict cases you always ought to give the benefit to as many people as possible. I argue that doing so is neither morally right nor fair. In 'Weighing Up Weighted Lotteries', I argue that the philosophical debate between unweighted and weighted lottery benefit distribution procedures has been misconceived and that fairness requires us to use a new kind of weighted lottery that I call the exclusive composition-sensitive lottery. In 'Can't Get No Satisfaction', I defend a new view that I call the dual-structure view about how lotteries satisfy potential beneficiaries' claims in equal conflict cases and highlight the implications of that view for the distribution of donor corneas to those who have suffered corneal degeneration. The second type of this distributional problem occurs when we can either benefit a very large number of potential beneficiaries with a very small benefit (call these the many) or a very small number of potential beneficiaries with a very major benefit (call these the few). In "Valuing the Few Over the Many" I argue that there are cases where not only ought we to benefit the few over the many no matter how numerous the many are, but it is also better to do so. However, this conclusion can be shown to conflict with a number of widely held tenets of value theory. I evaluate different ways of accommodating these intuitions and argue that in some contexts, benefits are not of finite value. The view I defend in 'Valuing the Few Over the Many', combined with some intuitively plausible axiological claims, is inconsistent with the transitivity of the 'better than' relation. In 'Making Betterness Behave' I argue that for what I call the conditional non-coextensive thesis: if 'better than' is not transitive, one ought to take the position that 'more reason to bring about rather than' is transitive. I argue that one can generate a transitive 'more reason to bring about rather than' deontic ordering from a non-transitive axiological ordering in a principled way. This deontic ordering avoids the major practical objections (money pumps, moral dilemmas and threats to practical reasoning) to non-transitivity of the 'better than' relation.</p

<研究論文(原著論文)>Against Always Benefiting the Greater Number

One of the most pressing problems in both ethics and economics is how we ought to distribute scarce, indivisible goods. This paper considers a particular variant of this problem, namely when each and every potential beneficiary has an equally strong claim on an equal good, and criticizes a prominent solution to this problem. Many prominent theories, both consequentialist and nonconsequentialist, claim that in such cases, you are morally required to give the benefit to as many people as possible. I will argue that always acting according to these prominent theories can lead to objectionable long-term discrimination and unfairness

What to do when there isn't enough : the fair distribution of scarce goods

My DPhil submission consists of a series of papers on related topics on the moral philosophy of scarce benefit distribution. It focuses on two types of scarce benefit distribution case. The first type occurs when which all potential beneficiaries of a good each have an equally strong moral claim on an equal benefit from the resource but scarcity or indivisibility prevents us from benefiting all potential beneficiaries. Call these cases equal conflict cases. In 'Anti-Majoritarianism', I argue against the view defended by both utilitarians and non-utilitarians that in equal conflict cases you always ought to give the benefit to as many people as possible. I argue that doing so is neither morally right nor fair. In 'Weighing Up Weighted Lotteries', I argue that the philosophical debate between unweighted and weighted lottery benefit distribution procedures has been misconceived and that fairness requires us to use a new kind of weighted lottery that I call the exclusive composition-sensitive lottery. In 'Can't Get No Satisfaction', I defend a new view that I call the dual-structure view about how lotteries satisfy potential beneficiaries' claims in equal conflict cases and highlight the implications of that view for the distribution of donor corneas to those who have suffered corneal degeneration. The second type of this distributional problem occurs when we can either benefit a very large number of potential beneficiaries with a very small benefit (call these the many) or a very small number of potential beneficiaries with a very major benefit (call these the few). In "Valuing the Few Over the Many" I argue that there are cases where not only ought we to benefit the few over the many no matter how numerous the many are, but it is also better to do so. However, this conclusion can be shown to conflict with a number of widely held tenets of value theory. I evaluate different ways of accommodating these intuitions and argue that in some contexts, benefits are not of finite value. The view I defend in 'Valuing the Few Over the Many', combined with some intuitively plausible axiological claims, is inconsistent with the transitivity of the 'better than' relation. In 'Making Betterness Behave' I argue that for what I call the conditional non-coextensive thesis: if 'better than' is not transitive, one ought to take the position that 'more reason to bring about rather than' is transitive. I argue that one can generate a transitive 'more reason to bring about rather than' deontic ordering from a non-transitive axiological ordering in a principled way. This deontic ordering avoids the major practical objections (money pumps, moral dilemmas and threats to practical reasoning) to non-transitivity of the 'better than' relation.EThOS - Electronic Theses Online ServiceGBUnited Kingdo

Ethical Care of the Traumatized: Conceptual Introduction to Trauma-Informed Care for Surgeons and Surgical Residents

Trauma-informed care (TIC) is a set of principles and practices designed to improve the ways professionals treat people who have been traumatized. This study reviews fundamental concepts of TIC and applies them to the work of surgeons. TIC is described in relation to fundamental medical ethical concepts, and evidence for TIC-based intervention is reviewed. Implementation of TIC in medical education is also described, and recommendations for practice changes are made

Malnutrition Increases Hospital Length of Stay and Mortality among Adult Inpatients with COVID-19

Background: Malnutrition has been linked to adverse health economic outcomes. There is a paucity of data on malnutrition in patients admitted with COVID-19. Methods: This is a retrospective cohort study consisting of 4311 COVID-19 adult (18 years and older) inpatients at 5 Johns Hopkins-affiliated hospitals between 1 March and 3 December 2020. Malnourishment was identified using the malnutrition universal screening tool (MUST), then confirmed by registered dietitians. Statistics were conducted with SAS v9.4 (Cary, NC, USA) software to examine the effect of malnutrition on mortality and hospital length of stay among COVID-19 inpatient encounters, while accounting for possible covariates in regression analysis predicting mortality or the log-transformed length of stay. Results: COVID-19 patients who were older, male, or had lower BMIs had a higher likelihood of mortality. Patients with malnutrition were 76% more likely to have mortality (p &lt; 0.001) and to have a 105% longer hospital length of stay (p &lt; 0.001). Overall, 12.9% (555/4311) of adult COVID-19 patients were diagnosed with malnutrition and were associated with an 87.9% increase in hospital length of stay (p &lt; 0.001). Conclusions: In a cohort of COVID-19 adult inpatients, malnutrition was associated with a higher likelihood of mortality and increased hospital length of stay