Public health emergencies sometimes require the restriction of civil liberties through social distancing: lockdowns, quarantines, the closure of public spaces and institutions, and so on. Social distancing measures can decrease mortality and morbidity, but they also cause social and economic harm. Policymakers have to make trade-offs between “lives and livelihoods,” while introducing only minimally necessary restrictions on civil liberties. Traditionally, cost-benefit analysis has played a central role in formulating these trade-offs. Recently, however, some philosophers have argued that the trade-offs should instead be made on the basis of contractualist moral theory. In this essay, I argue against the use of contractualism for this purpose.

Using the case of the Scientific Advisory Group for Emergencies in the United Kingdom as illustration, this essay offers a framework for understanding the role of narratives and competition among narratives in mediating the relationships between scientific advisers and policymakers during the COVID-19 pandemic. Throughout the pandemic, competing judgments about scientific independence and democratic accountability, about the risks of action and inaction, and about the appropriate balance of costs and benefits to society as a whole and to subgroups of the population were filtered through the narrative perspectives of different discourse coalitions. This narrativization of the process had both positive and negative effects. On the one hand, it provided common platforms for the integration of disparate types of knowledge relevant to policymaking. On the other hand, narratives provided platforms for rival coalitions in ongoing contests that left unresolved the central normative questions of distributional fairness and democratic accountability.

As more jurisdictions permit a medically assisted death (MAiD)—and none of the jurisdictions that introduced MAiD has seen any serious attempts at reversing it—the focus of debate has turned to the question of what is a morally defensible access threshold for MAiD. This permits us to rethink the moral reasons for the legalization or decriminalization of assisted dying. Unlike what is assumed in many legislative frameworks, unbearable suffering caused by terminal illness is not what oftentimes motivates decisionally capable people to request MAiD. This matters when access thresholds are considered. The argument advanced in this essay is that because MAiD is less destructive to people’s relationships and less harmful than medically unsupervised suicide, access to medical assistance in dying should be open to anyone who is legally capacitated and who persistently requests such assistance.

It is often morally important that you have a choice between two options in the sense that each option is available to you and you are not coerced into choosing one or the other. Even when you have a choice, though, the presence of time constraints and other noncoercive influences can prevent you from taking the time you need to make up your mind and really choose for yourself. How are we to understand this latter phenomenon? In this essay, I argue that while choosing for yourself seems, at first glance, to be an exercise in discovering your preferences, this is not the whole story. At least sometimes, choosing for yourself instead involves creating your preferences—and, in so doing, choosing what kind of person and valuer to be—through the exercise of what I call formative autonomy. I then explore some objections to this account and some implications for public health policy and clinical ethics. Throughout, I draw primarily on examples that involve choosing whether to continue or terminate a pregnancy and the regulations governing such choices.

This essay considers how the fact that some morally innocent person is nevertheless a threat to others can bear on the permissibility of health policies that harm some to protect others. Two types of innocent threats are distinguished. In the case of abortion, it is argued that even if the embryo/fetus were a person, abortion could be permissible to protect a woman’s life, health, or bodily autonomy. Whether there nevertheless should be time limits on abortions and what surprising form such limits might take are also considered. In the case of pandemics, it is suggested that discussions of health policies should, but often do not, distinguish morally between innocent threats and their potential victims as well as between providing benefits to people and preventing harms to them. The essay also examines discussions of pandemics by health professionals that make use of the trolley problem, the doctrine of double effect, and related philosophical distinctions.

The public health crisis caused by the COVID-19 pandemic led to a rapid surge in activity in biomedical and social science. The pandemic created a need for new scientific knowledge specifically related to the new, emerging infectious agent and it quickly showed huge gaps in knowledge in relation to social and policy responses to pandemics. Governments all over the world accepted the COVID-19 pandemic as a significant public health crisis and went into crisis mode in order to end the crisis and mitigate its impacts. One area in which rapid policy changes occurred was in relation to research ethics. Research ethics systems and guidelines were changed in many countries. The COVID-19 crisis also led to a flurry of philosophical and bioethical work arguing that traditional research ethics rules and principles should be suspended, rethought, or abolished. This essay will analyze whether a public health crisis justifies changing research ethics principles and policies and, if so, what the scope of justified changes is.

Thousands of people will suffer and die this year because we do not donate enough substances of human origin, including blood plasma. To solve this, some recommend that we allow commercial organizations to assist in collecting these and that we permit donor compensation as a tool to encourage donations. Many object to these proposals, including for semiotic or expressive reasons. But insofar as these objections rely on meanings and these meanings are social constructs, we can revise the meaning of these practices to avoid commodification. Revision may work in principle, but in practice some complain that changing meanings may be too difficult or practically infeasible. This essay attempts to show that this is not so in a wide range of cases and uses the case of commercial compensated blood plasma collection as an illustration. Getting people to conceive of this practice not as payment for blood plasma but as compensation for the time, effort, and inconvenience associated with the giving of plasma is practically feasible and preferable to prohibition.

There is a growing movement within contemporary medical ethics to blur the boundaries between clinical medicine and clinical research. Some writers now argue that the research-practice distinction is outdated and the importance of distinguishing between research and medicine is no longer as pressing as it once was or seemed to be. Instead, we are now urged to view the health-care system as a dynamic “learning health-care system” in which research components are embedded within standard clinical care. This essay defends the ethical significance of the research-practice distinction while acknowledging the reality and usefulness of integrated health care. A key claim that this essay advances is that the principle of clinical equipoise, which has largely been rejected by research ethicists, can be reinterpreted and repurposed to help distinguish medical practices that call for more demanding forms of informed consent from those that do not.

In clinical trials involving experimental subjects who are also patients, what is supposed to become of the imperative to focus on the patient’s best interest? A second set of policy questions concerns patients who want to die. Are there limits to the imperative to let patients choose for themselves? Is commodification a threat to autonomy? When, if ever, do costs and benefits become decisively important? Can we know what to count as a cost-effective preparation for the next pandemic? When we put procedures in place to protect against abuse, is there any way to prevent such measures from becoming bureaucratic obstacles to accomplishing anything at all?

Some ideologies, such as liberalism, conservatism, and socialism, are complex symbolic structures. Mastering them requires specialization, and because we are all amateurs in almost all symbolically rich domains, most people are not ideologically sophisticated. Instead, they reason about politics in a maturationally natural way, via friend-foe representations and inferences based on those representations (for example, friends of foes are foes). However, even complex ideologies are much simpler than the political, economic, and social systems that they are supposed to represent. Hence, all ideologies are inaccurate to varying degrees. More subtly, all are incomplete in various ways; in particular, they fail to anticipate some crucial events (for example, global warming), which leads to unanticipated value trade-offs and strategic conundrums. Ideologists sometimes adapt to incompleteness via recombinant innovation, producing hybrid ideologies (for example, ecosocialism). In turn, this tends to produce inconsistencies between new and old parts of an ideology. Thus, inaccuracy, incompleteness, and inconsistency are not pathologies of political belief systems. They are the inevitable result of ideologists grappling with a reality that is far more complex than their symbolic constructions can be. Therefore, evaluations of ideologies that identify errors, incompleteness, or inconsistency at a single point in time are often unenlightening. Following Imre Lakatos, evaluations should focus on how a sequence of ideologies—an ideological tradition—evolves.

This essay explores the range of phenomena that can be explained by application of a suitably broad but contentful concept of ideology. According to this concept, an ideology is an evaluative map of the social world, typically featuring an ingroup-outgroup distinction, at least in the case of political ideologies. This concept allows for ideologies that support the existing order and those that challenge it, including revolutionary ideologies. I refute the claim that the concept of ideology is not needed because “voluntary servitude” can be explained as a failure of collective action. I show that ideologies can inhibit revolutionary action as well as stimulate and guide it. They can inhibit revolutionary action by convincing the oppressed that their predicament is natural or inevitable or that they are not being oppressed. They can stimulate and guide revolution by debunking oppression-supporting ideologies and by supplying moral motivation that avoids the calculation of costs and benefits that cause failures of collective action.

This essay outlines an empirically grounded account of normative political legitimacy. The main idea is to give a normative edge to empirical measures of sociological legitimacy through a nonmoralized form of ideology critique. A power structure’s responsiveness to the values of those subjected to its authority can be measured empirically and may be explanatory or predictive insofar as it tracks belief in legitimacy, but by itself it lacks normative purchase. It merely describes a preference alignment, and so tells us nothing about whether the ruled have reason to support the rulers. I argue that we can close this gap by filtering the preferences of the ruled through a form of nonmoralized epistemic ideology critique, itself grounded in an empirical account of how belief in legitimacy is formed.

In response to a crisis, policymakers face the decision of whether to enumerate specific actions the public must do or, instead, to aim at an overall outcome while leaving room open for choice. This essay evaluates the merits and demerits of crisis response that leaves room open for choice, with a particular focus on pandemic response. I evaluate two approaches: trades and offsets. Trades allow individuals or groups to exchange protection against harm or entitlement to engage in risky activity. Offsets allow the same actors to pay to mitigate the effects of decisions that increase risk for others. Choice-friendly approaches can free people to better align their actions with their values, harness local knowledge for better social outcomes, and act as natural experiments. However, they also are subject to objections, including negative externalities, agency problems, exploitation, and exacerbating inequality.

This essay argues that we have a duty to protect biodiversity hotspots, rooted in an argument about the wrongful imposition of risk and intergenerational justice. State authority over territory and resources is not unlimited; the state has a duty to protect these areas. The essay argues that although biodiversity loss is a global problem, it can be tackled at the domestic level through clear rules. The argument thus challenges the usual view of state sovereignty, which holds that authority over territory, resources, and migration (all of which are connected to the protection of biodiversity hotspots) is unlimited.

My aim in this essay is to argue for a better moral-conceptual framework and for institutional innovation in preparation for the next pandemic. My main conclusions are as follows. (1) The primary moral principle that should guide responses to the next pandemic is the duty to prevent and mitigate serious harms. (2) A proper understanding of the moral foundations and scope of the duty to prevent and mitigate serious harms requires rejecting both Extreme Nationalism and Extreme Cosmopolitanism. (3) A better response to the next pandemic requires transforming the moral landscape through institutional innovation by developing an international institution that can perfect indeterminate duties (i) by identifying duty-bearers, (ii) by specifying their duties to provide medical resources and other forms of aid, (iii) by allocating the specified duties to various public and private entities in such a way as to ensure effective coordination and that the costs of providing aid are fairly distributed, and (iv) by providing effective mechanisms for compliance with the specified duties. (4) Institutional innovation is morally required, regardless of whether the harm prevention and mitigation duties of the better-off are duties of justice or of beneficence, because without institutionalization, some duties of justice, including those requiring the prevention and mitigation of serious harms, suffer some of the same indeterminacies that are present in duties of beneficence.

The COVID-19 pandemic brought about at least two normative challenges on unprecedented scale for liberal democracies. One concerned prioritization decisions when health care resources were constrained. The other, which arguably led to lasting damage to social cohesion and citizens’ trust in government and government public health institutions, concerned policies introduced with the aim of reducing the spread of SARS-CoV2, some of which turned out to be mistaken. I discuss in this essay a few examples of misguided, liberty-limiting public health policies and describe how public health and public health ethics principlism provided cover for such policies. Citizens had reasons to be concerned about the duration of such liberty-infringing policies, the absence of predictable government policies, and the absence of transparent justifications for the policies that were implemented.

Liberal political institutions have been an enormous boon for humanity. The free market aspect of liberalism has led to an explosion of innovation, ranging from new kinds of technology and novel forms of entertainment to advances in science and medicine. The emphasis on individual rights at the core of liberalism has increased our ability to explore new ways of living and to construct an identity of our own choosing. But liberal political institutions around the world are facing two crises: low fertility and declining social trust. In particular, liberalism’s focus on individual liberty rather than group cohesion can increase economic productivity by encouraging the free movement of people and capital, but this movement is associated with declines in social cohesion and fertility. In this essay, we highlight some challenges to the long-term evolutionary stability of liberalism. In other words, we raise the question: Can liberalism last?

This essay provides an account of four interrelated ideas. First, a person who is not poor by the standard conception of poverty can still be functionally poor. Second, poverty is a relationship between the poor and their environment (community, local markets, and local institutions). Third, poverty is a determinant of agency and impedes its exercise. Fourth, promoting agency promotes development. I conclude that agency is central to understanding both poverty and development.

We consider the concept of poverty from the asset-accumulation approach and propose an integrated framework, building upon existing theories, to describe how the interconnected factors of trust (or lack thereof) and social distance can reinforce poverty traps. Social distance is influenced by choice, while trust is the symptom that defines the strength of social ties on a group. We look at how an absence of trust influences how households make decisions about the use and accumulation of assets in ways that could perpetuate poverty. Weak trust also affects how groups interact with each other in a society, creating “trust clusters” within homogeneous groups and antagonism across groups, which in turn affects aspirations and leads to an erosion of the basis of a social contract. For more effective and sustainable poverty reduction, we need to understand these linkages and address them systematically.

Poverty can be an ephemeral life stage of a young person whose skill sets will become more valuable with training and experience, a personal setback such as losing a job, or a systemic affliction that puts a whole community in danger of widespread famine. A common theme of this volume’s essays is that we cannot understand poverty and famine unless we acknowledge that poor people are not mouths to be fed but agents. Amartya Sen got this right, crediting Adam Smith for the seeds of his insight. What has been enabling people by the billions since Smith’s time to work their way out of poverty?