Dale Murray

The Massachusetts Health Plan, Individual Mandates, and the Neutrality of the Liberal State

In 2007, Massachusetts instituted a universal coverage health plan that requires all citizens to purchase insurance. I argue that there is nothing wrong in principle with the use of an individual mandate to force citizens to secure health insurance. I argue that state neutrality is not tenable on this issue. Then I proceed to show that even if state neutrality were viable, it is not a violation of state neutrality (thought of as neutrality of intent) to force citizens to insure themselves with the primary purpose of securing the normative good of health. I adapt recent work on universal medical coverage to demonstrate that such a mandate is in keeping with several principles of fairness shared in liberal democratic societies. This argument not only applies to the Massachusetts plan but likely to any other health care coverage schemes using individual mandates in the US political context, including recently passed federal health care reform measures. However, even though the Massachusetts plan may provide increased access to health care for many, there are still legitimate worries that it currently places disproportionate financial burdens on the working poor and thus will need refinement.

Monitoring Shared Health Governance

countless other aspects of that individual’s life. The types of disadvantage suffered by an individual lacking a functioning, such as with the celibate monk, is not corrosive.4 The lack of sexual relationships in the monk’s life does not adversely affect his ability to pursue life plans, or to secure capabilities of the first-order variety. I argue that by extending Sen’s distinction between basic and non-basic capabilities in the way just described, we can begin to adequately explain the special moral importance of health in the context of the capabilities approach. Conceptualizing a capabilities framework in this way also assists in arguing for shared responsibility in the provision of basic health capabilities. Ruger rightly argues that national governments are in “the best position to create and disseminate public goods necessary for sustaining health capabilities” (32), and my notion of foundational material conditions justifies why, as a matter of justice, such a heavy responsibility lies as it does. It is only after we have adequately explained the special moral importance of health that the notion of SHG gains the traction to have an

Reflections on Public Funding for Professional Sports Facilities

During the past two decades, there has been increased debate over the acceptability of public financing of stadiums, arenas and other supplemental facilities1 for professional sports franchises, particularly in the United States and Canada. With one notable exception, all of these franchises are private, for-profit businesses.2 Mayors, community activists, neighborhood associations and other private citizens have at times strenuously contested the demands from pro sports teams for public support of stadiums. These stakeholders claim that taxpayers should not have to subsidize private interests, often citing the nebulous economic benefits of new sports facilities for the community.3 On the other side, sports franchise owners contend that for teams to remain in their current geographical regions, they need publicly funded venues to be built and maintained due to the high costs of such facilities.4 The position of team owners with respect to sporting facilities can be summed up as ‘we can only provide the programming if you supply the infrastructure.’ However, while some of the terms used by both sides of the debate have been normative (i.e., ‘taxpayers shouldn’t have to pay for the benefit of the few’ versus ‘citizens should pay for the benefits that sporting events offer,’ etc.), the arguments deployed have been primarily economic or otherwise pragmatic.5 But much of this begs the question of why citizens should or shouldn’t be taxed to pay for the building of sporting facilities intended for professional athletic competition in the first place. That is not to say that economic arguments have no bearing on the acceptability of such financing or that such arguments have no normative element. Obviously jobs and financial security provide important opportunities to citizens in constructing their own conceptions of the good life and no thoughtful political philosopher would deny this.6 In fact, I will take the economic arguments in favor of such financing very seriously. But I resist the temptation to mimic the approach of many who only appear to concern themselves with economic factors. In this paper, I examine public financing of professional sports facilities from a liberal egalitarian perspective of distributive justice. Pragmatically, I select this perspective to limit our scope. But, it is also (arguably) the dominant theory in political philosophy and fits well in the US liberal political tradition (which is

Liberalism, Art, and Funding

Since Ronald Dworkin published A Matter of Principle, a host of critics have attempted to systematically dismantle his arguments advocating state support for the arts that appear in a chapter entitled, “Can a Liberal State Support Art?”1 The combined critical force of Noël Carroll, Samuel Black, and most recently, Harry Brighouse, has dislodged the main supports of Dworkin’s position on this subject.2 However, while I am skeptical that the arguments of liberals who endorse state support for the arts can be fully resurrected, I reckon that a few remarks can be presented to try to deflect at least a fraction of the contentions cast on Dworkin’s argument by the critics listed above. In order to refine our understanding of precisely why state support for cultural expression should or should not be permitted, it is imperative that some sort of response to the critics of state support for the arts is offered. In this essay, I focus primarily on Brighouse’s objections that Dworkin’s arguments supporting arts funding fail primarily because they are not sensitive enough to the ways in which such support violates two demands of justice in a liberal state — state neutrality and publicity. I examine these two objections since they seem to be the most interesting, compelling, and damaging to Dworkin’s case if substantiated. If Brighouse is correct, these violations act as heavy bulwarks against state support for arts funding, especially since public distrust of the state’s intent (and the state’s perceived advocacy of notions of the good with which the public disagrees) is high. I will employ Brighouse’s neutrality of intent constraint, because it best represents the alleged specific violations of state neutrality that may undermine Dworkin’s case. Additionally, neutrality of intent is the most plausible form of neutrality for advocates of public arts funding to build a case for in the space of a short essay. I also wish to make a distinction, which for the most part, is ignored by Dworkin’s critics — that there is a degree to which moral value and aesthetic value are different and that this effects a possible alternative reading of the term “ways of life” as most liberals understand it. As a final note of preface, I will assume that the background conditions of income and wealth are just.3 This proviso will become important when we examine the role of the market in funding arts projects in lieu of the government. Now let us reiterate the two requirements of any just liberal state that are at issue when considering the legitimacy of state support for the arts.

The Global and the Local: An Environmental Ethics Casebook

In The Global and the Local: An Environmental Ethics Casebook, Dale Murray presents fifty-one compelling case studies. By interweaving theoretical considerations into case studies, Murray illuminates a comprehensive range of the most pressing environmental issues facing our biosphere.

An Expanded Understanding of Individual Medical Benefit

There has been some enthusiasm for the possibility of treating incarcerated psychopaths using deep brain stimulation (DBS) techniques. However, H€ ubner and White (2016) make a compelling case that incarcerated psychopaths cannot meet the legal and moral requirements of voluntary informed consent to such procedures in principle. Since psychopaths by definition don’t care if they are doing anything wrong when they transgress moral or legal boundaries, they do not have internal motivation to agree to research or therapeutic DBS for their condition. This would mean that if incarcerated psychopaths had any motivation to consent to DBS procedures, it would be for external reasons (perhaps for a reduced prison sentence) that would likely constitute undue influence. Since incarcerated psychopaths are members of a vulnerable group (prisoners), external motivations are not sufficient for voluntary informed consent to DBS. With this, H€ ubner and White make a sufficiently strong case to undermine the idea that incarcerated psychopaths could meet the requirements for voluntary informed consent to DBS. But H€ ubner and White make a second claim that is not as clearly substantiated. They argue that incarcerated psychopaths also cannot receive any individual medical benefit from DBS procedures, as they do not suffer from their condition. That is, psychopaths do not perceive themselves as having any problem at all—in fact, they seem quite content with their condition. Because incarcerated psychopaths are part of a vulnerable group that has been exploited before in research and clinical procedures, the threshold for individual medical benefit is high. Thus, for all prisoners what qualifies as individual medical benefit needs to be direct and subjective. The definition of individual medical benefit for incarcerated psychopaths (as for all other inmates) thus requires that they detect in their subjective experience suffering that treatment or research protocols have a reasonable chance of remedying. However, since incarcerated psychopaths don’t in fact experience such suffering, they would not receive individual medical benefit and thus not qualify for therapeutic or research DBS. On the one hand, H€ ubner and White worry that psychopathy is too “medicalized”—that it isn’t something from which one can really be cured because it isn’t really a disease, but instead a configuration of socially unacceptable traits. (I realize they say that for the sake of argument they accept psychopathy as an ailment.) However, H€ ubner and White also anticipate the objection that their focus is too much on medical research and therapy, while proposed DBS for psychopaths might be considered a “moral enhancement” instead of a medical intervention. Curiously, H€ ubner and White retort that they would worry about such “de-medicalization” of psychopathy. It’s unclear how H€ ubner and White can consistently hold both of these stances. It would be useful to know how they would (definitively) classify psychopathy—presumably it can’t be a medical and nonmedical condition simultaneously, so which is it? Also, it is unclear why removing the distress of the imposition of social sanctions wouldn’t be enough to qualify as an individual medical benefit. How do we distinguish the distress of a psychopath who is incarcerated from her subjective suffering? Even if this “distress” isn’t an example of subjective suffering, it will likely be experienced as some sort of impediment, perhaps to her autonomy. After all, incarcerated psychopaths are experiencing something that causes them to desire freedom over incarceration. But beyond that, H€ ubner and White could be correct that incarcerated psychopaths can’t subjectively suffer from their condition. This leaves us with an intriguing normative question. Should subjective individual medical benefit necessarily be the sole criterion for medical benefit for any prisoner? Why can’t other types of individual benefit qualify as medical benefit, at least to the extent that a condition can be treated? After all, when physicians strive

Deep Brain Stimulation, Autonomy, and Harm

Gilbert (2015) is correct to have worries about the implications of deep brain stimulation (DBS) on patient autonomy. However, it is not clear just how extensive these worries should be, for two re...

Clarifications of the Descriptive/Normative Distinction in Dubljević and Racine's “The ADC of Moral Judgment”

a distinct, separate process from the intuitions described earlier). In conclusion, the ADCmodel offers an exciting opportunity to test the interactions between agency, deeds, and consequences not only in normal subjects but also in neurological patients where dissociation of the influence of each factor in different patient groups can add validity to psychological theories regarding moral judgments. Existing evidence from patients argues against a separation of agency from deeds and suggests instead that deontological rules inherently involve determinations of intentional states of agents. Character virtues might contribute, along with current intentions of the agent and the severity of the deed, toward the heuristic of “moral goodness” and blameworthiness of the agent based on predictions of future social behavior, separate from consequentialist intuitions, which focus on the action and subsequent causative effects but not on the agents themselves. Further empirical data from both patients and normal subjects is needed to determine the validity of such an approach.

Presumptions against School District Secession.

While political philosophers have paid a great deal of attention to providing a theory of secession for cases of nations breaking away from nation-states, little has been said about perhaps the most common type of secession — school district secession. I argue that while there is no principled prohibition against school district secession, there are presumptions against the practice. After discussing why justice requires that all children are provided with an education that is autonomy-facilitating and also meets the standards of equality of opportunity, I show that many arguments offered for school district secession do not meet the criteria for justice. Finally, I investigate one policy alternative that concerned parents (at least those with more principled reasons for school district secession) may consider to mitigate their need to secede in cases where they seek more direct participation in the political decisions of their school districts.