Ethics

Are Incentives Corrupting? The Case of Paying People to be Healthy.

Written by Dr Rebecca Brown

Financial incentives are commonplace in everyday life. As tools of states, corporations and individuals, they enable the ‘tweaking’ of motivations in ways more desirable to the incentiviser. A parent may pay her child £1 to practice the piano for an hour; a café offers a free coffee for every nine the customer buys; governments offer tax breaks for homeowners who make their houses more energy efficient. Most people, most of the time, would probably find the use of financial incentives unobjectionable.

More recently, incentives have been proposed as a means of promoting health. The thinking goes: many diseases people currently suffer from, and are likely to suffer from in the future, are largely the result of behavioural factors (i.e. ‘lifestyles’). Certain behaviours, such as eating energy dense diets, taking little exercise, smoking and drinking large amounts of alcohol, increase the risk that someone will suffer from diseases like cancer, heart disease, lung disease and type II diabetes. These diseases are very unpleasant – sometimes fatal – for those who suffer from them, their friends and family. They also create economic harms, requiring healthcare resources to be directed towards caring for those who are sick and result in reduced productivity through lost working hours. For instance,the annual cost to the economy of obesity-related disease is variously estimated as £2.47 billion£5.1 billion and a whopping $73 billion (around £56.5 billion), depending on what factors are taken into account and how these are calculated. Since incentives are generally seen as useful tools for influencing people’s behaviour, why not use them to change health-related behaviours? Why not simply pay people to be healthy? Continue reading

Damages and communitarianism

By Charles Foster

The Lord Chancellor recently announced that the discount rate under the Damages Act 1996 would be decreased from 2.5% to minus 0.75%. This sounds dull. In fact it is financially tectonic, and raises some important ethical questions.

In the law of tort, damages are intended to put a claimant in the position that she would have been in had the tort not occurred. A claimant who, as result of negligence on the part of a defendant, suffers personal injury, will be entitled to, inter alia, damages representing future loss of earnings, the future cost of care and, often, private medical and other treatment.

Where damages are awarded as a lump sum, there is a risk of over-compensating a claimant. Suppose that the claimant is 10 years old at the time of the award, and will live for 70 years, and the future care costs are £1000 a year for life. Should the sum awarded be £1000 x 70 years = £70,000? (70, here, is what lawyers call the ‘multiplier’). It depends on the assumption one makes about what the claimant will do with the lump sum. If she invests it in equities that give her (say) an annual 5% return, £70,000 would over-compensate her.

In the case of Wells v Wells1, the House of Lords decided that, to avoid the risk of under-compensation, claimants should be treated as risk-averse investors. It should be assumed, said the House, that the discount rate should be fixed by reference to the return on index-linked gilts – Government securities. The rate was 2.5% from 2001 until February of this year. The reasons for the change to minus 0.75% are hereContinue reading

The bright side of Brexit

Let’s suppose, entirely hypothetically and for the sake of argument, that Brexit is a disaster for the UK. Let’s suppose that sterling crashes; that foreign travel is punishingly expensive and that, if you can afford to go abroad, you’re a laughing stock. Let’s suppose that the Treasury’s estimates of billions of pounds of losses each year are reasonably accurate; that unemployment rises; that credit ratings plummet. Let’s suppose Brexit creates a corrosive tide of racism; that things that should never be said, and can never be unsaid, are shouted at high volume. Let’s suppose that there’s a torrential brain drain; that UK universities fall down the international league tables; that the innovative treatments prescribed (to private patients only, unfortunately – no money left for the NHS) by the UK’s (predominantly white) doctors are all devised in New York, Paris and Rome rather than London and Leeds. Let’s suppose that the environment, unprotected by EU legislation, is trashed, and that Scotland leaves the UK.  Let’s suppose, too, that nervousness about all this creates an increasingly authoritarian style of government .

If all that happens, it’ll be great. At least if you’re a consistent utilitarian. The horror of the UK’s experience will strengthen the EU and prevent other countries from thinking that they should leave the Union – which would have similarly disastrous results for them and, if the EU itself dissolves, tectonic consequences for the stability of the world. Continue reading

The goodness of being multi-planetary

The Economist has a leader “For life, not for an afterlife“, in which it argues that Elon Musk’s stated motivation to settle Mars – making humanity a multi-planetary species less likely to go extinct – is misguided: “Seeking to make Earth expendable is not a good reason to settle other planets”. Is it misguided, or is the Economist‘s reasoning misguided? Continue reading

DNA papers, please

Kuwait is planning to build a complete DNA database of not just citizens but all other residents and temporary visitorsThe motivation is claimed to be antiterrorism (the universal motivation!) and fighting crime. Many are outraged, from local lawyers over a UN human rights committee to the European Society of Human Genetics, and think that it will not be very helpful against terrorism (how does having the DNA of a suicide bomber help after the fact?) Rather, there are reasons to worry about misuse in paternity testing (Kuwait has strict adultery laws),  and in the politics of citizenship (which provides many benefits): it is strictly circumscribed to paternal descendants of the original Kuwaiti settlers, and there is significant discrimination against people with no recognized paternity such as the Bidun minority. Plus, and this might be another strong motivation for many of the scientists protesting against the law, it might put off public willingness to donate their genomes into research databases where they actually do some good. Obviously it might also put visitors off visiting – would, for example, foreign heads of state accept leaving their genome in the hands of another state? Not to mention the discovery of adultery in ruling families – there is a certain gamble in doing this.

Overall, it seems few outside the Kuwaiti government are cheering for the law. When I recently participated in a panel discussion organised by the BSA at the Wellcome Collection about genetic privacy, at the question “Would anybody here accept mandatory genetic collection?” only one or two hands rose in the large audience. When would it make sense to make mandatory genetic information collection? Continue reading

The Chinese pleasure room: ethics of technologically mediated interaction

The author of the webcomic Left Over Soup proposed a sexual equivalent (or parody?) of Searle’s Chinese Room argument, posing some interesting questions about what it means to have sex, consent and relationships if there is technological mediation:

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Veterinarians and the best interests of animals

By Charles Foster

English law has traditionally, for most purposes, regarded animals as mere chattels. There is now animal welfare legislation which seeks to prevent or limit animal suffering, but provided that legislation is complied with, and that no other relevant laws (eg those related to public health) are broken, you are free to do what you want with your animal.

Veterinary surgeons are in an interesting position. The UK regulatory body for veterinarians, the Royal College of Veterinary Surgeons (‘RCVS’) publishes a Code of Professional Conduct. This provides, inter alia:

‘1.1  Veterinary surgeons must make animal health and welfare their first consideration when attending to animals.’

‘2.2  Veterinary surgeons must provide independent and impartial advice and inform a client of any conflict of interest.’ 

‘First consideration’ in 1.1 is a rather weasly formulation. Does it mean that it is the overriding consideration, trumping all others, however weighty those others might be? Or the one that veterinarians ought to consider first, before moving on to other criteria which might well prevail? Continue reading

Does late parenthood deprive children of grandparental love?

By Hannah Maslen

In a new post, published by Aeon, I argue that, even if there are moral reasons for and against intentionally delaying parenthood (including, amongst other things, the reduced opportunity for grandparental relationships as a reason against), older parents should not feel guilty if their late parenthood means that their child does not get to know his or her grandparents. Whilst the situation itself might be regrettable (i.e. there might be an understandable wish that things were different), the parent has not deprived their particular child in anyway. Correspondingly, the child has no legitimate complaint (on these grounds) against his or her parent. If the parent had been successful in conceiving earlier, that particular child would not have existed.

Republished in full below: Continue reading

Should we watch the Olympics?

Arthur Caplan and Brendan Parent

Cross-posted from OUP Blog, Ethics of Sport: Essential Readings 

We used to have to take time off from work –or at least leave work early– to watch the Olympics on TV. Now we can thank the engineering marvels of DVR and web replay for protecting our love affair with the Games from our evil work schedules. We are, rightly, mesmerized by the combination of talent, discipline, skill, and genetics embodied by the world’s greatest athletes. While admittedly luck plays a role, these elite athletes use strategies tuned over decades to prove who is the best on the world’s biggest sports stage. What is not to like? This year’s games promise to be epic with greats like Bolt and Phelps closing out their legacies, unstoppable rookies like Simone Biles planning to make their mark, and new sports like Rugby and Golf looking to reach new international audiences. Ready or not, here comes Rio 2016!

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The Unfairness of Unattractiveness

In the job market being attractive is advantageous. According to economist Daniel Hamermesh, an attractive man can earn, over a life time, $230,000 more than an unattractive one[1]. Attractive solicitors raise more money for charities[2].  Very attractive individuals are less likely to engage in criminal activities, whereas unattractive ones have higher propensity for crime[3]. Attractive criminals are punished less severely than unattractive ones[4].

Both children and adults judge attractive people to be more helpful, more intelligent, and more friendly than their unattractive counterparts[5].

Cute infants elicit stronger motivation for care-taking than less cute ones[6]. Moreover, cute infants are rated as most adoptable[7].

Adults have higher expectations of attractive kids compared to non attractive ones[8] and mothers of attractive infants tend to be more affectionate, playful, and attentive when interacting with their children than mothers of less attractive infants[9]. Teachers expect better performances from attractive students[10]. Transgressions of unattractive children are judged more negatively than transgressions of attractive ones[11].

Being attractive is also an advantage in romantic relationships[12] as there is a positive correlation  between physical attractiveness and dating [13][14].

One response to unfairness is to get people to stop discriminating unfairly. This might work for some domains, such as employment where interviews could be conducted blind. But it won’t be possible to counteract all the potential downsides.

We can’t require people to like or fall in love with people they find unattractive. There are at least two possible responses:

  1. Assist people to find attractive what they currently find unattractive
  2. Assist people to be more attractive to those who currently find them unattractive

Both of these are reasonable solutions. The second is cosmetic enhancement.

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