Climbing the Pension Mountain: A Review of Michael Otsuka’s 2020 Uehiro Centre Lecture Series

Written by Professor Larry Locke (University of Mary Hardin-Baylor and LCC International University)

On three successive Tuesdays last November, Michael Otsuka of the London School of Economics delivered the annual Uehiro Centre Lecture Series.  The Series, entitled “How to Pool Risk Across Generations”, focused on the ethics of pension reform.  Otsuka attacked the real-world problem of low bond yields producing a crisis of pension funding with three alternative models.  Echoing Derek Parfit’s magisterial work, On What Matters, Otsuka presented his proposals as three alternative means for scaling the dangerous summit of pension obligations.

Otsuka’s proposals are important.  Ethics issues rarely come with this much money at stake.  In 2018, the Office of National Statistics published a study showing that UK pension schemes were underfunded by over £5 trillion .  That is an attention-grabbing number but not extraordinary in the context.  The Trustees of the US Social Security system recently published their 2020 report indicating this scheme alone anticipates a shortfall of US$16.8 trillion over the next 75 years.  Like scientists employing standard form when the numbers they use become too large to comprehend, the US Social Security Administration now refers to its shortfall in terms of percentages of total payroll taxes.

The proposals Otsuka has set forth are not amoral financial models.  Each involves shifting risk and responsibility among parties, and sometimes across generations, with diverse arguments as to the fairness of these shifts.  Any resulting pension system’s impact on lifestyles and liberty for workers, employers, and governments may strain the social contract between these groups and set them up for a potential fall. Continue reading

In Defence of Pretentiousness

Written by Neil Levy

In Paul Brok’s book Into the Silent Land, the English neuropsychologist tells the story of Michael. Following a head injury, Michael is disinhibited. When he first returned from rehab, he lived on a diet of fish fingers and Led Zeppelin.  Michael experiences the change as a return to authenticity. “He’d always liked these things and now he didn’t feel he should pretend otherwise.” Continue reading

Could vaccine requirements for entering pubs be wrong, while closing pubs altogether is OK?

By Tom Douglas

Suppose that, before you could enter a pub, you had to produce a ‘vaccine passport’ showing that you had been vaccinated against the new coronavirus. 

Vaccine requirements like this are controversial. In the UK, the government has been keen to deny that it is even considering their use. This is in some ways puzzling, for closing pubs altogether has not been that controversial, and preventing people from entering pubs without exception seems, at first sight, to be a greater imposition on liberty than preventing people from entering pubs without first being vaccinated. As my colleagues Julian Savulescu and Alberto Giubilini recently noted, it seems better, in terms of liberty, to have some choice than none. 

This raises the question, could a vaccination requirement for entering pubs be wrong, while closing pubs altogether is not?

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DNACPR Orders in a Pandemic: Misgivings and Misconceptions.

by Dominic Wilkinson @Neonatalethics

This week, the Care Quality Commission (CQC) published an interim report into resuscitation decisions during the COVID-19 pandemic. According to a number of media outlets, the report found that in the first wave of the crisis inappropriate and possibly unlawful ‘do not resuscitate’ orders were used “without the consent of patients and families” (see eg Telegraph, Sky).

There are real concerns and important questions to answer about policies and care for patients in care homes and in the community during the pandemic. However, the media stories, and the CQC report itself appear to illustrate two ethical misconceptions.

 

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The Libertarian Argument Is the Best Argument Against Immunity Passports. But is it good enough?

Written by Julian Savulescu and Alberto Giubilini

The government has reportedly flirted with the introduction of vaccination passports that would afford greater freedoms to people who have been vaccinated for COVID-19. However, the UK’s Minister for the Cabinet Office, Michael Gove, recently announced that vaccination passports are not currently under consideration in the UK. However, the issue may linger and businesses may introduce such requirements.

One of us (JS) defended immunity passports in the context of affording people with natural immunity greater freedom during lockdown, if immunity significantly reduces the risk of infecting others.

Vaccination passports–after vaccines have been made available–can be seen as a mild form of ‘mandatory vaccination’.  Proof of vaccination could be a requirement to, for example, access certain places (e.g. restaurants, hospitals, public transport, etc, depending on how restrictive we want the mandate to be) or engaging in certain social activities (e.g. mixing with people from different households) or enable health care or other care workers to not self-isolate if in contact with a person with COVID (there were 35 000 NHS workers in isolation at the peak of the pandemic because of contact). It is worth noting that this kind of measure has already been in place globally for a long time in a more selective way, e.g. in the US where, in most states, children cannot be enrolled in schools unless they are up to date with certain vaccinations. These are also a form of “vaccination passports”, which simply do not use that term. Yellow Fever Vaccination Certificates are required to travel to certain parts of the world where Yellow Fever is endemic.

The ethical ground for restriction of liberty is a person represents a threat of harm to others. That is, the grounds for lockdown, quarantine, isolation or mandating vaccination is to reduce the risk one person poses to another. However, if a person is no longer a threat to others, the justification for coercion evaporates. If either natural immunity or a vaccine prevents virus transmission to others (and this remains to be determined), the grounds for restricting liberty disappear. This is one argument for an immunity or vaccination passport – it proves you are not a threat to others.

Moreover, if we thought there were sufficient grounds for the drastic and long lasting restrictions of individual liberties entailed by lockdowns and isolation requirements, it is at least legitimate to ask whether there are also sufficient grounds for vaccination passports, given that the individual cost imposed – getting vaccinated – is likely to be much smaller than the cost entailed by those other measures (unless the risks of vaccines are significant).

However, the more effective a vaccine is, the greater the opportunity for individuals to protect themselves. A Libertarian could then argue that the risk of harming others is nullified. If you want to protect yourself, you can vaccinate yourself. If this is true, then a vaccine doesn’t need to give us herd immunity. We can take individual responsibility.

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Mandatory Morality: When Should Moral Enhancement Be Mandatory?

By Julian Savulescu

Together with Tom Douglas and Ingmar Persson, I launched the field of moral bioenhancement. I have often been asked ‘When should moral bioenhancement be mandatory?’ I have often been told that it won’t be effective if it is not mandatory.

I have defended the possibility that it could be mandatory. In that paper with Ingmar Persson, I discussed the conditions under which mandatory moral bioenhancement that removed “the freedom to fall” might be justified: a grave threat to humanity (existential threat) with a very circumscribed limitation of freedom (namely the freedom to kill large numbers of innocent people), but with freedom retained in all other spheres. That is, large benefit for a small cost.

Elsewhere I have described this as an “easy rescue”, and have argued that some level of coercion can be used to enforce a duty of easy rescue in both individual and collective action problems. Continue reading

Cross post: Pandemic Ethics: Should COVID-19 Vaccines Be mandatory? Two Experts Discuss

Written by Alberto Giubilini (Oxford Uehiro Centre for Practical Ethics and WEH, University of Oxford )

Vageesh Jaini (University College London)

(Cross posted with the Conversation)

 

To be properly protective, COVID-19 vaccines need to be given to most people worldwide. Only through widespread vaccination will we reach herd immunity – where enough people are immune to stop the disease from spreading freely. To achieve this, some have suggested vaccines should be made compulsory, though the UK government has ruled this out. But with high rates of COVID-19 vaccine hesitancy in the UK and elsewhere, is this the right call? Here, two experts to make the case for and against mandatory COVID-19 vaccines.

 

Alberto Giubilini, Senior Research Fellow, Oxford Uehiro Centre for Practical Ethics, University of Oxford

COVID-19 vaccination should be mandatory – at least for certain groups. This means there would be penalties for failure to vaccinate, such as fines or limitations on freedom of movement.

The less burdensome it is for an individual to do something that prevents harm to others, and the greater the harm prevented, the stronger the ethical reason for mandating it.
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Refusal Redux. Revisiting Debate About Adolescent Refusal of Treatment.

by Prof Dominic Wilkinson @Neonatalethics

Last month, in an emergency hearing, the High court in London heard a case that characterises a familiar problem in medical ethics. A 15 year old adolescent (known as ‘X’) with a long-standing medical condition, Sickle Cell disease, had a very low blood count and required an urgent blood transfusion. However, X is a Jehovah’s Witness and did not wish to receive blood as it was contrary to her religious beliefs. X’s doctors believed that she was at risk of very serious health consequences without a blood transfusion (a stroke, or even death).

Of no great surprise to anyone, the court authorised the emergency blood transfusion for X. Although X was “mature and wise beyond her years”, and judged to be ‘Gillick competent’ (see below), the judge made the decision in her best interests.

That decision is consistent with many previous cases that have come to the courts in the UK and overseas (see here, here, here )[1]. It is very similar to the case in Ian McEwan’s novel and film “The Children Act” (the book, had been based on real cases before the courts). The courts, in the UK at least, have always decided to over-rule under-eighteens who wish to refuse potentially life-saving treatment. Once the teenager reaches the age of eighteen, the decision is different, however. At that point, if they are judged to have “capacity”, (ie they have the ability to use, understand, and communicate the information necessary for a decision)  they can refuse even if the treatment would certainly save their life.

Although the decision is unsurprising, the judge made a comment implying that future cases might not always reach the same conclusion. X’s lawyer argued that the traditional legal approach may be “in need of urgent re-analysis and review”, and the judge appeared to agree that these arguments needed careful consideration (not possible acutely given the urgency of X’s case).

Should the ethical and legal approach to adolescents who refuse treatment change?

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Legacies

By Stephen Rainey

Joe Biden won the recent US election. As yet, the normal concession speech from the losing candidate has not been forthcoming. Donald Trump’s actions since losing the presidency have been, well, Trumpian, prompting Biden to label them an ‘embarrassment.’ He also suggested that The Donald was endangering his legacy in not reacting more gracefully. But what use is talk of ‘legacy’? What matters most about it?

It would be easy to ‘Goldwater’ Trump, that is, diagnose some mental incapacity from afar. One could suggest he was ill-equipped to absorb his defeat. He has behaved in ways that could be seen as pathological. Maybe, we might continue, he really doesn’t believe this is the end. If that were the case, there would be no need to consider legacy. It would also be easy to have suspected that, far from sticking around, 45 would flounce out of the White House, his pride wounded. Legacy wouldn’t matter in that case, because the electorate, the people, would have shown themselves to be unworthy, having voted the wrong way. Sad. Continue reading

Antenatal Care During The COVID-19 Pandemic: Couples As Dyads

Written by Rebecca Brown

 

During the pandemic, many healthcare services have been reduced. One instance of this is the antenatal care of expectant mothers. Ordinarily, partners of pregnant women are permitted to attend appointments. This includes the 12 week scan: typically the first opportunity expectant parents get to see the developing foetus, to discover whether it has a heartbeat and is growing in the right place. This can be very exciting and, if there’s bad news, devastating. It also includes scans in mid pregnancy and (for first-time mothers) at 36 weeks, as well as the entirety of labour.

During the pandemic, many healthcare providers have restricted attendance at antenatal appointments as well as labour and postnatal care. Even when lockdown restrictions were eased, with pubs, zoos and swimming pools re-opening and diners in England being encouraged to Eat Out to Help Out, some hospitals continued to exclude partners from all antenatal appointments and all but the final stage of labour, requiring them to leave shortly after birth. This included cases where mother and newborn had to remain on wards for days following delivery. With covid cases rising, it seems likely that partners will once again be absent from much antenatal, labour, and postnatal care across the country. Continue reading

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