What purpose can be served by empirically unsubstantiated speculation in ethics? In answering that question, we need to distinguish between the major branches of ethics. In foundational moral philosophy, the use of speculative examples is warranted to the extent that ethical principles and theories are assumed to be applicable even under the extreme circumstances referred to in these examples. Such an assumption is in need of justification, and it cannot just be taken for granted. In applied ethics, the use of unrealistic scenarios is more difficult to justify. It can be positively harmful if it diverts our attention from more urgent issues. Neuroethics is one of the areas of applied ethics where speculative scenarios have taken up much of the attention that could instead have been devoted to problems that are relevant for the treatment and care of patients. Speculative ethics has often been defended with mere possibility arguments that may at first hand seem difficult to refute. It is shown with examples how such claims can be defeated with a combination of science and argumentation analysis.

In their daily clinical work, healthcare professionals generally apply what seems to be a double standard for the responsibility of patients. On the one hand, patients are encouraged to take responsibility for lifestyle changes that can improve their chances of good health. On the other hand, when patients fail to follow such recommendations, they are not held responsible for the failure. This seeming inconsistency is explained in terms of the distinction between task responsibility and blame responsibility. The double standard for responsibility is shown to be epistemologically rational, ethically commendable, and therapeutically advantageous. However, this non-blaming approach to patient responsibility is threatened by proposals to assign lower priority in healthcare to patients who are themselves responsible for their disease. Such responsibility-based priority setting requires that physicians assign blame responsibility to their patients, a practice that would run into conflict with the ethical foundations of the patient–physician relationship. Therefore, such proposals should be rejected.

Occupational exposures of pregnant workers can give rise to foetal damage. Two major types of strategies against detrimental effects on the foetus are described: differentiated protection that reduces only the exposure of pregnant workers (or only of female workers) and unified protection that reduces the exposure of all workers to a level that is sufficiently low to protect against detrimental effects on the foetus. The former strategy is shown to be inefficient, as it does not provide the desired protection. Protection only of pregnant workers is insufficient since protection is needed early in pregnancy when it is not known, and in the case of substances that are accumulated in the woman's body even prior to conception. Protection of all women is also insufficient to protect the foetus since evidence indicates that preconception exposure of the father can also give rise to malformations. Furthermore, differentiated protection that requires more costly protective measures for women tends to aggravate the already prevalent discrimination of women on the labour market. It is therefore concluded that unified protection is the only efficient and non-discriminatory strategy against foetal damage.

In order to shorten queues to healthcare, the Swedish government has introduced a yearly “queue billion” that is paid out to the county councils in proportion to how successful they are in reducing queues. However, only the queues for first visits are covered. Evidence has accumulated that queues for return visits have become longer. This affects the chronically and severely ill. Swedish physicians, and the Swedish Medical Association, have strongly criticized the queue billion and have claimed that it conflicts with medical ethics. Instead they demand that their professional judgments on priority setting and medical urgency be respected. This discussion provides an interesting illustration of some of the limitations of new public management and also more generally of the complicated relationships between medical ethics and public policy.

The outcome set of a belief change operator is the set of outcomes that can be obtained with it. Axiomatic characterizations are reported for the outcome sets of the standard AGM contraction operators and eight types of base-generated contraction. These results throw new light on the properties of some of these operators.

Richard Wollheim (1962) provided an acute formulation of the problematic situation of an outvoted democrat. We are invited to consider an individual who endorses the democratic procedure, or ‘democratic machine’. Furthermore, this person prefers policy A, and has voted for it. “He chooses A or prefers A to B, because he thinks that A is the best policy, is the policy that ought to be enacted, or, alternatively, that A is a better policy than B or ought to be enacted in preference to B” (pp. 77–78). Now, how does this person react when it turns out that the democratic decision was in favour of B? “How can the citizen accept the machine's choice, which involves his thinking that B ought to be enacted when, as we already know, he is of the opinion, of the declared opinion, that A ought to be enacted?” (p. 78).

The prescriptive ‘ought’ has both an objective and a subjective interpretation. In the objective sense, what one ought to do depends on what is actually true. In the subjective sense it depends on what one believes to be true. Ordinary usage seems to vacillate between these two interpretations. An example (the indecisive terrorist) is used to show that a subjective ought statement can have a determinate truth-value in situations where the corresponding objective ought statement has no truth-value, not even an unknowable one. Therefore the subjective ought is not definable in terms of the objective ought. However, definability in the other direction is not excluded by this argument.

Three of the bioethical issues recently discussed in Sweden appear to be particularly interesting also to an international audience. A new law allowing restrictive use of preimplantation genetic diagnosis (PGD)/human leukocyte antigen (HLA) (“savior siblings”) has been implemented, a new recommendation for the cessation of life-sustaining treatment has been issued, and the scope of individual responsibility for medical mistakes has been rather thoroughly discussed.

Cost–benefit analysis (CBA) is much more philosophically interesting than has in general been recognized. Since it is the only well-developed form of applied consequentialism, it is a testing-ground for consequentialism and for the counterfactual analysis that it requires. Ten classes of philosophical problems that affect the practical performance of cost–benefit analysis are investigated: topic selection, dependence on the decision perspective, dangers of super synopticism and undue centralization, prediction problems, the indeterminateness of our control over future decisions, the need to exclude certain consequences for moral reasons, bias in the delimitation of consequences, incommensurability of consequences, difficulties in defending the essential requirement of transferability across contexts, and the normatively questionable but equally essential assumption of interpersonal compensability.

Healthcare depends increasingly on advanced medical technology. In addition, other forms of technology contribute to determine how our lives are influenced by disease and disability. The extent to which persons with impaired bodily functions are forced to live their lives differently than other people depends to a large part on a variety of technologies, from wheelchairs to computer interfaces, from hearing aids to garage doors. This wide-ranging influence of technology has important ethical aspects, but has seldom been discussed in bioethics, the ethics of technology, or other branches of applied ethics.

Mainstream risk analysis deviates in at least two important respects from the rationality ideal of mainstream economics. First, expected utility maximization is not applied in a consistent way. It is applied to endodoxastic uncertainty, i.e. the uncertainty (or risk) expressed in a risk assessment, but in many cases not to metadoxastic uncertainty, i.e. uncertainty about which of several competing assessments is correct. Instead, a common approach to metadoxastic uncertainty is to only take the most plausible assessment into account. This will typically lead to risk-prone deviations from risk-neutrality. Secondly, risks and benefits for different persons are added to form a total value of risk. Such calculations are used to support the view that one should accept being exposed to a risk if it brings greater benefits for others. This is in stark contrast to modern Paretian welfare economics, that refrains from interindividual comparisons and does not require people to accept a disadvantage because it brings a larger advantage for others.

Sweden is probably one of the most secularized nations in the world. Therefore religious arguments tend to play a smaller role in the public bioethical debate than in most other countries. Issues such as abortion, stem-cell research, and therapeutic cloning have been far less controversial in Sweden than elsewhere. Instead, other issues have dominated recent bioethical debates in Sweden, in particular those concerning privacy and the control over biological information about individuals.

This article argues that, contrary to the received view, prioritarianism and egalitarianism are not jointly incompatible theories in normative ethics. By introducing a distinction between weighing and aggregating, the authors show that the seemingly conflicting intuitions underlying prioritarianism and egalitarianism are consistent. The upshot is a combined position, equality-prioritarianism, which takes both prioritarian and egalitarian considerations into account in a technically precise manner. On this view, the moral value of a distribution of well-being is a product of two factors: the sum of all individuals' priority-adjusted well-being, and a measure of the equality of the distribution in question. Some implications of equality-prioritarianism are considered.

Due to modern biochemistry and, in particular, recent developments in genomics, proteomics, and bioinformatics, human samples (organs, tissues, cells, genes, etc.) have become the most important raw materials for advancement in the health sciences. Such material has been at the center of fundamental biomedical research for a long time. What is new is its increased usefulness in research with direct clinical relevance, such as the development of drugs. Because of the larger commercial involvement in such research, this has also led to greater economic interests in human biological material and in the information that can be extracted from it.

Five types of constructions are introduced for non-prioritized belief revision, i.e., belief revision in which the input sentence is not always accepted. These constructions include generalizations of entrenchment-based and sphere-based revision. Axiomatic characterizations are provided, and close interconnections are shown to hold between the different constructions.

The notion of residual obligations can be used as a tool to overcome, at least in part, the conflict between the individual's prima facie right not to be exposed to involuntary risks, and the rights of industries and other large organisations to carry out activities that are associated with risks. A typology of residual obligations is developed, and it is applied in a discussion of the moral obligations of those who impose risks on others. The major types are obligations to compensate, to communicate, to improve, to search for knowledge, and to have an appropriate attitude. It is argued that conscientious compliance with risk-related residual obligations is an essential component of what makes it morally acceptable to expose others to risk.