In order to comply with California’s End of Life Option Act, healthcare organizations must post their medical aid in dying (AID) policy on their publicly accessible website. We analyzed available policies for whether organizations choose to participate in AID and whether organizations add restrictions to or conditions of participation for healthcare providers or patients that are not contained in the text of the law. Our research demonstrates that healthcare organizations, most of them private, mediate medical decision-making rights granted by the state. This chapter focuses on a few organizations’ AID policies to illustrate this process, and demonstrates how employment contracts with healthcare professionals and medical staff bylaws and staff privileges for physicians constrain involvement in AID and affect the physician–patient relationship. This chapter argues that the spread of AID across the United States is mostly a symbolic victory for patient rights advocates because in practice, this option is not available to many patients due to healthcare organizations’ policies. This chapter concludes by suggesting changes to informed consent practices so that seriously ill patients are informed about whether their current care providers participate in AID before the patients would need to make the request, so they can find new doctors if this is an end-of-life option they wish to pursue.

Chapter 5 takes stock and considers the bigger picture in normative ethics. I first make explicit the analogy to the three strategies outlined in Chapter 1 and what we can learn from this about the analogous strategies in ethics. I discuss the charge of gimmickyness against conseqentializing and deontologizing, arguing that these algorithms in ethics are more plausible than similar ones in science. Still, I acknowledge the need for case studies, arguing that, even though much has been missing so far, we have a very strong case study in Parfit and that, due to the completeness of moral theories, this might already establish more than one might think at first sight. Next, I draw a map of underdetermination in ethics, assessing each version of the thesis that has been identified for the scientific realm in Chapter 1 in terms of its status in ethics. To finish, I outlinethe three most important impacts of moral underdetermination for the future of normative moral theorizing, having to do with falsification, the role of theoretical virtues, and the justification of moral theorizing itself.

The ability of private law to shape health care and public health is evident in the effects that tort law had on improving patient safety in anesthesiology and curtailing the marketing of tobacco products. One would think of health care costs as a fertile area for litigation, for many reasons: widespread provider of opportunism that invites legal challenges under a number of theories; the considerable resources that payers and health policy philanthropies have available to invest in litigation strategies; and the high stakes involved in a large industry that is unusually aggressive in the chase for consumer and health insurance dollars. One can find numerous examples of parties pursuing legal action to lower costs, often successfully. But what is striking about these cases is how isolated they are – largely individual, uncoordinated efforts – and how they have failed to meaningfully curtail provider excesses. Most tellingly, the problem of balance billing by out-of-network physicians never gave rise to significant litigation and was resolved by Congressional action that, ironically, incorporated existing common law doctrines.

This paper reviews instances of provider opportunism to obtain higher prices, including contriving to bill “charges” rather than accepting market prices for services; “upcoding” for services by overstating the amount of work involved; and consolidation to achieve market concentration and power vis-a-vis payers. It then discusses available legal theories to remedy such conduct and inventories efforts to invoke them. Finally, it applies political science theories to analyze potential explanations for the dearth of litigation in this area.

Chapter 7 discussesa novel position in metaethics that the skeptical argument might give rise to: constructive deonticism. This position is structurally analogous to one of the most discussed anti-realist positions in science, Bas van Fraassen’s constructive empiricism. I start with an overview of van Fraassen’s view, discussing both its most important features and how it relates to its main rivals, scientific realism and logical positivism. Next, I flesh out the new position in ethics, focussing on the pragmatic understanding of moral explanation that it entails. Following this, I discuss how constructive deonticism should be classified as a metaethical position. I show that it is clearly not part of the expressivist family and at most half error theory (or fictionalism). However, the position is arguably not what realists are looking for either, instead prompting us to rethink how the metaethical realism debate has been framed. Finally, I point out what I consider to be the two most important challenges, i.e., whether we can draw such a sharp distinction bewteen deontic and explanatory claims and whether the position is a stable one.

Chapter 4 looks at two recent projects that aim to establish far more radical conclusions than Parfit, so-called consequentializing and deontologizing. Proponents of these projects try to come up with a simple mechanism to produce deontically equivalent counterparts to any consequentialist or non-consequentialist theory. I first explain how the two projects work on a technical level, that is, what steps are required to achieve deontic equivalence. I then reject several interpretations of the results of these projects, from the idea that we are all consequentialists (or deontologists) to the idea that consequentialism (or deontology) turn out to be empty traditions. Finally, I introduce the underdetermination interpretation of these projects and argue why it is to be preferred to yet another interpretation, the notational variants interpretation. If consequentializing and deontologizing can be interpreted in this way, we are presented with a much more far-reaching version of moral underdetermination.

States are in a difficult position. Health care costs are spiraling up and becoming increasingly unaffordable for consumers and businesses. Yet political and practical barriers constrain the government’s ability to contain health care costs through traditional regulatory channels. This Essay explores how some states have tried to maneuver around these constraints and contain costs through their contracts with health insurers and providers. We focus on three examples of state influence: health-insurance marketplaces, market-based public health insurance options, and state employee health plans. The Essay examines the impacts and limitations of state purchasing activities vis-a-vis regulatory alternatives, and discusses the opportunities and challenges that states face containing costs as purchasers. It ultimately finds that contracting solutions offer only modest political benefits over traditional regulatory approaches, and are significantly limited by consolidation in the health care provider market. Further, state officials may be hesitant to wield their market power to extract cost savings if it might result in fewer choices for consumers. However, these measures can achieve incremental savings in the right circumstances and, in the face of strong political opposition to broader health care reforms, states will need to use all levers available to hold the line on health care costs until more legislative breakthroughs can be made.

In the aftermath of the Supreme Court’s decision in Dobbs v. Jackson Women’s Health Organization, several corporations signaled their support for reproductive rights by announcing expanded abortion care coverage and/or travel stipends for employees who are forced to travel out of state to receive care, including abortion care. While such moves may be celebrated and recognized as a commitment to pro-choice politics, these decisions require scrutiny and suspicion. This article details why.

Part I of this paper will discuss the corporate response to Dobbs. It will discuss the type of benefits that corporations offered, and the class of employees these benefits were offered to (for instance, “independent contractors” were mostly excluded from availing of these benefits). Part II will discuss the movement for reproductive rights, some of the harms it reinforced, and the criticisms it received from the Reproductive Justice movement. Against this backdrop, Part III will discuss the possible intentions behind corporations conferring these benefits, including those related to staff retention, microeconomic logics, and DEI efforts. It will review them against large corporations’ histories of (not) providing reproductive supports, including a living wage, paid leave, sick leave, and childcare. It will also analyze some of the evidence in the public sphere that shows the roles some of these large corporations have played in supporting antiabortion agendas and politicians. Part IV will discuss the long-term harms that this new crop of workplace policies and benefits might create. Mainly, it will discuss how the provision of abortion care without other reproductive supports reemphasizes a reproductive rights approach despite its criticisms, which were highlighted by the Reproductive Justice movement. For instance, this section will discuss the expanding role corporations are assuming in providing healthcare, and how that may lead to the exclusion of certain historically marginalized classes of workers and people. It will also discuss the impact of these policies on the deprioritization of certain types of care, which have been overlooked for decades, including gender-affirming care and fertility treatments. Part V will suggest a few steps corporations can take to mitigate the harm created by Dobbs.