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In the latter, wholly instrumental case, it is hard to see why the Patient's ex ante preference has moral weight for the Agent--even within a preferentialist and nonconsequentialist view of welfare.
Plausibly, the Agent has moral reason to advance the Patient's agency: either as one aspect of welfare (on a substantive rather than preferentialist account of welfare which makes agency one of various substantive values), or independent of welfare.
First, the substantive rather than preferentialist account of welfare is arguably correct.
If a substantive rather than preferentialist account of welfare is correct--and there are plausible reasons to believe this is the case (39)--the fact that the Patient prefers outcome [W.sub.1] to [W.sub.2] neither (1) means that [W.sub.1] is better than [W.sub.2] for the Patient's welfare; nor (2) means that [W.sub.1] is better for the Patient in some other way (for example, by enhancing his agency).
But the convergence, crucially, will not occur except on a preferentialist view of welfare--a view that, as I have said, is problematic.
Given RU, the rationally approvable action for the Patient is necessarily the action with the best outcome for the Patient's welfare if, and only if, the preferentialist view of welfare is correct.
It cannot be entirely accidental that religious free-marketeers are disproportionately Jewish and secular, evangelical and other orthodox Protestants fill the ranks of Christian preferentialists, and religious nonpreferentialists are represented by those churches that have been the historical victims of discrimination.