The luck egalitarian view famously maintains that inequalities in individuals’ circumstances are unfair or unjust, whereas inequalities traceable to individuals’ own responsible choices are fair or just. On this basis, the distinction between so-called brute luck and option luck has been seen as central to luck egalitarianism. Luck egalitarianism is interpreted, by advocates and opponents alike, as a view that condemns inequalities in brute luck but permits inequalities in option luck. It is also thought to be expressed in terms of (...) the view that no individual ought to be worse off other than because of a fault or choice of his or her own. I argue that these two characterizations of luck egalitarianism are not equivalent and that, properly understood, luck egalitarianism is compatible with widespread, potentially radical, inequalities in brute luck. (shrink)

This paper reconsiders some themes and arguments from my earlier paper “Fairness, Respect and the Egalitarian Ethos.” That work is often considered to be part of a cluster of papers attacking “luck egalitarianism” on the grounds that insisting on luck egalitarianism's standards of fairness undermines relations of mutual respect among citizens. While this is an accurate reading, the earlier paper did not make its motivations clear, and the current paper attempts to explain the reasons that led me to write the (...) earlier paper, assesses the force of its arguments, and locates it in respect to work of Richard Arneson and Elizabeth Anderson. The paper concludes by bringing out what now appears to be the main message of the earlier paper: that the attempt to implement an “ideal” theory of equality can harm the very people that the theory is designed to help. (shrink)

In the old days, material egalitarians tended to favor equality of outcome advantage, on some suitable conception of advantage (happiness, resources, etc.). Under the influence of Dworkin’s seminal articles on equality[i], contemporary material egalitarians have tended to favor equality of brute luck advantage—on the grounds that this permits people to be held appropriately accountable for the benefits and burdens of their choices. I shall argue, however, that a plausible conception of egalitarian justice requires neither that brute luck advantage always be (...) equalized nor that people always bear the full cost of their voluntary choices. Instead, justice requires that initial opportunities for advantage be equalized—roughly along the lines suggested by Arneson and Cohen.[ii] Brute luck egalitarianism and initial opportunity egalitarianism are fairly similar in motivation, and as a result they have not been adequately distinguished. Once the two views are more clearly contrasted, equality of opportunity for advantage will, I claim, be seen to be a more plausible conception of equality. (shrink)

The goal of this article is modest. It is simply to help illuminate the nature of egalitarianism. More particularly, I aim to show what certain egalitarians are committed to, and to suggest that equality, as these egalitarians understand it, is an important normative ideal that cannot simply be ignored in moral deliberations. In doing this, I distinguish between equality as universality, equality as impartiality, and equality as comparability, and also between instrumental and non-instrumental egalitarianism. I then characterise the version of (...) egalitarianism with which I am concerned, which I call equality as comparative fairness. I discuss the relations between equality, fairness, luck, and responsibility, and defend egalitarianism against rival views that focus on subsistence, sufficiency, or compassion. I also defend egalitarianism against the Levelling Down and Raising Up Objections, and present several key examples to illustrate egalitarianism's distinct appeal, in contrast to prioritarianism's. I conclude by considering two common questions about my view: first, whether my ultimate concern is really with comparative fairness, rather than equality, so that my view is not, in fact, a substantive, non-instrumental version of egalitarianism, and second, whether my view ultimately reduces to a theory about desert. (shrink)

I appreciate all of the commentaries as they raise a series of critical and constructive points. Due to limited space, I can only address some of the issues in brief ways. Knox and Anderson indicate that classification according to testosterone levels should be applied only at the elite level and with a more inclusive approach in amateur and recreational sport. Indeed, I agree, and this is also the case in the International Association of Athletics Federation's Differences of Sexual Development regulations (...) that hold only for international events. A second comment questions whether my use of the adjective ‘systemic’ adds meaning beyond what is already included in ‘stable inequality’. I find ‘systemic’ useful as it emphasises inequalities with effects more or less on the whole organism, but I am definitely open for improving the terminology. A third comment relates to whether inequalities must be inborn to justify classification. This is a valid point, and I need to be more precise. Inequalities need not be inborn. For instance, as Knox and Anderson note, stable testosterone levels can be outcomes of hormone therapy as in the case of elite transwomen athletes. Chambers challenges my view that sport is structured on a luck egalitarian principle. She points to significant impact of inequalities in …. (shrink)

Severe poverty is a major global problem about risk and inequality. What, if any, is the relationship between equality, fairness and responsibility in an unequal world? I argue for four conclusions. The first is the moral urgency of severe poverty. We have too many global neighbours that exist in a state of emergency and whose suffering is intolerable. The second is that severe poverty is a problem concerning global injustice that is relevant, but not restricted, to questions about (...) class='Hi'>responsibility. If none were responsible, this does not eliminate all compelling claims to provide assistance. The third is that severe poverty represents an inequality too far; it is a condition of extremity with denial of basic needs. The fourth is that there is a need for an approach that captures all relevant cases – and the capabilities approach and the connection theory of remedial responsibilities are highlighted as having special promise. (shrink)

This chapter contains sections titled: Distinguishing Different Kinds of Egalitarianism Equality, Fairness, Luck, and Responsibility Equality of What? The Subsistence Level, Sufficiency, and Compassion Prioritarianism and the Leveling Down Objection19 Equality or Priority? Illustrating Egalitarianism's Distinct Appeal Conclusion Notes.

[ Susan Hurley] I argue that the aim to neutralize the influence of luck on distribution cannot provide a basis for egalitarianism: it can neither specify nor justify an egalitarian distribution. Luck and responsibility can play a role in determining what justice requires to be redistributed, but from this we cannot derive how to distribute: we cannot derive a pattern of distribution from the 'currency' of distributive justice. I argue that the contrary view faces a dilemma, according to whether (...) it understands luck in interpersonal or counterfactual terms. /// [Richard J. Arneson] Does it make sense to hold that, if it is bad that some people are worse off than others, it is worse if those who are worse off come to be so through sheer bad luck that it is beyond their power to control? In her contribution to this symposium, Susan Hurley cautions against a closely related fallacy: from the fact that people have come to an unequal condition through unchosen bad luck, it does not follow that, if we aim to undo the influence of unchosen luck, we ought to institute equality of condition. Forswearing the fallacy that Hurley analyses is compatible with answering the question affirmatively, and more generally with holding that principles of distributive justice should be sensitive to the distinction between chosen and unchosen bad luck. This essay explores how this might be done. (shrink)

Egalitarians claim that inequality in society is only justified to the extent that it results from choices freely and responsibly made. Inequality resulting from brute bad luck is not justified. I argue that luck, and therefore responsibility, are defined in terms of the reward structure. Luck and responsibility are epiphenomena of the incentives that people have to choose from the opportunity sets available. To that end egalitarians should look more directly at the degree of inequality that is acceptable (...) and examine more closely the classes of actions they want to leave to individual responsibility even though these will lead to greater inequality. State action should concentrate upon reducing inequality between classes of people; it cannot be expected to reduce all inequalities between people even though many of these will have only peripheral relationships to responsibility. (shrink)

A recent movement within political philosophy called luck egalitarianism has attempted to synthesize the right’s regard for responsibility with the left’s concern for equality. The original motivation for subscribing to luck egalitarianism stems from the belief that one’s success in life ought to reflect one’s own choices and not brute luck. Luck egalitarian theorists differ in the decision procedures that they propose, but they share in common the general approach that we ought to equalize individuals with respect to brute (...) luck so that differences in distribution are only a consequence of the responsible choices that individuals make. I intend to show that through the application of its own distributive procedures, the interpersonal luck egalitarian approach actually undermines its original motivation by making the lives of individuals subject to brute luck. I propose two alternative methods that the luck egalitarian could use to prevent the problems suffered by the interpersonal luck egalitarian standard. (shrink)

In Chapter 6 (“Why the Aim to Neutralize Luck Cannot Provide a Basis for Egalitarianism”) of her Justice, Luck, and Knowledge, Susan Hurley defends two claims: that “the aim to neutralize luck [does not] contribute to identifying and specifying what egalitarianism is”, and that it also provides no “independent non‐question‐begging reason or justification for egalitarianism” (p. 147). In the present response, I reject the first of Hurley's claims, and I show that the second, while true, lacks polemical force. I said, (...) in “On the Currency of Egalitarian Justice” (Ethics, 1989), that. (shrink)

In the old days, material egalitarians tended to favor equality of outcome advantage, on some suitable conception of advantage. Under the influence of Dworkin’s seminal articles on equality, contemporary material egalitarians have tended to favor equality of brute luck advantage---on the grounds that this permits people to be held appropriately accountable for the benefits and burdens of their choices. I shall argue, however, that a plausible conception of egalitarian justice requires neither that brute luck advantage always be equalized nor that (...) people always bear the full cost of their voluntary choices. Instead, justice requires that initial opportunities for advantage be equalized---roughly along the lines suggested by Arneson and Cohen. Brute luck egalitarianism and initial opportunity egalitarianism are fairly similar in motivation, and as a result they have not been adequately distinguished. Once the two views are more clearly contrasted, equality of opportunity for advantage will, I claim, be seen to be a more plausible conception of equality. (shrink)

This paper explores how luck egalitarianism fares in capturing our intuitions about the fairness of market-generated outcomes. Critics of luck egalitarianism have argued that it places no restrictions on what outcomes are acceptable, at least when all agents are equally situated before entering the market, and that this gives us a reason to reject it as an account of fairness. I will argue that luck egalitarianism does make specific judgements about which market-generated outcomes are compatible with maintaining a fair distribution. (...) In addition, I will argue that luck egalitarian prescriptions accord with our pre-theoretical intuitions about the (un)fairness of certain market-generated outcomes. Securing these points both speaks in favour of luck egalitarianism as an ethical principle and provides a framework within which to analyze the fairness of practical, real world cases. (shrink)

:This article analyzes the criteria for the distribution of healthcare services through different justice theories such as utilitarianism and liberalism, pointing out the problems that arise when providing services to a culturally diverse population. The international epidemiological setting is a favorable one for discussing personal responsibility and luck egalitarianism; however, some provisions have to be made so that healthcare institutions do not treat ethnic, cultural, religious, and linguistic minorities unfairly. The article concludes by proposing that accommodations and culturally sensible (...) attention should be provided when possible, without affecting the equal opportunity of others to access these services. (shrink)

Moral luck occurs when factors beyond an agent’s control positively affect how much praise or blame she deserves. Kinds of moral luck are differentiated by the source of lack of control such as the results of her actions, the circumstances in which she finds herself, and the way in which she is constituted. Many philosophers accept the existence of some of these kinds of moral luck but not others, because, in their view, the existence of only some of them would (...) make morality unfair. I, however, argue that this intermediary approach is unstable, because either morality is fair in ways that rule out resultant, circumstantial, and constitutive moral luck (and this leads to moral responsibility skepticism), or morality is unfair in ways that permit the existence of those kinds of moral luck. Thus, such intermediary approaches lack the motivation that their proponents have long taken them to have. In the appendix, I point to ways in which morality is unfair concerning the scope of moral responsibility, moral obligation, moral taint, being a good or bad person, and flourishing. (shrink)

How should we decide which inequalities between people are justified, and which are unjustified? One answer is that such inequalities are only justified where there is a corresponding variation in responsible action or choice on the part of the persons concerned. This view, which has become known as 'luck egalitarianism', has come to occupy a central place in recent debates about distributive justice. This book is the first full length treatment of this significant development in contemporary political philosophy. Each of (...) its three parts addresses a key question concerning the theory. Which version of luck egalitarian comes closest to realizing luck egalitarian objectives? Does luck egalitarianism succeed as a view of egalitarian justice? And is it sound as an account of distributive justice in general? The book provides a distinctive answer to each of these questions, along the way engaging with the leading theorists identified in the literature as luck egalitarians, such as Richard Arneson, G. A. Cohen, and Ronald Dworkin, as well as the most influential critics, including Elizabeth Anderson, Marc Fleurbaey, Susan Hurley, Samuel Scheffler, and Jonathan Wolff. (shrink)

This article explores the Rawlsian goal of ensuring that distributions are not influenced by the morally arbitrary. It does so by bringing discussions of distributive justice into contact with the debate over moral luck initiated by Williams and Nagel. Rawls’ own justice as fairness appears to be incompatible with the arbitrariness commitment, as it creates some equalities arbitrarily. A major rival, Dworkin’s version of brute luck egalitarianism, aims to be continuous with ordinary ethics, and so is (a) sensitive to non-philosophical (...) beliefs about free will and responsibility, and (b) allows inequalities to arise on the basis of option luck. But Dworkin does not present convincing reasons in support of continuity, and there are compelling moral reasons for justice to be sensitive to the best philosophical account of free will and responsibility, as is proposed by the revised brute luck egalitarianism of Arneson and Cohen. While Dworkinian brute luck egalitarianism admits three sorts of morally arbitrary disadvantaging which correspond to three forms of moral luck (constitutive, circumstantial, and option luck), revised brute luck egalitarianism does not disadvantage on the basis of constitutive or circumstantial luck. But it is not as sensitive to responsibility as it needs to be to fully extinguish the influence of the morally arbitrary, for persons under it may exercise their responsibility equivalently yet end up with different outcomes on account of option luck. It is concluded that egalitarians should deny the existence of distributive luck, which is luck in the levels of advantage that individuals are due. (shrink)

If we want to make people more equal, what should we make them more equal in? For example, should it be resources, such as income, or should it be subjective well-being, such as preference satisfaction? The aim of this article is to critically examine the two main answers to this question within a luck egalitarian moral framework, which is a framework that aims to eliminate inequalities caused by non-responsibility factors, while preserving inequalities due to responsibility factors. I argue (...) that the arguments typically presented in favor of equalizing incomes rather than subjective well-being are weak and that within a luck egalitarian moral framework the claim that resources and not welfare should be considered the appropriate basis for interpersonal comparisons is in need of justification.The question of what society should equalize is applied to the issue of what should be the fair level of unemployment insurance compensation: Should we only compensate the involuntary unemployed for the income loss associated with unemployment, or also for the non-pecuniary costs associated with unemployment? The answer to this question, I argue, depends on where the cut between responsibility factors and non-responsibility factors is drawn. (shrink)

Algorithms increasingly make managerial decisions that people used to make. Perceptions of algorithms, regardless of the algorithms' actual performance, can significantly influence their adoption, yet we do not fully understand how people perceive decisions made by algorithms as compared with decisions made by humans. To explore perceptions of algorithmic management, we conducted an online experiment using four managerial decisions that required either mechanical or human skills. We manipulated the decision-maker, and measured perceived fairness, trust, and emotional response. With the mechanical (...) tasks, algorithmic and human-made decisions were perceived as equally fair and trustworthy and evoked similar emotions; however, human managers' fairness and trustworthiness were attributed to the manager's authority, whereas algorithms' fairness and trustworthiness were attributed to their perceived efficiency and objectivity. Human decisions evoked some positive emotion due to the possibility of social recognition, whereas algorithmic decisions generated a more mixed response – algorithms were seen as helpful tools but also possible tracking mechanisms. With the human tasks, algorithmic decisions were perceived as less fair and trustworthy and evoked more negative emotion than human decisions. Algorithms' perceived lack of intuition and subjective judgment capabilities contributed to the lower fairness and trustworthiness judgments. Positive emotion from human decisions was attributed to social recognition, while negative emotion from algorithmic decisions was attributed to the dehumanizing experience of being evaluated by machines. This work reveals people's lay concepts of algorithmic versus human decisions in a management context and suggests that task characteristics matter in understanding people's experiences with algorithmic technologies. (shrink)

Oppression can be unjust from a luck egalitarian point of view even when it is the consequence of choices for which it is reasonable to hold persons responsible. This is for two reasons. First, people who have not been oppressed are unlikely to anticipate the ways in which their choices may lead them into oppressive conditions. Facts about systematic phenomena (like oppression) are often beyond the epistemic reach of persons who are not currently subject to such conditions, even when they (...) possess adequate information about the particular consequences of their choices. Second, people may be (much) less responsible for remaining in oppressive conditions, even if they are responsible for entering circumstances of oppression. Oppression that results from a person’s choice may cause or contribute to dramatic changes in that person, and these changes may be sufficient to undermine the person’s responsibility for the results of her earlier choice. (shrink)

We study the influence of the existence of large cardinals on the existence of wellorderings of power sets of infinite cardinals κ with the property that the collection of all initial segments of the wellordering is definable by a Σ1‐formula with parameter κ. A short argument shows that the existence of a measurable cardinal δ implies that such wellorderings do not exist at δ‐inaccessible cardinals of cofinality not equal to δ and their successors. In contrast, our main result shows that (...) these wellorderings exist at all other uncountable cardinals in the minimal model containing a measurable cardinal. In addition, we show that measurability is the smallest large cardinal property that imposes restrictions on the existence of such wellorderings at uncountable cardinals. Finally, we generalise the above result to the minimal model containing two measurable cardinals. (shrink)

Brian Barry attacks the `resource account' of power providing a set of definitions through which power should be analysed. While there might be different, equally good, ways of defining power, I argue that the formulations provided by Dowding are superior to those of Barry as they produce fewer anomalies and provide a better foundation for empirical research. The article defends the resource account against Barry's criticisms and argues for the utility of the ideas of luck and `systematic luck'. Key Words: (...) power • luck • systematic luck • resources • Barry • Dowding • Harsanyi • capitalists. (shrink)

Moral luck occurs when factors beyond an agent’s control affect her blameworthiness. Several scholars deny the existence of moral luck by distinguishing judging blameworthy from blame-related practices. Luck does not affect an agent’s blameworthiness because morality is conceptually fair, but it can affect the appropriate degree of blame for that agent. While separatism resolves the paradox of moral luck, we aim to show it that it needs amendment, because it is unfair to treat two equally blameworthy people unequally. We argue (...) that separatists should conceive fairness as a pro tanto reason for blame. By locating fairness as a ground for blame within a wider axiology of blame, separatism could resolve the challenge of blaming fairly. In such an axiology, reasonable and fair blame diverge. (shrink)

Kymlicka has offered an influential luck egalitarian justification for a catalogue of polyethnic rights addressing cultural disadvantages of immigrant minorities. In response, Quong argues that while the items on the list are justified, in the light of the fact that the relevant disadvantages of immigrants result from their choice to immigrate, (i) these rights cannot be derived from luck egalitarianism and (ii) that this casts doubt on luck egalitarianism as a theory of cultural justice. As an alternative to Kymlicka’s argument, (...) Quong offers his own justification of polyethnic rights based on a Rawlsian ideal of fair equality of opportunity. I defend luck egalitarianism against Quong’s objection arguing that if choice ever matters, it matters in relation to cultural disadvantages too. Also, the Rawlsian ideal of fair equality of opportunity cannot justify the sort of polyethnic rights that Quong wants it to justify, once we set aside an unwarranted statist focus in Quong’s conception of fair equality of opportunity. Whatever the weaknesses of luck egalitarianism are, the inadequacy of the position in relation to accommodating cultural disadvantages of immigrants is not among them. (shrink)

Distribution of responsibility is one of the main focus areas in discussions about climate change ethics. Most of these discussions deal with the distribution of responsibility for climate change mitigation at the international level. The aim of this paper is to investigate if and how these principles can be used to inform the search for a fair distribution of responsibility for climate change adaptation on the local level. We found that the most influential distribution principles on the (...) international level were in turn built on one or more of seven basic principles: (P1) equal shares, (P2) desert, (P3) beneficiary pays, (P4) ability, (P5) self-help, (P6) limited responsibility for the worst off, and (P7) status quo preservation. It was found that all the basic principles, but P1, P3, and P7, are to some extent translatable to local climate adaptation. Two major problems hamper their usefulness on the local level: (1) several categories of agents need to take on responsibility; and (2) emissions do not work as a base for all principles. P4, P5, and P6 are applicable to local adaptation without changes. P4 is of particular importance as it seems to solve the first problem. P2 is applicable only if the second problem is solved, which can be achieved by using risk of harm instead of emissions as the basis for desert. (shrink)

When distributing an indivisible harm or benefit between multiple individuals, all of whom have an equal claim to avoid the harm or receive the benefit, it is commonly thought that one should hold a lottery in order to give each claimant an equal chance of winning. Moreover, it is often said that, by holding a lottery, one makes the resultant outcome inequality between those who receive the harm or benefit and those who do not less unfair than it would otherwise (...) have been. The stated view – the ‘egalitarian mixed view’ – claims that the unfairness of a brute luck ex post distribution is a function of both the degree of inequality in the ex post distribution itself, and the degree of inequality in the ex ante distribution of chances from which it is derived. Versions of the view have been prominently endorsed by a number of authors, including Arneson, Broome, Diamond, Lang, Otsuka, Parfit, and Temkin. The appeal of the view is linked to its apparent promise to accommodate intuitions that have been thought to threaten views which link the fairness of an outcome either solely to the ex ante distribution or solely to the ex post distribution. I argue, to the contrary, that the egalitarian mixed view is mistaken. In particular, I argue that the distinction at the heart of the view – that between outcomes and changes to probabilities – is morally arbitrary at best and incoherent at worst. I consider possible responses to the charge and find them wanting. I note that the failure of the egalitarian mixed view has significant consequences for policy, including most importantly for how we should interpret the goal of fair equality of opportunity. (shrink)

This essay explores a conception of responsibility at work in moral and criminal responsibility. Our conception draws on work in the compatibilist tradition that focuses on the choices of agents who are reasons-responsive and work in criminal jurisprudence that understands responsibility in terms of the choices of agents who have capacities for practical reason and whose situation affords them the fair opportunity to avoid wrongdoing. Our conception brings together the dimensions of normative competence and situational control, and (...) we factor normative competence into cognitive and volitional capacities, which we treat as equally important to normative competence and responsibility. Normative competence and situational control can and should be understood as expressing a common concern that blame and punishment presuppose that the agent had a fair opportunity to avoid wrongdoing. This fair opportunity is the umbrella concept in our understanding of responsibility, one that explains it distinctive architecture. (shrink)

In recent work, Norman Daniels extends the application of Rawls's principle of ‘fair equality of opportunity’ from health care to health proper. Crucial to that account is the view that health care, and now also health, is special. Daniels also claims that a rival theory of distributive justice, namely luck egalitarianism (or ‘equal opportunity for welfare’), cannot provide an adequate account of justice in health and health care. He argues that the application of that theory to health policy would result (...) in an account that is, in a sense, too narrow, for it denies treatment to imprudent patients (e.g. lung cancer patients who smoked). In a different sense, Daniels argues, luck egalitarian health policy would be too wide: it arguably tells us to treat individuals for such brute-luck conditions as shyness, stupidity, ugliness, and having the ‘wrong’ skin colour. I seek to advance three claims in response to Daniels's revised theory, and in defence of a luck egalitarian view of health policy. First, I question Daniels's assertion regarding the specialness of health. While he is right to abandon his insistence on the specialness of health care, it is doubtful that health proper can be depicted as special. Second, I try and meet Daniels's objections to luck egalitarianism. Luck egalitarian health policy escapes being too narrow for it does not in fact require denying basic care to imprudent patients. As for it being allegedly too wide, I try to show that it is not, after all, counterintuitive to rid individuals of unfortunate and disadvantageous biological traits (say, a disadvantageous skin colour). And third, I question whether Daniels's own Rawlsian account is in fact wide enough. I argue that fair equality of opportunity fails to justify some standard medical procedures that many health systems do already practice. (shrink)

One response to the existential threat posed by a super-intelligent AI is to design it to be friendly to us. Some have argued that even if this were possible, the resulting AI would treat us as we do our pets. Sparrow (AI & Soc. https://doi.org/10.1007/s00146-023-01698-x, 2023) argues that this would be a bad outcome, for such an AI would dominate us—resulting in our freedom being diminished (Pettit in Just freedom: A moral compass for a complex world. WW Norton & Company, (...) 2014). In this paper, I consider whether this would be such a bad outcome. (shrink)

My aim in this chapter is to place John Stuart Mill’s distinctive utilitarian political philosophy in the context of the debate about luck, responsibility, and equality. I hope it will reveal the extent to which his utilitarianism provides a helpful framework for synthesizing the competing claims of luck and relational egalitarianism. I attempt to show that when Mill’s distributive justice commitments are not decided by direct appeal to overall happiness, they are guided by three main public principles: an impartiality (...) principle, a sufficiency principle, and a merit principle. The question then becomes how luck and relational considerations figure into his articulation of these public principles. I argue that relational egalitarianism is more fundamental than considerations of luck and responsibility in Mill’s thought, but I also hope to show that any fleshed out picture of Mill’s reform proposals must recognize his condemnation of the role luck plays in determining the distribution of opportunities and outcomes. (shrink)

Photo by Tingey Injury Law Firm on Unsplash ABSTRACT The coverage of healthcare costs allegedly brought about by people’s own earlier health-adverse behaviors is certainly a matter of justice. However, this raises the following questions: justice for whom? Is it right to take people’s past behaviors into account in determining their access to healthcare? If so, how do we go about taking those behaviors into account? These bioethical questions become even more complex when we consider them in the context of (...) a commitment to publicly funded, universal healthcare coverage. INTRODUCTION Healthcare coverage of lifestyle-related conditions is certainly a matter of justice. However, this raises the following justice-related question: Is it right to consider people’s past behaviors in determining their access to healthcare? If so, the methods of taking those behaviors into account must be fair and justifiable. This bioethical question becomes even more complex when we consider it in the context of a commitment to publicly funded, universal healthcare coverage. This paper takes an old, classic debate, evaluates newer approaches, and offers an argument favoring a combined approach which alters the liberal-egalitarian solution to account for social justice. ANALYSIS I. Causes of Disease If healthcare coverage were universal, irrespective of socioeconomic status and lifestyle, people would contribute to the cost of remedying the lifestyle-induced health problems of others. In the West, lifestyle-related diseases are burdensome.[i] This paper approaches this concern from a western lens that incorporates both a European tradition of “social safety nets” and an American tradition of personal freedoms. By taking such an approach, solutions to the consequences of one’s past behavior burdening others must consider an individual’s personal freedom to choose to act as he or she wishes, with the distributive social and economic equality of the many. The concept of disease caused by lifestyle and diet is proven. Many health conditions include behavioral risk factors. Multi-pack smoking increases the risk of chronic lung disease, while obesity increases the risk of type 2 diabetes. Inattention to high blood pressure, high cholesterol, and a lack of exercise leads to increased risks of coronary artery disease.[ii] While poor lifestyle choices certainly influence these conditions, their causes are multifactorial, and it is difficult to say that any single string of poor choices led to their development. In a scenario where two men excessively eat fast food for 20 years, several discrete factors impact whether any of them might suffer an ischemic-embolic stroke or not. Genetics, circumstances, and activity will also contribute to outcomes. II. Alcohol-Related End-Stage Liver Disease One paper suggests that alcohol-related end-stage liver disease (ARESLD) differs from other multifactorial disorders as alcohol alone causes the disease.[iii] It justifies attributing personal responsibility to patients with ARESLD because the condition develops only after the cumulative effects of large quantities of alcohol consumed from years to decades.[iv] However, the paper undermines its position by admitting that even the susceptibility to becoming an alcoholic has some degree of genetic predisposition.[v] Given the extreme scarcity of donor livers, some patients may be prioritized over others on the transplant waiting list. Since donor livers cannot be given to everyone, transplanting a liver into an alcoholic may result in death for competing candidates whose liver disease was not their fault. All else being equal, if bioethicists avoid claiming moral deficiency or judgment, those with apparently self-inflicted ARESLD will not be deprived of treatment but will have a lower priority for transplant.[vi] In contrast, another position suggests that it is often difficult to define what behaviors are punishable as these are largely personal and value-laden.[vii] Still, people do not support using their own resources to support the consequences of others’ poor choices, no matter how objective.[viii] In democratic societies, one must take into consideration community morals and values.[ix] Even if we were to punish people for their health-adverse behaviors, we could not logistically employ the vigorous and sustained efforts necessary to determine whose actions are morally weak.[x] III. The Liberal-Egalitarian Proposal One past argument proposes a liberal-egalitarian solution to manage personal responsibility for so-called “lifestyle diseases.”[xi] This Rawlsian system combines the European-style “social safety net” commitment to social and economic equality with the American liberal notion of pluralist toleration and personal freedoms. This idealized system aims to hold people responsible for their choices rather than the consequences to mitigate the downside of blaming those who might not be blameworthy. The approach avoids determining the questionable nature of luck and personal responsibility for health outcomes, fairness in the distribution of economic burden, and the intrusiveness required to practically determine who acts in a morally wrong and health-adverse way. The liberal-egalitarian model, a theory of distributive justice, has two facets: the liberal principle that people should be held accountable for their choices and the egalitarian principle that people who make the same choices should have the same outcomes.[xii] This model attempts to fuse responsibility with equity by seeking to reward good behavior and tax bad behavior rather than punish the consequences of the action and navigate who deserves treatment. For instance, the hospital bedside is not the appropriate place to introduce responsibility for one’s health outcomes.[xiii] This appeals to the reality that, at that time, discerning the true causes of disease was not plausible and to humanity in avoiding a heartless and cruel approach. An argument in favor of the liberal-egalitarian model considers its method of implementation. This approach assumes that the healthcare system treats all individuals regardless of their choices or ability to cover costs. The liberal-egalitarian model also assumes that a certain adverse health condition is related, statistically speaking, to the consumption of a certain good and that good can be taxed. As such, it proposes to tax the consumption of that good to finance the collective burden which arises from that good’s consumption rather than require individuals to pay for their own treatment. In the example of ARESLD, the recommended solution would be taxing all alcohol. While a systematic infrastructure is not explicit, there is the implication that a per-unit tax can be imposed on alcohol so the total tax revenue would make up for the additional healthcare costs due to consumption.[xiv] Upholding the principle that all people who make the same choices should face the same costs, all consumers of alcohol would pay the same tax, regardless of factors such as genetic predisposition to alcoholism, lifestyle, or expected cost of treatment. Upholding the principle of individual responsibility, this model does not deny treatment to anyone, neutralizing factors outside that individual’s control by imposing the tax ex-ante. Other people are not burdened by those who consume the good. People who consume alcohol face a burden proportional to the amount consumed. This tax-based implementation is justified so long as the tax is not prohibitively high for the average consumer. Further, the model mitigates concerns over the intrusiveness of ascribing morality to health-adverse behaviors. IV. Moral and Social Arguments Against the Liberal-Egalitarian Position Arguments against the liberal-egalitarian model concerns its many assumptions. First, this model assumes that consumption of such goods is directly related to the health outcome and that these goods can be taxed.[xv] Certain people genetically predisposed to alcoholism would be predisposed to consume more alcohol. The model falls short when applied to scenarios where health outcomes are not consumption-based, such as engaging in unsafe sex or abstaining from healthy lifestyle choices like exercise. Second, some might argue that the liberal-egalitarian model fails to remain neutral. Residual moral judgments tied to consumption choices introduce non-neutrality. Although taxation in free societies is determined by democratic procedures rather than by individuals in the healthcare system, moral and value-based judgments will be implicit in deciding what behaviors are taxable, such as the purchase of cigarettes. Third, the liberal-egalitarian model fails to determine whether one’s behavior is autonomous, as socio-cultural-economic factors may influence it and behavior is more a product of society, peer pressure, or income. Those also may reflect systemic inequalities. Therefore, this model, which rewards, or taxes based solely on decisions, regardless of their consequences and motivations, fails to consider that a person’s decisions may not be completely autonomous. V. Libertarian Arguments Against the Liberal-Egalitarian Model a. State Intrusiveness as Counter to the Liberal-Egalitarian Model Last, there is a libertarian worry that if the state guarantees universal healthcare coverage to all people, the state will have to become highly intrusive and investigate people’s morals.[xvi] At least one-third of all disease burden in North America, Europe, and the Asia-Pacific is attributable to lifestyle measures such as tobacco smoking, alcohol consumption, high cholesterol, and obesity.[xvii] With these various lifestyles, it is not likely to agree on what conduct to tax or condemn.[xviii] The fine-toothed comb required to determine whether each citizen has been engaging in these behaviors would intrude on daily life and personal freedom. Libertarians champion the argument that impractical intrusiveness would result from universal healthcare, and such a degree of intrusiveness would likely be universally unacceptable.[xix] The liberal-egalitarian model mitigates the libertarian worry about state intrusiveness as it does not involve prying into one’s life and choices other than taxing goods. A liberal state should ideally be neutral to how people decide to live their lives. In all, libertarians can rest assured that the liberal-egalitarian tax-based model, through its ex-ante implementation, will require no prying state eyes. States that provide universal healthcare coverage and wish to condemn certain misconduct do not need to become overly intrusive to carry out measures to hold individuals accountable. b. Fairness Another libertarian worry regarding the guarantee of universal healthcare coverage in the context of lifestyle-driven diseases is that the public will be burdened unfairly with covering others’ ill-advised mistakes or bad luck. An ideal system to address this worry would link treatment or payment for treatment with whatever behavior caused that need.[xx] The distribution of burdens should be linked to how different individuals contributed to the creation of those burdens. Applied to health policy, we should ask how the need for a certain treatment arose when determining how to distribute its cost.[xxi] The liberal-egalitarian model aspires to hold individuals responsible for their choices, not for the consequences of such choices. This model significantly mitigates the libertarian worry over unfair burdens for covering other people’s mistakes or social conditions, which lead to those bad outcomes, by ensuring to not burden others with any of the costs for the treatment of people who decide to engage in certain health-adverse behaviors. The aforementioned taxation-based system would only tax those who also engage in the health-adverse behavior through consumption, and that tax directly pays for the necessary collective treatment. As such, those who do not consume the good are not involved with the payment scheme, while those who do consume the good are responsible for payment in a matter proportional to the amount of the good they have consumed. VI. Universal Coverage Taking a step back, one should consider whether these worries regarding the coverage of apparently self-inflicted health conditions in the context of universal healthcare are worthwhile issues. One perspective raises what is called the culturally imagined objection — an idea erroneously held by many that sick people, especially those who are poor and uneducated, bring these illnesses upon themselves due to poor decision-making and irresponsible risk-taking.[xxii] This perspective critiques the uniquely American view that, since individuals are free to choose their lifestyles, they should bear the costs of their lifestyle.[xxiii] Taking this argument further, some (perhaps the strongly libertarian) would say that the poor health status among many individuals is the price individuals must pay for their American way of life and the liberty and freedom to live as they wish. However, people should not completely punish individuals for their health-adverse behaviors because these choices are largely pre-determined by a person’s socioeconomic influences.[xxiv] The outcomes from these allegedly ill-advised behaviors, which largely affect poorer people, are not just poor behavior but rather a public health crisis. Perhaps the state and its people should take collective responsibility and cover the costs of treatment for those health outcomes without question, as a form of public service. Rather than worrying about accountability and taxing bad behavior or intrusiveness into personal decisions, some might argue that people need to collectively take responsibility for reducing the overarching systemic inequalities and covering the associated treatment costs as a measure of public health. VII. Proposed Solution Given the strengths of the liberal-egalitarian model and taking into account libertarian and social justice-oriented objections, an ideal solution for the coverage of lifestyle-related health problems needs to consider the complex relationship between a person’s behaviors and their apparent health outcomes. It must consider how society as a whole passes judgment on behaviors and how to take into account that many health-adverse decisions are not truly autonomous decisions, as various genetic and socioeconomic factors influence them. An ideal solution combines the liberal-egalitarian tax-based model with the social justice concerns of universal coverage. Whatever the cost for the treatment of medical issues resulting in part or entirely from lifestyle and diet, taxes collected from spending associated with the behavior (like the purchase of alcohol, junk food, and cigarettes) ex-ante should fund 50 percent of the cost of treatment, while the universal healthcare taxation scheme should include the other 50 percent. Such a system would provide an incentive to avoid the purchases that can lead to unhealthy consumption and make healthier choices, slightly punish and discourage such purchases through taxation, yet not overly punish people whose outcomes may have more to do with socioeconomic factors and genetics. Adding public responsibility demonstrates acknowledgement that health care is in the public interest and can mitigate public health inequalities. This solution would fuse personal responsibility with the public responsibility of state-sponsored social improvement while ensuring that all people have fair access to necessary treatment, no matter their ability to pay. CONCLUSION The 50-50 system this paper proposes reflects both justice and personal responsibility in covering healthcare costs allegedly brought about by people’s own health-adverse behaviors. By allocating tax revenue from consumption that contributes or even alone causes poor health outcomes, such a system incorporates personal responsibility. By using general tax revenue for health care, such a system would meet the libertarian requirement of providing care without any moral investigation of past behaviors and the social justice consideration of providing health care to those who may have unwittingly ventured into ill-health due to systemic injustice, socioeconomics, or genetics. - [i] Cappelen, A. W. (2005). Responsibility in health care: A liberal egalitarian approach. Journal of Medical Ethics, 31(8), 476–480. https://doi.org/10.1136/jme.2004.010421 [ii] Moss, A. H. (1991). Should alcoholics compete equally for liver transplantation? JAMA: The Journal of the American Medical Association, 265(10), 1295–1298. https://doi.org/10.1001/jama.1991.03460100097032 [iii] Moss, p. 1295-1298. [iv] Moss, p. 1296. [v] Moss, p. 1295-1298. [vi] Moss, p. 1295-1298. [vii] Cohen, C. IS THIS SUPPOSED TO BE COHEN AND BENJAMIN (1991). Alcoholics and liver transplantation. JAMA: The Journal of the American Medical Association, 265(10), 1299–1301. https://doi.org/10.1001/jama.1991.03460100101033 [viii] Cohen, p. 1299-1301. [ix] Moss, p. 1297. [x] Cohen, p. 1300. [xi] Cappelen, p. 478-480. [xii] Cappalen, p. 478-480. [xiii] Cappelen, p.479. [xiv] Cappelen, p. 479. [xv] Cappelen, p. 479 [xvi] Cohen, p. 1301. [xvii] Cappelen, p. 478. [xviii] Cohen, p. 1299-1301. [xix] Cohen, p. 1301. [xx] Cappelen, p. 476-480. [xxi] Cappelen, p. 476-480. [xxii] Kawachi, I. (2005). Why the United States is not number one in Health. Healthy, Wealthy, and Fair, 18–33. https://doi.org/10.1093/acprof:oso/9780195170665.003.0013 [xxiii] Kawachi, p. 18-33. [xxiv] Kawachi, p. 18-33. (shrink)

Miracles and the problem of evil are two prominent areas of research within philosophy of religion. On occasion these areas converge, with God’s goodness being brought into question by the claim that either there is a lack of miracles, or there are immoral miracles. In this paper I shall highlight a second manner in which miracles and the problem of evil relate. Namely, I shall give reason as to why what is considered to be miraculous may be dependent upon a (...) particular response to the problem of natural evil. To establish this claim, I shall focus upon Aquinas’s definition of a miracle and a particular free-will defence, the Luciferous defence. (shrink)

There is something attractive about combining the values of equality and responsibility, even though the view most commonly associated with doing so, of luck egalitarianism, is beset with objections. This article hence proposes an alternative approach to being a responsibility-sensitive egalitarian: one grounded on our valuable social practices of responsibility, rather than on a desire to mitigate the influence of luck on people's prospects. First, I argue that this practice-based approach better captures the very reasons that (...) class='Hi'>responsibility is significant for justice than does the prevalent approach among luck egalitarians: namely, the values of fairness, choice and respect. Second, I show that the remaining motivation of the luck egalitarian approach, of being ‘anti-luck’, is impoverished. I conclude by suggesting that this practice-based approach is better motivated and more palatable than existing forms of luck egalitarianism, even for those relational egalitarians who standardly criticise making egalitarianism responsibility-sensitive. (shrink)

Photo by Tingey Injury Law Firm on Unsplash ABSTRACT The coverage of healthcare costs allegedly brought about by people’s own earlier health-adverse behaviors is certainly a matter of justice. However, this raises the following questions: justice for whom? Is it right to take people’s past behaviors into account in determining their access to healthcare? If so, how do we go about taking those behaviors into account? These bioethical questions become even more complex when we consider them in the context of (...) a commitment to publicly funded, universal healthcare coverage. INTRODUCTION Healthcare coverage of lifestyle-related conditions is certainly a matter of justice. However, this raises the following justice-related question: Is it right to consider people’s past behaviors in determining their access to healthcare? If so, the methods of taking those behaviors into account must be fair and justifiable. This bioethical question becomes even more complex when we consider it in the context of a commitment to publicly funded, universal healthcare coverage. This paper takes an old, classic debate, evaluates newer approaches, and offers an argument favoring a combined approach which alters the liberal-egalitarian solution to account for social justice. ANALYSIS l. Causes of Disease If healthcare coverage were universal, irrespective of socioeconomic status and lifestyle, people would contribute to the cost of remedying the lifestyle-induced health problems of others. In the West, lifestyle-related diseases are burdensome.[1] This paper approaches this concern from a western lens that incorporates both a European tradition of “social safety nets” and an American tradition of personal freedoms. By taking such an approach, solutions to the consequences of one’s past behavior burdening others must consider an individual’s personal freedom to choose to act as he or she wishes, with the distributive social and economic equality of the many. The concept of disease caused by lifestyle and diet is proven. Many health conditions include behavioral risk factors. Multi-pack smoking increases the risk of chronic lung disease, while obesity increases the risk of type 2 diabetes. Inattention to high blood pressure, high cholesterol, and a lack of exercise leads to increased risks of coronary artery disease.[2] While poor lifestyle choices certainly influence these conditions, their causes are multifactorial, and it is difficult to say that any single string of poor choices led to their development. In a scenario where two men excessively eat fast food for 20 years, several discrete factors impact whether any of them might suffer an ischemic-embolic stroke or not. Genetics, circumstances, and activity will also contribute to outcomes. ll. Alcohol-Related End-Stage Liver Disease One paper suggests that alcohol-related end-stage liver disease (ARESLD) differs from other multifactorial disorders as alcohol alone causes the disease.[3] It justifies attributing personal responsibility to patients with ARESLD because the condition develops only after the cumulative effects of large quantities of alcohol consumed from years to decades.[4] However, the paper undermines its position by admitting that even the susceptibility to becoming an alcoholic has some degree of genetic predisposition.[5] Given the extreme scarcity of donor livers, some patients may be prioritized over others on the transplant waiting list. Since donor livers cannot be given to everyone, transplanting a liver into an alcoholic may result in death for competing candidates whose liver disease was not their fault. All else being equal, if bioethicists avoid claiming moral deficiency or judgment, those with apparently self-inflicted ARESLD will not be deprived of treatment but will have a lower priority for transplant.[6] In contrast, another position suggests that it is often difficult to define what behaviors are punishable as these are largely personal and value-laden.[7] Still, people do not support using their own resources to support the consequences of others’ poor choices, no matter how objective.[8] In democratic societies, one must take into consideration community morals and values.[9] Even if we were to punish people for their health-adverse behaviors, we could not logistically employ the vigorous and sustained efforts necessary to determine whose actions are morally weak.[10] lll. The Liberal-Egalitarian Proposal One past argument proposes a liberal-egalitarian solution to manage personal responsibility for so-called “lifestyle diseases.”[11] This Rawlsian system combines the European-style “social safety net” commitment to social and economic equality with the American liberal notion of pluralist toleration and personal freedoms. This idealized system aims to hold people responsible for their choices rather than the consequences to mitigate the downside of blaming those who might not be blameworthy. The approach avoids determining the questionable nature of luck and personal responsibility for health outcomes, fairness in the distribution of economic burden, and the intrusiveness required to practically determine who acts in a morally wrong and health-adverse way. The liberal-egalitarian model, a theory of distributive justice, has two facets: the liberal principle that people should be held accountable for their choices and the egalitarian principle that people who make the same choices should have the same outcomes.[12] This model attempts to fuse responsibility with equity by seeking to reward good behavior and tax bad behavior rather than punish the consequences of the action and navigate who deserves treatment. For instance, the hospital bedside is not the appropriate place to introduce responsibility for one’s health outcomes.[13] This appeals to the reality that, at that time, discerning the true causes of disease was not plausible and to humanity in avoiding a heartless and cruel approach. An argument in favor of the liberal-egalitarian model considers its method of implementation. This approach assumes that the healthcare system treats all individuals regardless of their choices or ability to cover costs. The liberal-egalitarian model also assumes that a certain adverse health condition is related, statistically speaking, to the consumption of a certain good and that good can be taxed. As such, it proposes to tax the consumption of that good to finance the collective burden which arises from that good’s consumption rather than require individuals to pay for their own treatment. In the example of ARESLD, the recommended solution would be taxing all alcohol. While a systematic infrastructure is not explicit, there is the implication that a per-unit tax can be imposed on alcohol so the total tax revenue would make up for the additional healthcare costs due to consumption.[14] Upholding the principle that all people who make the same choices should face the same costs, all consumers of alcohol would pay the same tax, regardless of factors such as genetic predisposition to alcoholism, lifestyle, or expected cost of treatment. Upholding the principle of individual responsibility, this model does not deny treatment to anyone, neutralizing factors outside that individual’s control by imposing the tax ex-ante. Other people are not burdened by those who consume the good. People who consume alcohol face a burden proportional to the amount consumed. This tax-based implementation is justified so long as the tax is not prohibitively high for the average consumer. Further, the model mitigates concerns over the intrusiveness of ascribing morality to health-adverse behaviors. lV. Moral and Social Arguments Against the Liberal-Egalitarian Position Arguments against the liberal-egalitarian model concerns its many assumptions. First, this model assumes that consumption of such goods is directly related to the health outcome and that these goods can be taxed.[15] Certain people genetically predisposed to alcoholism would be predisposed to consume more alcohol. The model falls short when applied to scenarios where health outcomes are not consumption-based, such as engaging in unsafe sex or abstaining from healthy lifestyle choices like exercise. Second, some might argue that the liberal-egalitarian model fails to remain neutral. Residual moral judgments tied to consumption choices introduce non-neutrality. Although taxation in free societies is determined by democratic procedures rather than by individuals in the healthcare system, moral and value-based judgments will be implicit in deciding what behaviors are taxable, such as the purchase of cigarettes. Third, the liberal-egalitarian model fails to determine whether one’s behavior is autonomous, as socio-cultural-economic factors may influence it and behavior is more a product of society, peer pressure, or income. Those also may reflect systemic inequalities. Therefore, this model, which rewards, or taxes based solely on decisions, regardless of their consequences and motivations, fails to consider that a person’s decisions may not be completely autonomous. V. Libertarian Arguments Against the Liberal-Egalitarian Model a. State Intrusiveness as Counter to the Liberal-Egalitarian Model Last, there is a libertarian worry that if the state guarantees universal healthcare coverage to all people, the state will have to become highly intrusive and investigate people’s morals.[16] At least one-third of all disease burden in North America, Europe, and the Asia-Pacific is attributable to lifestyle measures such as tobacco smoking, alcohol consumption, high cholesterol, and obesity.[17] With these various lifestyles, it is not likely to agree on what conduct to tax or condemn.[18] The fine-toothed comb required to determine whether each citizen has been engaging in these behaviors would intrude on daily life and personal freedom. Libertarians champion the argument that impractical intrusiveness would result from universal healthcare, and such a degree of intrusiveness would likely be universally unacceptable.[19] The liberal-egalitarian model mitigates the libertarian worry about state intrusiveness as it does not involve prying into one’s life and choices other than taxing goods. A liberal state should ideally be neutral to how people decide to live their lives. In all, libertarians can rest assured that the liberal-egalitarian tax-based model, through its ex-ante implementation, will require no prying state eyes. States that provide universal healthcare coverage and wish to condemn certain misconduct do not need to become overly intrusive to carry out measures to hold individuals accountable. b. Fairness Another libertarian worry regarding the guarantee of universal healthcare coverage in the context of lifestyle-driven diseases is that the public will be burdened unfairly with covering others’ ill-advised mistakes or bad luck. An ideal system to address this worry would link treatment or payment for treatment with whatever behavior caused that need.[20] The distribution of burdens should be linked to how different individuals contributed to the creation of those burdens. Applied to health policy, we should ask how the need for a certain treatment arose when determining how to distribute its cost.[21] The liberal-egalitarian model aspires to hold individuals responsible for their choices, not for the consequences of such choices. This model significantly mitigates the libertarian worry over unfair burdens for covering other people’s mistakes or social conditions, which lead to those bad outcomes, by ensuring to not burden others with any of the costs for the treatment of people who decide to engage in certain health-adverse behaviors. The aforementioned taxation-based system would only tax those who also engage in the health-adverse behavior through consumption, and that tax directly pays for the necessary collective treatment. As such, those who do not consume the good are not involved with the payment scheme, while those who do consume the good are responsible for payment in a matter proportional to the amount of the good they have consumed. Vl. Universal Coverage Taking a step back, one should consider whether these worries regarding the coverage of apparently self-inflicted health conditions in the context of universal healthcare are worthwhile issues. One perspective raises what is called the culturally imagined objection — an idea erroneously held by many that sick people, especially those who are poor and uneducated, bring these illnesses upon themselves due to poor decision-making and irresponsible risk-taking.[22] This perspective critiques the uniquely American view that, since individuals are free to choose their lifestyles, they should bear the costs of their lifestyle.[23] Taking this argument further, some (perhaps the strongly libertarian) would say that the poor health status among many individuals is the price individuals must pay for their American way of life and the liberty and freedom to live as they wish. However, people should not completely punish individuals for their health-adverse behaviors because these choices are largely pre-determined by a person’s socioeconomic influences.[24] The outcomes from these allegedly ill-advised behaviors, which largely affect poorer people, are not just poor behavior but rather a public health crisis. Perhaps the state and its people should take collective responsibility and cover the costs of treatment for those health outcomes without question, as a form of public service. Rather than worrying about accountability and taxing bad behavior or intrusiveness into personal decisions, some might argue that people need to collectively take responsibility for reducing the overarching systemic inequalities and covering the associated treatment costs as a measure of public health. Vll. Proposed Solution Given the strengths of the liberal-egalitarian model and taking into account libertarian and social justice-oriented objections, an ideal solution for the coverage of lifestyle-related health problems needs to consider the complex relationship between a person’s behaviors and their apparent health outcomes. It must consider how society as a whole passes judgment on behaviors and how to take into account that many health-adverse decisions are not truly autonomous decisions, as various genetic and socioeconomic factors influence them. An ideal solution combines the liberal-egalitarian tax-based model with the social justice concerns of universal coverage. Whatever the cost for the treatment of medical issues resulting in part or entirely from lifestyle and diet, taxes collected from spending associated with the behavior (like the purchase of alcohol, junk food, and cigarettes) ex-ante should fund 50 percent of the cost of treatment, while the universal healthcare taxation scheme should include the other 50 percent. Such a system would provide an incentive to avoid the purchases that can lead to unhealthy consumption and make healthier choices, slightly punish and discourage such purchases through taxation, yet not overly punish people whose outcomes may have more to do with socioeconomic factors and genetics. Adding public responsibility demonstrates acknowledgement that health care is in the public interest and can mitigate public health inequalities. This solution would fuse personal responsibility with the public responsibility of state-sponsored social improvement while ensuring that all people have fair access to necessary treatment, no matter their ability to pay. CONCLUSION The 50-50 system this paper proposes reflects both justice and personal responsibility in covering healthcare costs allegedly brought about by people’s own health-adverse behaviors. By allocating tax revenue from consumption that contributes or even alone causes poor health outcomes, such a system incorporates personal responsibility. By using general tax revenue for health care, such a system would meet the libertarian requirement of providing care without any moral investigation of past behaviors and the social justice consideration of providing health care to those who may have unwittingly ventured into ill-health due to systemic injustice, socioeconomics, or genetics. - [1] Cappelen, A. W. (2005). Responsibility in health care: A liberal egalitarian approach. Journal of Medical Ethics, 31(8), 476–480. https://doi.org/10.1136/jme.2004.010421 [2] Moss, A. H. (1991). Should alcoholics compete equally for liver transplantation? JAMA: The Journal of the American Medical Association, 265(10), 1295–1298. https://doi.org/10.1001/jama.1991.03460100097032 [3] Moss, p. 1295-1298. [4] Moss, p. 1296. [5] Moss, p. 1295-1298. [6] Moss, p. 1295-1298. [7] Cohen, C. IS THIS SUPPOSED TO BE COHEN AND BENJAMIN (1991). Alcoholics and liver transplantation. JAMA: The Journal of the American Medical Association, 265(10), 1299–1301. https://doi.org/10.1001/jama.1991.03460100101033 [8] Cohen, p. 1299-1301. [9] Moss, p. 1297. [10] Cohen, p. 1300. [11] Cappelen, p. 478-480. [12] Cappalen, p. 478-480. [13] Cappelen, p.479. [14] Cappelen, p. 479. [15] Cappelen, p. 479 [16] Cohen, p. 1301. [17] Cappelen, p. 478. [18] Cohen, p. 1299-1301. [19] Cohen, p. 1301. [20] Cappelen, p. 476-480. [21] Cappelen, p. 476-480. [22] Kawachi, I. (2005). Why the United States is not number one in Health. Healthy, Wealthy, and Fair, 18–33. https://doi.org/10.1093/acprof:oso/9780195170665.003.0013 [23] Kawachi, p. 18-33. [24] Kawachi, p. 18-33. (shrink)

We are surrounded by threats of environmental harm whose actual dangers to public health are scientifically unverified. It is widely presumed that under conditions of uncertainty, when it is not possible to foresee the outcomes of our actions, or to calculate the probability they will actually cause harm, we cannot be held culpable for the risks and harms our actions impose on others. It is commonly presumed, that is, that exposing others to what this paper terms ‘uncertain threats’ is permissible, (...) because conventional theories of moral responsibility understand uncertainty as implying that the effects of our actions are out of our control and, therefore, beyond our fault. In contrast, in rejecting arguments from moral luck, this paper denies that authors of uncertain threats of environmental harm are excusably ignorant, and denies that prevailing uncertainty diminishes their moral obligations or attenuates their culpability. For under conditions of uncertainty, culpability turns on the lack of due regard for others as moral equals – a consideration that neither luck nor ignorance excuses. To expose others to unconsented-to uncertain threats of harm without exercising due care to prevent possible injury is to wrongfully gamble with their welfare and their capacity for self-authorship. (shrink)

The increased incidences of academic misconduct in universities are compromising the reputation of higher education in Australia and increasing the work of academics responsible for the delivery of quality learning outcomes to students. Confronted with increasing instances of academic dishonesty in university classrooms, universities play a pivotal role in ensuring their academic staff are well-equipped with academic integrity knowledge. It is therefore important to understand academic staff perspectives about the training their workplaces could provide them on academic integrity. Specifically, this (...) qualitative case study explores the opinions and perceptions of sessional or casual university academic staff on what content they would like to know about academic integrity, and how this knowledge could best be delivered to them. The study found that participants were genuinely interested in furthering their understanding of academic integrity issues, particularly in the areas of contract cheating, effective use of plagiarism detection tools, and developing a toolkit of skills that they could use to detect and deter plagiarism. In terms of the delivery of academic integrity training programs, webinars and orientation sessions were suggested as effective delivery mechanisms. Imparting knowledge about the content areas through the identified delivery mechanisms could enhance teaching faculty’s understanding of student academic dishonesty and how to curb this behaviour proactively. (shrink)

PurposeThe purpose of this paper is to outline a case where people's intuitions regarding the ethical status of an action performed in a massively multiplayer online role‐playing game are divided, and provide an argument to resolve this division.Design/methodology/approachThis paper takes a philosophical approach, from the analytical tradition. It details the main arguments for each side and provides counter‐arguments in order to indicate the salient points.FindingsThe paper argues that, of the three arguments for the morality of particular virtual action outlined in (...) this paper, none are satisfactory. An argument for the immorality of the action in questions based upon the fairness/sportsmanship distinction is offered.Originality/valueThe development of case‐based ethical studies, which draw upon current and controversial events within popular virtual environments, are useful in the construction of a deeper understanding of moral action within such spaces. (shrink)

Impaired control over drug use is a defining characteristic of addiction in the major diagnostic systems. However there is significant debate about the extent of this impairment. This qualitative study examines the extent to which leading Australian addiction neuroscientists and clinicians believe that addicted individuals have control over their drug use and are responsible for their behaviour. One hour semi-structured interviews were conducted during 2009 and 2010 with 31 Australian addiction neuroscientists and clinicians (10 females and 21 males; 16 with (...) clinical experience and 15 with no clinical experience). Although many addiction neuroscientists and clinicians described uncontrolled or compulsive drug use as characteristic of addiction, most were ambivalent about whether or not addicted people could be said to have no control of their drug use. Most believed that addicted individuals have fluctuating levels of impaired control over their drug use but they nonetheless believed that addicted persons were responsible for their behaviour, including criminal behaviour engaged in to fund their drug use. Addiction was not seen as exculpating criminal behaviour but as a mitigating factor. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Buddhism, Christianity, and Modern Science:A Response to Masao AbeFrank FairAfter number of years of teaching philosophy of science, a few years ago I took up the challenge of teaching philosophy of religion. As one might imagine, it has always seemed to me to be important that our religious convictions harmonize with our best scientific knowledge of how the world works, and this became a more interesting issue when the (...) change in my teaching assignment brought me into contact with the work of Masao Abe, the eminent Japanese Buddhist scholar. His essay "Religion and Science in the Global Age—Their Essential Character and Mutual Relationship" (Abe 1985: 241–248) challenged me to expand my thinking to consider not only how theistic religions such as Christianity relate to science, but also to consider how nontheistic religions, such as Buddhism, might fare when interacting with modern science.In his essay on religion and science Abe expressed his agreement with the thought of Keiji Nishitani in this way:1. It is necessary for each religion to re-examine the basis of its world view. For any religion its world view is not like clothes that one can change whenever one pleases. A world view is to religion what water is to a fish. It is the indispensable condition through which religion can actually come into existence. Water is neither the life of the fish as such, nor its body, yet it is fundamentally linked to both. For a religion to change its world view is a matter no less fatal to it than for a fish to change from salt water to fresh.2. What is even more crucial and important is that each religion re-examine and reinterpret that tradition's understanding of God or the 'ultimate' and His or its relation to human beings and the world. With regard to this second point, Buddhism which is fundamentally non-theistic, is in a somewhat different situation from Christianity, which is basically theistic. (Abe 1985: 244–245)Abe continues: "Theistic answers to the question 'why' in Christianity, such as the 'will of God' and the 'rule of God' are incompatible with modern scientific answers to the question 'how.' This is because the former strongly emphasize the personality of the ultimate while the latter is essentially impersonal" (Abe 1985: 245). In this [End Page 67] discussion, I will follow Abe's lead and consider the question of whether Buddhism is more compatible with modern science than Christianity.Christianity and Modern Science: Tensions and HarmoniesOne set of issues causing tension between modern science and Christianity has to do with history. Briefly, ideas about the creation of the universe, about the special creation of humankind, and about miracles, as in the claims about the resurrection of Jesus, are ideas about the action of God in history. These ideas relate the stance that Abe attributed to Christianity as involving an attempt to answer "why" questions about meaning and purpose, an attempt which he feels brings Christianity into conflict with modern science. I will give a brief account of what I take to be the current state of the discussion about each of these matters, and my point is to argue that Abe's conclusion about the relative superiority of Buddhism over Christianity in relation to modern science is premature at best.The Creation of the UniverseThe rise of the Big Bang theory, which traces the origin of the universe back to a tremendously powerful event several billion years ago, at first gave comfort to traditional ideas of divine creation. However, it soon became apparent that this comfort was ambiguous at best. It was not clear, for instance, that one could really prove on the basis of observational evidence that there was an absolute starting point those many billions of years ago, or whether the totality of things could be going through a huge set of cycles. Then there is the issue that even if there is a "First Cause" responsible for the Big Bang, this does not automatically give evidence that the First Cause is a personal being who cares about us or has any immediate involvement in our lives. The First Cause... (shrink)

Rawls famously argued against meritocratic conceptions of distributive justice on the grounds that the accumulation of merit is an unavoidably lucky process, both because of differences in early environment, and innate talents. Thomas Mulligan (2018a) has recently provided a novel defense of meritocracy against the “luck objection”, arguing that both sources of luck would be mostly eliminated in a meritocracy. While a system of fair equality of opportunity ensures that differences in social class or early environment do not lead to (...) differences in the accumulation of merit, Kripke’s essentiality of origin thesis means that our genetic endowments, and thus our innate talents, could not have been any other way. But if we could not fail to have our innate talents, Mulligan argues, then it is not a matter of luck that we have them, and so the merits we accumulate on their basis are not so luck-dependent. This paper argues that Mulligan’s appeal to the essentiality of origin thesis fails to rescue meritocratic conceptions of distributive justice from the luck objection for two reasons. First, even granting essentiality of origin and fair equality of opportunity, the contingencies of the market and the social environment mean that having some innate talents is far luckier than having others. And second, the appeal to essentiality of origin misses the underlying motivation for the luck objection, and ignores the intimate connection between desert and responsibility. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Buddhist-Christian Studies 20 (2000) 282-287 [Access article in PDF] Book Review Wrestling with the Ox: A Theology of Religious Experience Wrestling with the Ox: A Theology of Religious Experience. By Paul O. Ingram. New York: Continuum, 1997. 276 pp. Paul Ingram has set out a formidable task for himself. Even though he identifies himself as an historian of religion, he has chosen to push beyond phenomenological description of the (...) religious enterprise to make a prescriptive proposal, a theology that can illuminate and guide the great faith traditions. Simultaneously, his proposal aims at interpreting the necessity and the outlines of interreligious dialogue. Such dialogue, he argues, is not a peripheral enterprise reserved for a handful of religious exotics. It is central to understanding any and all religious traditions in the postmodern world.All religions have been discovered to reflect inescapable historical and cultural relativization. The old assumptions of unconditional claims and absolute assertions are no longer tenable. The world shared by all the religions today is characterized by an unavoidable religious pluralism. It is in this context that religious affirmations must be expressed and religious life embraced. According to Ingram, this is no accident. It is an ontological inevitability. As process philosophy and its roots in modern physics [End Page 282] --and, interestingly, the Buddhist recognition of dependent co-arising (pratitya samutpada)--understand, reality is unending process. This entails the inevitable relativization and contextualization of everything--including the religions. The theological questions that emerge are crucial ones. Among them: Is there an ultimate unity underlying this diversity, generic features common to all conditioned forms of religious faith and practice? What does religious pluralism show about the nature of the Sacred and of being human? Is any one religious Way best or is this even a question worth pursuing?Ingram proposes that the answers to these questions and the only viable response to religious pluralism can be found in interreligious dialogue. He does not even consider religious exclusivism as a viable option. This means only "inclusivist" and "pluralist" approaches are worthy of consideration, approaches that he names the "theology-of-religions model" and the "primordial model" respectively. Both recognize the problem of the relativity of belief and seek to overcome it. Both see the importance of interreligious dialogue as fundamental to religious affirmation. But Ingram rejects the theology-of-religions model because, despite its openness to other religions and its willingness to have interreligious encounter shape the affirmations and life of the believing community, it is self-encapsulated. One moves out from a particular community of faith, "passing over"--to use the language of John Dunne--into another religious Way in order to be creatively transformed, but only to return once again to the original community of faith. One stays within "the theological circle" (Tillich), one does not get beyond it. Some Christians, accordingly, make a blanket assertion about the ultimate and unsurpassable lordship of Christ despite their indebtedness to the creative transformation that interreligious dialogue can produce.Ingram clearly prefers the "primordial model" even though he recognizes that some of its classical proponents have made it vulnerable to criticism. Aldous Huxley's "perennial philosophy" and Sri Ramakrishan's assertion that "all paths lead to the summit" will not do. Huxley assumes that the mystical recognition of the ineffable common root of all religion critiques the historical and culturally relative expressions of this ultimate reality. But Huxley's attempt to make an end run around the problems involved won't work. His approach is ahistorical, makes uncritical assumptions about the nature of mysticism and religious experience, and is totally undialogical. The particularities of the differing religious Ways are dissolved in a universal solvent that is anything but self-evident. The same holds true for Ramakrishnan's subtly imperialistic (and very Hindu) model. It too has no room for religious particularity and imposes a pre-conceived common denominator on the multiplicity of religious phenomena.Ingram derives his term "primordial model" from Huston Smith's argument that a "primordial tradition" can be discerned underlying the multiplicity and variety of religious expressions. His is... (shrink)

In this book, an international group of philosophers, economists and theologians focus on the relationship between justice, luck and responsibility in health care. Together, they offer a thorough reflection on questions such as: How should we understand justice in health care? Why are health care interests so important that they deserve special protection? How should we value health? What are its functions and do these make it different from other goods? Furthermore, how much equality should there be? Which inequalities (...) in health and health care are unfair and which are simply unfortunate? Which matters of health care belong to the domain of justice, and which to the domain of charity? And to what extent should we allow personal responsibility to play a role in allocating health care services and resources, or in distributing the costs? With this book, the editors meet a double objective. First, they provide a comprehensive philosophical framework for understanding the concepts of justice, luck and responsibility in contemporary health care; and secondly, they explore whether these concepts have practical force to guide normative discussions in specific contexts of health care such as prevention of infectious diseases or in matters of reproductive technology. Particular and extensive attention is paid to issues regarding end-of-life care. (shrink)

Issue Title: Moral Luck, Social Networking Sites, and Trust on the Web I argue that the problem of 'moral luck' is an unjustly neglected topic within Computer Ethics. This is unfortunate given that the very nature of computer technology, its 'logical malleability', leads to ever greater levels of complexity, unreliability and uncertainty. The ever widening contexts of application in turn lead to greater scope for the operation of chance and the phenomenon of moral luck. Moral luck bears down most heavily (...) on notions of professional responsibility, the identification and attribution of responsibility. It is immunity from luck that conventionally marks out moral value from other kinds of values such as instrumental, technical, and use value. The paper describes the nature of moral luck and its erosion of the scope of responsibility and agency. Moral luck poses a challenge to the kinds of theoretical approaches often deployed in Computer Ethics when analyzing moral questions arising from the design and implementation of information and communication technologies. The paper considers the impact on consequentialism; virtue ethics; and duty ethics. In addressing cases of moral luck within Computer Ethics, I argue that it is important to recognise the ways in which different types of moral systems are vulnerable, or resistant, to moral luck. Different resolutions are possible depending on the moral framework adopted. Equally, resolution of cases will depend on fundamental moral assumptions. The problem of moral luck in Computer Ethics should prompt us to new ways of looking at risk, accountability and responsibility.[PUBLICATION ABSTRACT]. (shrink)

A commitment to holding persons responsible for the consequences of their choices has come to find a central expression in certain popular liberal egalitarian views. However, the basis for their commitment to responsibility remains imprecisely understood. Specifically, there is a failure to distinguish between two distinct grounds for holding persons responsible for the consequences of their choices. On the one hand there is a fairness-type basis for responsibility – that an agent’s being better or worse off than others (...) in virtue of their own choice renders that inequality fair, on the other hand an importantly distinct cost-internalisation-type basis for responsibility – that an agent’s being better or worse off than others in virtue of their own choice is just because others have entitlements against certain costs being imposed upon them. This distinction is illuminated by a debate in which issues of egalitarian responsibility figure prominently; namely the debate concerning procreative justice. (shrink)

What is a fair distribution of resources and other goods when individuals are partly responsible for their achievements? This book develops a theory of fairness incorporating a concern for personal responsibility, opportunities and freedom. With a critical perspective, it makes accessible the recent developments in economics and philosophy that define social justice in terms of equal opportunities. It also proposes new perspectives and original ideas. The book separates mathematical sections from the rest of the text, so that the main (...) concepts and ideas are easily accessible to non-technical readers. -/- It is often thought that responsibility is a complex notion, but this monograph proposes a simple analytical framework that makes it possible to disentangle the different concepts of fairness that deal with neutralizing inequalities for which the individuals are not held responsible, rewarding their effort, respecting their choices, or staying neutral with respect to their responsibility sphere. It dwells on paradoxes and impossibilities only as a way to highlight important ethical options and always proposes solutions and reasonable compromises among the conflicting values surrounding equality and responsibility. -/- The theory is able to incorporate disincentive problems and is illustrated in the examination of applied policy issues such as: income redistribution when individuals may be held responsible for their choices of labor supply or education; social and private insurance when individuals may be held responsible for their risky lifestyle; second chance policies; the measurement of inequality of opportunities and social mobility. (shrink)