Priority and Prioritarianism

Many welfarists wish to assign to each possible state of the world a numerical value that measures something like its moral goodness. How are we to determine this quantity? This paper proposes a contractualist approach: a legitimate measure of moral goodness is one that could be justified to each member of the population in question. How do we justify a measure of moral goodness to each individual? Each individual recognises the measure of moral goodness must be a compromise between the (...) different levels of well-being within the population. Some compromises are more reasonable than others; and some are better justifiable to a given member of the population than others. Each member recognises that the social chooser's measure of moral goodness is going to have to deviate from the well-being function of at least some of the members of the population. But we can nonetheless justify it to each of them if it doesn't deviate more than is necessary, and if the deviations from each member are given equal weighting in whatever process we use to determine it. This paper proposes that we begin with a measure of the distance from a proposed compromise to an individual's level of well-being, and then say that the moral goodness is the candidate compromise that minimizes the sum of distances from it to the individuals' levels of well-being. I describe a range of such measures of distance and show that some give utilitarianism, others different versions of prioritarianism. (shrink)

It has been argued that Prioritarianism violates Risky Non-Antiegalitarianism, a condition stating roughly that an alternative is socially better than another if it both makes everyone better off in expectation and leads to more equality. I show that Risky Non-Antiegalitarianism is in fact compatible with Prioritarianism as ordinarily defined, but that it violates some other conditions that may be attractive to prioritarians. While I argue that the latter conditions are not core principles of Prioritarianism, the choice between these conditions and (...) Risky Non-Antiegalitarianism nonetheless constitutes an important intramural debate for prioritarians. (shrink)

School boosters are tax-exempt organizations that engage in fundraising efforts to provide public schools with supplementary resources. This paper argues that prevailing forms of school boosting are defeasibly unjust. Section 1 shows that inequalities in public education funding in the United States violate John Rawls’s two principles of domestic justice. Section 2 argues that prevailing forms of school boosting exacerbate and plausibly perpetuate these injustices. Section 3 then contends that boosting thereby defeasibly violates Rawlsian principles of nonideal theory for rectifying (...) injustice. Thus, boosting should be presumptively either made illegal or substantially reformed. Finally, Section 4 responds to potential objections. (shrink)

This paper provides an axiomatic analysis of sufficientarian social evaluation. Sufficientarianism has emerged as an increasingly important notion of distributive justice. We propose a class of principles that we label generalized critical-level sufficientarian orderings. The distinguishing feature of our new class is that its members exhibit constant critical levels of well-being that are allowed to differ from the threshold of sufficiency. Our basic axiom assigns priority to those below the threshold, a property that is shared by numerous other sufficientarian approaches. (...) When combined with the well-known strong Pareto principle and the assumption that there be a constant critical level, the axiom implies that the critical level cannot be below the threshold. The main results of the paper are characterizations of our new class and an important subclass. As a final observation, we identify the generalized critical-level sufficientarian orderings that permit us to avoid the repugnant conclusion and the sadistic conclusion, which are known as two fundamental challenges in population ethics. (shrink)

La presente investigación tiene como objetivo principal exponer un problema de coherencia presente en las teorías que plantean que los todos mereológicos son prioritarios a las partes que lo componen. El argumento central consiste en mostrar que la dependencia de identidad que las partes tienen con los todos que componen —que define la prioridad ontológica del todo respecto a sus partes— implica un principio de identidad a partir del cual se puede establecer que los todos, a su vez, dependen para (...) su identidad de sus partes, por lo tanto las partes son ontológicamente prioritarias respecto al todo que componen. Así, la teoría colapsa en un círculo vicioso que atenta contra la noción misma de dependencia de identidad. Por esta razón, la teoría no puede sostener de manera coherente la tesis de que los todos son ontológicamente prioritarios a sus partes. (shrink)

The good of those who are worse off matters more to the overall good than the good of those who are better off does. But being worse off than one’s fellows is not itself bad; nor is inequality itself bad; nor do differences in well-being matter more when well-being is lower in an absolute sense. Instead, the good of the relatively worse-off weighs more heavily in the overall good than the good of the relatively better-off does, in virtue of the (...) fact that the former are relatively worse off. This paper articulates and defends the view just described. (shrink)

This paper shows that weak Pareto and strong Pareto are equivalent under continuity and strong quasi-concavity. We use a framework that incorporates welfare as well as non-welfare information.

Population axiology includes two major arguments. The first is the repugnant conclusion, which was originally formulated by Derek Parfit to criticize total utilitarianism. The second is the sadistic conclusion. In this study, I demonstrate that no additively separable principle can avoid both repugnant and sadistic conclusions if individual moral values have no upper bound. This impossibility holds not only for utilitarian principles but also for any population principles that guarantee the separability of people’s well-being. I emphasize the importance of examining (...) non-separable principles in population ethics. (shrink)

Some philosophers and segments of the public think age is relevant to healthcare priority-setting. One argument for this is based in equity: “Old” patients have had either more of a relevant good than “young” patients or enough of that good and so have weaker claims to treatment. This article first notes that some discussions of age-based priority that focus in this way on old and young patients exhibit an ambiguity between two claims: that patients classified as old should have a (...) low priority, and that patients classified as young should have high priority. The author next argues, drawing on a problem raised by Christine Overall, that equity cannot justify giving “old” patients low priority, since there is wide variety in the total lifetime experiences of older people, partly influenced by gender, race, class, and disability injustice. Finally, the author suggests that there might be a limited role for age-based prioritization in the context of infant and childhood death, since those who die in childhood are always and uncontroversially among the worst-off. (shrink)

The transgenerational community is based on moral similarity between contemporary and future people, referring to an ongoing moral deliberation across generations. It justifies obligations of justice towards the not yet born. Prioritarianism gives extra weight to the wellbeing of the least advantaged. I argue that both sentiments are egalitarian, and ask whether there is any tension between them. If we assume economic growth, and/or technological improvements and/or inflation, then prioritarianism prima facie implies that we should prefer to spend any dollar (...) on today’s disadvantaged than on future generations, hence is in tension with the demands of the transgenerational community. Analyzing four ways of meeting this challenge, I argue that the two principles are not in tension. (shrink)

The COVID-19 pandemic has helped to clarify the fair and equitable allocation of scarce medical resources, both within and among countries. The ethical allocation of such resources entails a three-step process: (1) elucidating the fundamental ethical values for allocation, (2) using these values to delineate priority tiers for scarce resources, and (3) implementing the prioritisation to faithfully realise the fundamental values. Myriad reports and assessments have elucidated five core substantive values for ethical allocation: maximising benefits and minimising harms, mitigating unfair (...) disadvantage, equal moral concern, reciprocity, and instrumental value. These values are universal. None of the values are sufficient alone, and their relative weight and application will vary by context. In addition, there are procedural principles such as transparency, engagement, and evidence-responsiveness. Prioritising instrumental value and minimising harms during the COVID-19 pandemic led to widespread agreement on priority tiers to include health-care workers, first responders, people living in congregate housing, and people with an increased risk of death, such as older adults and individuals with medical conditions. However, the pandemic also revealed problems with the implementation of these values and priority tiers, such as allocation on the basis of population rather than COVID-19 burden, and passive allocation that exacerbated disparities by requiring recipients to spend time booking and travelling to appointments. This ethical framework should be the starting point for the allocation of scarce medical resources in future pandemics and other public health conditions. For instance, allocation of the new malaria vaccine among sub-Saharan African countries should be based not on reciprocity to countries that participated in research, but on maximally reducing serious illness and deaths, especially among infants and children. (shrink)

This paper presents a new kind of problem in the ethics of distribution. The problem takes the form of several “calibration dilemmas,” in which intuitively reasonable aversion to small-stakes inequalities requires leading theories of distribution to recommend intuitively unreasonable aversion to large-stakes inequalities. We first lay out a series of such dilemmas for prioritarian theories. We then consider a widely endorsed family of egalitarian views and show that they are subject to even more forceful calibration dilemmas than prioritarian theories. Finally, (...) we show that our results challenge common utilitarian accounts of the badness of inequalities in resources. (shrink)

Prioritarianism is an ethical theory that gives extra weight to the well-being of the worse off. In contrast, dominant policy-evaluation methodologies, such as benefit-cost analysis, cost-effectiveness analysis, and utilitarianism, ignore or downplay issues of fair distribution. Based on a research group founded by the editors, this important book is the first to show how prioritarianism can be used to assess governmental policies and evaluate societal conditions. This book uses prioritarianism as a methodology to evaluate governmental policy across a variety of (...) policy domains: taxation, health policy, risk regulation, education, climate policy, and the COVID-19 pandemic. It is also the first to demonstrate how prioritarianism improves on GDP as an indicator of a society's progress over time. Edited by two senior figures in the field with contributions from some of the world's leading economists, this volume bridges the gap from the theory of prioritarianism to its practical application. (shrink)

This paper shows that versions of prioritarianism that focus at least partially on well-being levels at certain times conflict with conventional views of prudential value and prudential rationality. So-called timeslice prioritarianism, and pluralist views that ascribe importance to timeslices, hold that a benefit matters more, the worse off the beneficiary is at the time of receiving it. We show that views that evaluate outcomes in accordance with this idea entail that an agent who delays gratification makes an outcome worse, even (...) if it is better for the agent and worse for no one else. We take this to show that timeslice prioritarianism and some pluralist views violate Weak Pareto, and we argue that these versions of prioritarianism are implausible. (shrink)

Prioritarianism holds that improvements in someone's life are morally more valuable, the worse off the person would otherwise be. The doctrine is impartial, holding that a gain in one person's life counts exactly the same as an identical gain in the life of anyone equally well off. If we have some duty of beneficence to make the world better, prioritarianism specifies the content of the duty. Unlike the utilitarian, the prioritarian holds that we should not only seek to increase human (...) well-being, but also distribute it fairly across persons, by tilting in favor of the worse off. A variant version adds that we should also give priority to the morally deserving – to saints over scoundrels. The view is a standard for right choice of individual actions and public policies, offering a distinctive alternative to utilitarianism, sufficiency and egalitarianism. (shrink)

This paper provides a characterization of a new class of ordinal poverty measures that are defined by means of the aggregate generalized poverty gap. To be precise, we propose to use the sum of the differences between the transformed fixed poverty line and the transformed level of income of each person below the line as our measure. If the transformation is strictly concave, the resulting measure is strictly inequality averse with respect to the incomes of the poor. In analogy to (...) some existing results on inequality measurement, we show that the only relative (scale-invariant) members of our class are based on strictly concave power functions or the natural logarithm. Moreover, we show that our measures allow for a useful decomposition that is akin to those examined in some earlier contributions. In an empirical analysis, we compare the logarithmic variant of our index to two well-established alternative orderings. Unlike numerous indices that appear in the earlier literature, ours do not explicitly depend on the number of poor or on the total population size, thereby ruling out any direct influence of the head-count ratio on poverty comparisons. (shrink)

Schaffer ha argumentado que la prioridad ontológica del cosmos puede ser inferida a partir de la ausencia de la libertad modal de sus partes. En este artículo ofrezco razones en contra de las siguientes premisas de su argumento: (i) el supuesto según el cual los objetos fundamentales gozan de libertad modal, y (ii) el supuesto según el cual los objetos que están en la relación de ser compañeros de mundo, dada la teoría de contrapartidas, carecen de libertad modal.

Hun Chung argues for a theory of distributive justice – ‘prospect utilitarianism’ – that overcomes two central problems purportedly faced by sufficientarianism: giving implausible answers in ‘lifeboat cases’, where we can save the lives of some but not all of a group, and failing to respect the axiom of continuity. Chung claims that prospect utilitarianism overcomes these problems, and receives empirical support from work in economics on prospect theory. This article responds to Chung's criticisms of sufficientarianism, showing that they are (...) misplaced. It then shows that prospect utilitarianism faces independent problems, since it too requires a threshold, which Chung bases on the idea of ‘adequate functioning’. The article shows that there are problems with this as a threshold, and that it is not empirically supported by prospect theory. (shrink)

Prioritarianism is a variant of utilitarianism. It differs from utilitarianism in that benefiting individuals matters more the worse off these individuals are. On this view, there are two standard ways of handling risky prospects: Ex-Post Prioritarianism adjusts for prioritizing the worse off in final outcomes and then values prospects by the expectation of the sum total of those adjusted values, whereas Ex-Ante Prioritarianism adjusts for prioritizing the worse off on each individual's expectation and then values prospects by the sum total (...) of those adjusted expectations. A standard objection to Ex-Post Prioritarianism is that it violates Ex-Ante Pareto, that is, it prescribes choices that worsen the expectations for everyone. In this article, I argue that Ex-Ante Prioritarianism suffers from much the same problem: it violates a sequential version of Ex-Ante Pareto, that is, it prescribes sequences of choices that worsen the expectations for everyone. (shrink)

In this essay I argue that even though egalitarianism and prioritarianism are different theories of social welfare, they can use the same social welfare measures. I present six different arguments for this thesis. The first argument is that conceptual connections between egalitarianism and prioritarianism ensure that any measure that works for either theory works for both. The second argument is that conditions necessary and sufficient to identify egalitarian and prioritarian measures, respectively, are equivalent. The third argument is that both egalitarianism (...) and prioritarianism can use two standard measures, typically proposed for only one theory. The fourth to sixth arguments contend that four properties that have been proposed as distinctive of either egalitarian or prioritarian measures cannot distinguish between them. I conclude that any egalitarian measure is also a prioritarian measure, and vice versa. (shrink)

Many find that the objectionable nature of paternalism has something to do with belief. However, since it is commonly held that beliefs are directly governed by epistemic as opposed to moral norms, how could it be objectionable to hold paternalistic beliefs about others if they are supported by the evidence? Drawing on central elements of relational egalitarianism, this paper attempts to bridge this gap. In a first step, it argues that holding paternalistic beliefs about others implies a failure to regard (...) them as equals in terms of their moral agency. In a second step, it shows that the fact that we should regard others as equals in this sense raises the threshold for sufficiency of evidence for paternalistic beliefs to be epistemically justified. That is, moral reasons of relational equality encroach on the epistemic. However, these reasons are not decisive. In cases where others are about to jeopardize critical goods such as their lives, mobility or future autonomy, relational equality sometimes calls for paternalistic action and, by extension, the formation of beliefs that render such action rational. The upshot is that in order to meet demands of relational equality we have a pro tanto reason to not hold paternalistic beliefs about others. (shrink)

In his restriction of prioritarianism to cases in which the same people would exist in all the possible outcomes, Parfit stakes out an unstable position, both for himself and more generally. There is no plausible rationale for a prioritarianism that is so restricted, which is consistent with the key features of Parfit’s elaboration and defence of this view and his other commitments. The principles that might be appealed to, in an attempt to justify such a restriction, give rise to a (...) different view—one that is sensitive to the presence or absence of the competing claims of different individuals, where both the existence and the magnitude of these claims are determined by gains and losses to individuals in a manner that is not fully captured by Parfit’s prioritarian weighting. (shrink)

This paper argues that we ought to rethink the harm-reduction prioritization strategy that has shaped early responses to acute resource scarcity (particularly of intensive care unit beds) during the COVID-19 pandemic. Although some authors have claimed that “[t]here are no egalitarians in a pandemic,” it is noted here that many observers and commentators have been deeply concerned about how prioritization policies that proceed on the basis of survival probability may unjustly distribute the burden of mortality and morbidity, even while reducing (...) overall deaths. The paper further argues that there is a general case in favor of an egalitarian approach to medical rationing that has been missed in the ethical commentary so far; egalitarian approaches to resource rationing minimize wrongful harm. This claim is defended against some objections and the paper concludes by explaining why we should consider the possibility that avoiding wrongful harm is more important than avoiding harm simpliciter. (shrink)

Aiming at the allocation of scarce medical resources, Immanuel and other scholars have put forward a set of influential ethical values and guiding principles. It assigns the priority of resource allocation to those whose lives can be saved and maximized, those who can bring the greatest instrumental value, and those who are the worse off. For other members of society, random selection under the same conditions is adopted. Following the Rawlsian "lexical order, lexicographical" rule, this priority arrangement requires that the (...) "utilitarian principle" should be placed before the "equality principle", and the "instrumental difference principle", the "integrity difference principle" and the "fair opportunity principle" in turn acts on specific distribution agents. Although the framework and its priority rules have obvious drawbacks when faced with Medical Resources Squeeze and other dilemmas, with the help of an understanding of its internal structure, it can effectively respond to the four core issues in the allocation of scarce medical resources. (shrink)

Elizabeth Anderson and Debra Satz continue in the tradition of Plato with their work on the role of education in a just society. Both argue that a just society depends on education enabling citizens to realize democratic or civic equality and that this equality depends on sufficiency in the distribution of educational goods. I agree that education is important to preparing democratic citizens, but I disagree about the plausibility of sufficiency here, especially in the educational context. My argument is two‐fold: (...) I first reconsider a generic positional goods objection to educational inequality, I then argue that plausible sufficientarian replies to this objection fail insofar as they are premised on an impoverished conception of class and power that treats all statuses more like socio‐cultural traits when they should instead be referencing the material conditions someone has inside a social structure. One cannot bring an individual X into the halls of power and simultaneously have X represent or compensate those who are presently disadvantaged in the way that X had formerly been disadvantaged. In short, we should worry about the realistic possibility of securing and sustaining a civic‐minded elite because elites have the power and motivation to enrich themselves at the expense of the rest of us. For the sufficientarian story to work, we need more that explains the realistic possibility of a benevolent ruling elite, until then, democratic equality seems to be better realized by aiming for equal educations, adequacy isn't enough. (shrink)

The article develops an internalist justification of welfare ethics based on empathy. It takes up Hume’s and Schopenhauer’s internalistic (but not consistently developed) justification approach via empathy, but tries to solve three of their problems: 1. the varying strength of empathy depending on the proximity to the object of empathy, 2. the unclear metaethical foundation, 3. the absence of a quantitative model of empathy strength. 1. As a solution to the first problem, the article proposes to limit the foundation of (...) welfare ethics to certain types of empathy. 2. In response to the second problem, an internalistic metaethical conception of the justification of moral principles is outlined, the result of which is: The moral value of the well-being of persons is identical to the expected extent of (positive and negative) empathy arising from this well-being. 3. The contribution to the solution of the third problem and focus of the article is an empirical model of the (subject’s) expected extent of empathy depending on (an object’s) well-being. According to this model, the extent of empathy is not proportional to the expected empathy, but follows a concave function and is therefore prioritarian. Accordingly, the article provides a sketch of an internalist justification of prioritarianism. (shrink)

In this paper, first the term 'prioritarianism' is defined, with some mathematical precision, on the basis of intuitive conceptions of prioritarianism, especially the idea that "benefiting people matters more the worse off these people are". (The prioritarian weighting function is monotonously ascending and concave, while its first derivation is smoothly descending and convex but positive throughout.) Furthermore, (moderate welfare) egalitarianism is characterized. In particular a new symmetry condition is defended, i.e. that egalitarianism evaluates upper and lower deviations from the social (...) middle symmetrically and equally negatively (as do e.g. variance and Gini). Finally, it is shown that this feature distinguishes egalitarianism also extensionally from prioritarianism. (shrink)

Matthew Adler's Measuring Social Welfare is an introduction to the social welfare function (SWF) methodology. This essay questions some ideas at the core of the SWF methodology having to do with the relation between the SWF and the measure of well-being. The facts about individual well-being do not single out a particular scale on which well-being must be measured. As with physical quantities, there are multiple scales that can be used to represent the same information about well-being; no one scale (...) is special. Like physical laws, the SWF and its ranking of distributions cannot depend on exactly which of these scales we use. Adler and other theorists in the SWF tradition have used this idea to derive highly restrictive constraints on the shape of the SWF. These constraints rule out seemingly plausible views about distributive justice and population ethics. I argue, however, that these constraints stem from a simple but instructive mistake. The SWF should not be applied to vectors of numbers such as 1 and 2, but rather to vectors of dimensioned quantities such as 1 util and 2 utils. This seemingly pedantic suggestion turns out to have far-reaching consequences. Unlike the orthodox SWF approach, treating welfare levels as dimensioned quantities lets us distinguish between real changes in well-being and mere changes in the unit of measurement. It does this without making the SWF depend on the scale on which welfare is measured, and in a way that avoids the restrictive constraints on the shape of the SWF. (shrink)

Torbjörn Tännsjö has written a clear and thought-provoking book on healthcare priority setting. He argues that different branches of ethical theory—utilitarianism, egalitarianism, and prioritarianism—are in general agreement on real-world healthcare priorities, and that it is human irrationality that stands in the way of complying with their recommendations. While I am generally sympathetic to the overall project and line of argumentation taken by the book, this paper raises two concerns with Tännsjö’s argument. First, that he is wrong to set aside deontic (...) constraints as irrelevant or as pointing in the same direction as consequentialism. Secondly, that his argument against prioritarianism in favor of utilitarianism is insufficient and under-developed. Given these problems, I conclude that we should welcome Tännsjö’s contribution but with these qualifications in mind. (shrink)

In this Correspondence, I argue that given that scarcity has existed both for critical care resources and for vaccines, allocating critical care resources to prioritize the prevention of early COVID-19 deaths (i.e. COVID-19 deaths among younger patients) could valuably counterbalance the disproportionate exclusion of minority patients and those with life shortening disabilities that age-based vaccine allocation produces. -/- Covid-19 deaths early in life have overwhelmingly befallen minorities and people with life-shortening disabilities. Policies preventing early deaths prevent an outcome widely recognized (...) as worse—dying earlier in one’s life rather than later—while counteracting intersecting forms of injustice. Ultimately, prohibiting the use of age as a tiebreaker in critical care allocation, as Brown et al. propose, will worsen disparities and is not mandated by law. (shrink)

The U.S. FDA has issued emergency use authorizations for monoclonal antibodies for non-hospitalized patients with mild or moderate COVID-19 disease and for individuals exposed to COVID-19 as post-exposure prophylaxis. One EUA for an oral antiviral drug, molnupiravir, has also been recommended by FDA’s Antimicrobial Drugs Advisory Committee, and others appear likely in the near future. Due to increased demand because of the Delta variant, the federal government resumed control over the supply and asked states to ration doses. As future variants (...) with increased infectivity and/or severity emerge, further rationing may be required. We identify relevant ethical principles and priority groups for access to therapies based on an integrated approach to population health and medical factors. Using priority categories to allocate scarce therapies effectively operationalizes important ethical values. This strategy is preferable to the current approach of categorical rules based on vaccination, immunocompromise status, or older age, or the ad hoc consideration of clinical risk factors. (shrink)

Tännsjö’s book Setting Health-Care Priorities defends the view that there are three main normative theories in the domain of distributive justice, and that these theories are both highly plausible in themselves, and practically convergent in their normative conclusions. All three theories point to a somewhat radical departure from the present distribution of medical resources: in particular, they suggest redirecting resources from marginal life extension to the care of mentally ill patients. In this paper I wish to argue, firstly, that prioritarianism (...) should not be considered as an amendment to utilitarianism, as it is in Tännsjö’s view, but as a distinctive fourth option. This can best be appreciated if we focus on a reading of the theory that emphasizes its derivation from egalitarianism and its attempt to develop an intermediate approach between utilitarian and egalitarian intuitions. Secondly, in response to Tännsjö’s central objection to prioritarianism, I will argue that the theory does not apply in intrapersonal cases but is only relevant for decisions regarding the interpersonal distribution of benefits. Finally, I will suggest that a practical convergence of the four theories on specific issues such as artificial reproduction or mood enhancement is far less likely than Tännsjö seems to believe. (shrink)

This article is concerned with social and political equality. In its prescriptive usage, ‘equality’ is a highly contested concept. Its normally positive connotation gives it a rhetorical power suitable for use in political slogans (Westen 1990). At least since the French Revolution, equality has served as one of the leading ideals of the body politic; in this respect, it is at present probably the most controversial of the great social ideals. There is controversy concerning the precise notion of equality, the (...) relation of justice and equality (the principles of equality), the material requirements and measure of the ideal of equality (equality of what?), the extension of equality (equality among whom?), and its status within a comprehensive (liberal) theory of justice (the value of equality). First published Tue Mar 27, 2001; substantive revision Mon Apr 26, 2021. (shrink)

The veil of ignorance argument was used by John C. Harsanyi to defend Utilitarianism and by John Rawls to defend the absolute priority of the worst off. In a recent paper, Lara Buchak revives the veil of ignorance argument, and uses it to defend an intermediate position between Harsanyi's and Rawls' that she calls Relative Prioritarianism. None of these authors explore the implications of allowing that agent's behind the veil are averse to ambiguity. Allowing for aversion to ambiguity---which is both (...) the most commonly observed and a seemingly reasonable attitude to ambiguity---however supports a version of Egalitarianism, whose logical form is quite different from the theories defended by the aforementioned authors. Moreover, it turns out that the veil of ignorance argument neither supports standard Utilitarianism nor Prioritarianism unless we assume that rational people are insensitive to ambiguity. (shrink)

A half-century of Rawls interpreters have overemphasized economic equality in A Theory of Justice, slighting liberty—the central value of liberalism—in the process. From luck-egalitarian readings of Rawls to more recent claims that Rawls was a “reticent socialist,” these interpretations have obscured Rawls’s identity as a philosopher of freedom. They have also obscured the perhaps surprising fact that Rawlsian liberties (basic and non-basic) restrain and even undermine that same economic equality. As I will show in this article, such undermining occurs in (...) three areas: first, in the lexical priority of the basic liberties; second, in the (underappreciated) role played by free and competitive markets in Rawls’s theory; and third, in the structure and functioning of Rawls’s preferred economic institutions, viz., liberal socialism and property-owning democracy. (shrink)

A possible person’s conditional expected well-being is what the quality of their prospects would be if they were to come into existence. This paper examines the role that this form of expected well-being should play in distributing benefits among prospective people and in deciding who to bring into existence. It argues for a novel egalitarian view on which it is important to ensure equality in people’s life prospects, not merely between actual individuals, but also between all individuals who, given our (...) choices, have a chance of coming into existence. The paper argues that such egalitarianism for prospective people springs from equal concern for each person and has plausible implications. It further shows that it has a rationale in respect for both the unity of the individual and the separateness of persons. Finally, it defends this view against a key objection and shows it is superior to a rival view. (shrink)

In this article, we propose the Fair Priority Model for COVID-19 vaccine distribution, and emphasize three fundamental values we believe should be considered when distributing a COVID-19 vaccine among countries: Benefiting people and limiting harm, prioritizing the disadvantaged, and equal moral concern for all individuals. The Priority Model addresses these values by focusing on mitigating three types of harms caused by COVID-19: death and permanent organ damage, indirect health consequences, such as health care system strain and stress, as well as (...) economic destruction. It proposes proceeding in three phases: the first addresses premature death, the second long-term health issues and economic harms, and the third aims to contain viral transmission fully and restore pre-pandemic activity. -/- To those who may deem an ethical framework irrelevant because of the belief that many countries will pursue "vaccine nationalism," we argue such a framework still has broad relevance. Reasonable national partiality would permit countries to focus on vaccine distribution within their borders up until the rate of transmission is below 1, at which point there would not be sufficient vaccine-preventable harm to justify retaining a vaccine. When a government reaches the limit of national partiality, it should release vaccines for other countries. -/- We also argue against two other recent proposals. Distributing a vaccine proportional to a country's population mistakenly assumes that equality requires treating differently situated countries identically. Prioritizing countries according to the number of front-line health care workers, the proportion of the population over 65, and the number of people with comorbidities within each country may exacerbate disadvantage and end up giving the vaccine in large part to wealthy nations. (shrink)

The ex ante Pareto principle has an intuitive pull, and it has been a principle of central importance since Harsanyi’s defence of utilitarianism. The principle has been used to criticize and refine a range of positions in welfare economics, including egalitarianism and prioritarianism. But this principle faces a serious problem. I have argued elsewhere :303-323 2017) that the concept of ex ante Pareto superiority is not well defined, because its application in a choice situation concerning a fixed population can depend (...) on how the members of that population are designated. I show in this paper that in almost all cases of policy choice, there will be numerous sets of rival designators for the same fixed population. I explore two ways that we might complete the definition of ex ante Pareto superiority. I call these the ‘supervaluationist’ reading and the ‘subvaluationist’ reading. I reject the subvaluationist reading as uncharitable, and argue that the supervaluationist reading is the most promising interpretation of the ex ante Pareto principle. I end by exploring some of the implications of this principle for prioritarianism and egalitarianism. (shrink)

Lara Buchak argues for a version of rank-weighted utilitarianism that assigns greater weight to the interests of the worse off. She argues that our distributive principles should be derived from the preferences of rational individuals behind a veil of ignorance, who ought to be risk averse. I argue that Buchak’s appeal to the veil of ignorance leads to a particular way of extending rank-weighted utilitarianism to the evaluation of uncertain prospects. This method recommends choices that violate the unanimous preferences of (...) rational individuals and choices that guarantee worse distributions. These results, I suggest, undermine Buchak’s argument for rank-weighted utilitarianism. (shrink)

Certifications of immunity are sometimes called “immunity passports” but are better conceptualized as immunity-based licenses. Such policies raise important questions about fairness, stigma, and counterproductive incentives but could also further individual freedom and improve public health. Immunity licenses should not be evaluated against a baseline of normalcy, ie, uninfected free movement. Rather, they should be compared to the alternatives of enforcing strict public health restrictions for many months or permitting activities that could spread infection, both of which exacerbate inequalities and (...) impose serious burdens. This Viewpoint presents a framework for analyzing the ethics of immunity licenses. (shrink)

Initial vaccine allocations for the coronavirus disease 2019 (COVID-19) will be limited. It is crucial to assess the ethical values associated with different methods of allocation, as well as important scientific and practical questions. This Viewpoint identifies three ethical values, benefiting people and limiting harm; prioritizing disadvantaged populations; and equal concern for all. It then explains why these values support prioritizing three groups: health care workers; other essential workers and people in high-transmission settings; and people with medical vulnerabilities associated with (...) poorer COVID-19 outcomes. In contrast, two other groups, people over 65 without medical vulnerabilities and participants in clinical research, present more complex ethical questions. This prioritization also encompasses valuing direct benefits to vaccinated individuals, indirect benefits to individuals protected from spread of infection, and indirect health and socioeconomic benefits to those protected from harm as health system and societal functioning improve. Vaccine allocation that recognizes important ethical values and avoids arbitrariness, waste, and corruption can ensure that the distribution of a COVID-19 vaccine is both fair and perceived as fair. (shrink)

Proposals for allocating scarce lifesaving resources in the face of the Covid-19 pandemic have aligned in some ways and conflicted in others. This paper attempts a kind of priority setting in addressing these conflicts. In the first part, we identify points on which we do not believe that reasonable people should differ—even if they do. These are (i) the inadequacy of traditional clinical ethics to address priority-setting in a pandemic; (ii) the relevance of saving lives; (iii) the flaws of first-come, (...) first-served allocation; (iv) the relevance of post-episode survival; (v) the difference between age and other factors that affect life-expectancy; and (vi) the need to avoid quality-of-life judgments. In the second part, we lay out some positions on which reasonable people can and do differ. These include (i) conflicts between maximizing benefits and priority to the worst off; (ii) role-based priority; and (iii) whether patients’ existing lifesaving resources should be subject to redistribution. (shrink)

Prioritarianism is a moral view that ranks outcomes according to the sum of a strictly increasing and strictly concave transformation of individual well-being. Prioritarianism is ‘welfarist’ (namel...

A well-known objection to prioritarianism, famously levelled by Mike Otsuka and Alex Voorhoeve, is that it wrongly ignores the unity of the individual in treating intra-personal cases like inter-personal cases. In this paper we accept that there should be a moral shift between these cases, but argue that this is because autonomy is a relevant consideration in intra-personal but not inter-personal cases, and one to which pluralist prioritarians ought to attend. To avoid this response, Otsuka and Voorhoeve must assume we (...) know nothing about the subjective information of the person being chosen for. But we show that this commits them to two controversial assumptions: that welfare consists in an objective list of goods, and – if one accepts an unorthodox but plausible account of the relationship between risk aversion and rationality – that there is only a narrow range of rational risk aversions. Only prioritarians who accept both these assumptions are on the hook of Otsuka and Voorhoeve’s objection; for all others, the examples have insufficient information, and so lose their sting. (shrink)

In this article, I firstly discuss why a prioritarian clause can rescue the utilitarian doctrine from the risk of exacerbating inequality in the distribution of resources in those cases in which utility of income does not decline at the margin. Nonetheless, when in the presence of adaptive preferences, classic prioritarianism is more likely than utilitarianism to increase the inequality of resources under all circumstances, independently of the diminishing trend of utility. Hence, I propose to shift the informational focus of prioritarianism (...) from welfare to either social income or capabilities in order to safeguard those who are worse off. Following this, I argue that we may have reasons to limit the aggregative logic of priority-amended utilitarianism through one or more sufficiency thresholds, and that we can partially defuse the negative-thesis objection that is usually levelled against sufficientarianism, provided we interpret the threshold(s) as valid only as long as everyone is led above it. (shrink)

This chapter argues that rather than viewing transparency as a right, we should regard it as a finite resource whose allocation involves tradeoffs. It then argues that those tradeoffs should be resolved by using a multi-principle approach to distributive justice. The relevant principles include maximizing welfare, maximizing autonomy, and giving priority to the worst off. Finally, it examines some of the implications for law of recognizing the tradeoffs presented by transparency proposals.

Many assume that theories of distributive justice must obviously take people’s lifetimes, and only their lifetimes, as the relevant period across which we distribute. Although the question of the temporal subject has risen in prominence, it is still relatively underdeveloped, particularly in the sphere of health and healthcare. This paper defends a particular view, “momentary sufficientarianism,” as being an important element of healthcare justice. At the heart of the argument is a commitment to pluralism about justice, where theorizing about just (...) principles demands paying attention to the role particular goods play in our lives. This means that different approaches to the temporal subject—as well as other relevant issues—may be appropriate for different goods, including different goods within healthcare. In particular, the paper discusses two central goods targeted by healthcare: life-saving and pain relief. The view is offered as complementary to, rather than competitive with, lifetime approaches. As such, the paper finishes by considering how a pluralist approach, which engages both with people’s lives as a whole and with their states at particular moments, can reconcile the potentially competing claims in healthcare that emerge from these two perspectives. (shrink)

Discrimination, understood as differential treatment of individuals on the basis of their respective group memberships, is widely considered to be morally wrong. This moral judgment is backed in many jurisdictions with the passage of equality of opportunity legislation, which aims to ensure that racial, ethnic, religious, sexual, sexual-orientation, disability and other groups are not subjected to discrimination. This chapter explores the conceptual underpinnings of discrimination and equality of opportunity using the tools of analytical moral and political philosophy.