This chapter explores the relational critique of distributive conceptions of justice, according to which the proper focus of egalitarian justice is the egalitarian nature of social relations rather than the equal distribution of certain goods. It maintains that the relational critique constitutes a fundamental challenge to distributive egalitarianism only if it rejects the “core distributive thesis” that holds that the distribution of some nonrelational goods has relation-independent significance for justice. It argues that several relational proposals are compatible with that thesis, (...) and therefore constitute extensions or revisions of the distributive conception rather than alternatives to it, and that those relational views that reject the core distributive thesis are the least plausible ones. Finally, the chapter shows that relational views are often ambiguous regarding the nature of the significance of egalitarian relations, i.e. whether it consists in their contribution to well-being, or in being the fitting response to equal moral status. (shrink)

Since 1984, the idea of health equity has proliferated throughout public health discourse with little mainstream critique for its variability and distance from its original articulation signifying social transformation and a commitment to social justice. In the years since health equity’s emergence and proliferation, it has taken on a seemingly endless range of invocations and deployments, but it most often translates into proactive and apolitical discourse and practice. In Margaret Whitehead’s influential characterization, achieving health equity requires determining what is inequitable (...) by examining and judging the causes of inequalities in the context of what is going on in the rest of society. However, it also remains unclear how or if public health actors examine and judge the causes of health inequality. In this article, we take the concept of health equity itself as an object of study and consider the ways in which its widespread deployment has entailed a considerable emptying of its semantic and political content. We point toward equity’s own discursive productivity as well as the quantifying imperative embedded within evidentiary norms that govern knowledge making, and performance management regimes that govern public health practices. Under current conditions of knowledge making and performance evaluation, a range of legitimate action and inaction is produced at the same time that more socially transformative action is legitimately curtailed—not merely by politics, but by the rules of the field in which public health actors work. Ultimately, meaningful progress on a normative ethical idea like health equity will require both substantial philosophical content and an analysis of what is going on in the rest of society. (shrink)

This paper identifies a challenge for liberal relational egalitarians—namely, how to respond to the prospect of emergent inequalities of power, status, and influence arising unintentionally through the free exercise of fundamental individual liberties over time. I argue that these emergent social inequalities can be produced through patterns of nonmalicious choices, that they can in fact impede the full realization of relational equality, and that it is possible they cannot be eliminated entirely without abandoning fundamental liberal commitments to leave individuals substantial (...) discretion in their personal lives. In such cases, I argue that liberal egalitarians should accept fair relational equality—a demanding but nevertheless imperfect form of relational equality. (shrink)

According to luck egalitarianism, it is not unfair when people are disadvantaged by choices they are responsible for. This implies that those who are disadvantaged by choices that prevent disadvantage to others are not eligible for compensation. This is counterintuitive. We argue that the problem such cases pose for luck egalitarianism reveals an important distinction between responsibility for creating disadvantage and responsibility for distributing disadvantage which has hitherto been overlooked. We develop and defend a version of luck egalitarianism which only (...) holds people responsible for creating disadvantage. This revision enables luck egalitarianism to offer compensation to those who are disadvantaged by preventing disadvantage to others, like dependent caretakers, without compromising the responsibility–sensitivity at the heart of luck egalitarianism. (shrink)

Social egalitarians hold that one fundamental requirement of the ideal of social equality is that people should stand in relations of non-domination to one another. In the light of this, they reject luck egalitarian principles of justice as incompatible with a society of equals, because the former violate the non-domination requirement. I call this the domination objection. In this paper I examine its force against Dworkinian resource egalitarianism. There are two reasons why equality of resources might be thought to be (...) vulnerable to it. First, Dworkin has been interpreted to maintain that as long as people’s preferences are authentic, people should be consequentially responsible for the choices that flow from such preferences. However, Dworkin’s view on when people’s choices should be considered to be authentic does not rule out that the latter are sometimes influenced by norms and processes that are the outcome of domination and oppression, and so holding people fully consequentially responsible for choices that are the outcome of such preferences is itself unjust. Second, equality of resources objectionably permits bad-option-luck victims to become vulnerable to domination. I argue that Dworkinian egalitarianism is not susceptible to either of the two parts of the domination objection and defend the view that it is—contrary to the social egalitarian criticism—faithful to the social egalitarian demand for non-domination. (shrink)

According to relational egalitarians, equality is not primarily about the distribution of some good but about people relating to one another as equals. However, compared with other theorists in political philosophy – including other egalitarians – relational egalitarians have said relatively little on what role personal responsibility should play in their theories. For example, is equality compatible with responsibility? Should economic distributions be responsibility-sensitive? This article fills this gap. I develop a relational egalitarian framework for personal responsibility and show that (...) relational equality commits us to responsibility. I develop two sets of arguments. First, I draw on relational theories of moral responsibility – particularly Strawsonian views – to show that valuable egalitarian relationships require responsibility. Second, I show why relational equality sometimes requires that economic distributions be sensitive to responsibility and choice. I also defend a seemingly paradoxical result: being committed to responsibility, relational egalitarianism not only justifies some distributive inequalities but some relational inequalities too. Overall, relational egalitarianism gives a nuanced and coherent answer as to why and how responsibility matters from within egalitarianism. That it does should be an important argument in its favour. (shrink)

How important is it for managers to have the “nice” virtues of modesty, civility, and humility? While recent scholarship has tended to focus on the organizational consequences of leaders having or lacking these traits, I want to address the prior, deeper question of whether and how these traits are intrinsically morally important. I argue that certain aspects of modesty, civility, and humility have intrinsic importance as the virtues of relational equality – the attitudes and dispositions by which we relate as (...) moral equals. I provide a novel account of the normative grounds of the virtues of relational equality and develop a corresponding framework for how these virtues can be enacted by managers. The virtues are grounded in the value of opposing objectionable forms of social hierarchy, which requires social norms that grant all persons the same personal authority over their lives and interactions. I show how this view of virtue contrasts with prevailing Aristotelian, Personalist, and Smithian views in business ethics. I then explain how, for managers, sustaining and enacting the virtues of relational equality involves a distinctive cluster of role-specific traits: respect for employees’ equal personal authority, a commitment to express such respect, and a disposition to give equal weight and deference to employees’ relevant interests. (shrink)

This paper critically examines Richard Rorty’s “justice as larger loyalty” proposal. While Rorty is right, I argue, to reject the Kantian idea of a strict bifurcation between justice and loyalty, the former corresponding to reason the latter corresponding to sentiment, my argument is that it is nevertheless a mistake to follow Rorty in conceiving of justice as he recommends we should. This is not an endorsement of the rationalistic Kantian view Rorty rejects. Rather, I argue that there are compelling Rortyan (...) reasons for rejecting the “justice as larger loyalty” proposal, and that the argument against that proposal is paradoxically very much in the spirit of Rorty’s moral and political thought. (shrink)

This article reconsiders the reciprocity objection to unconditional basic income based on the idea that reciprocity is not only a duty but a limiting condition on other duties. If the objection wer...

In any normal population, health is unequally distributed across different age groups. Are such age-based health inequalities unjust? A divide has recently developed within egalitarian theories of...

This essay provide an overview of debates about the method of political philosophy that have recently gripped the field, focusing on the relationship of theory to practice. These debates can be usefully organized using two oppositions that together carve the field into three broad families of views. Call “practicalism” the view that the theory of justice exists to guide political action. Call “utopianism” the view that reflection on the idea of a just society plays an important role in the theory (...) of justice. Call the view that combines the two positions, “utopian practicalism”. On this view, reflection on the nature of a just society has an important role to play in guiding action. There would appear to be two ways to depart from this position: by rejecting the view's utopianism or its practicalism. So we find in the literature three broad camps: utopian practicalists, anti‐utopians, and anti‐practicalists. This essay provide an opinionated overview the ongoing debates between these three broad positions. It touches on the recent cases against practicalism by G.A. Cohen and David Estlund, the comparativist methodologies advocated by anti‐utopians such as Amartya Sen and Gerry Gaus, and systems failure approaches of Elizabeth Anderson and David Wiens. It also considers the recent development of novel utopian practicalist perspectives in the work of theorists including Erik Wright, Tommie Shelby, Lea Ypi, Pablo Gilabert, and Ben Laurence. (shrink)

In this article, we argue that apart from evaluating the causes and the social determinants of health inequalities, an evaluation of the effects of health inequalities is due. For this, we propose the ideal of relational equality as an evaluative framework, and test to what extent health inequalities threaten this ideal of a society of equals. We identify three ways in which they do and argue that these risks are especially great for those lower down the socio-economic strata. We thus (...) conclude that equality in health is instrumental to social justice, and that socio-economic inequalities in health are not only unjust due to their causes but also due to their consequences. We continue to argue that our instrumental approach opens a perspective to mitigate the identified injustices by changing society, rather than reducing inequalities in health, and argue that this is an advantage in the light of the realistic assumption that of the socio-economic health inequalities will persist. The article thus offers a complementary approach to both the evaluation and the mitigation of the injustice of socio-economic inequalities in health. (shrink)

The feasibility constraint on the concept of justice roughly states that a necessary condition for something to qualify as a conception of justice is that it is possible to achieve and maintain given the conditions of the human world. In this paper, I propose three alternative interpretations of this constraint that could be derived from different understandings of the Kantian formula ‘ought implies can’: the ability constraint, the motivational constraint and the institutional constraint. I argue that the three constraints constitute (...) a sequence in the sense that accepting the motivational constraint presupposes that we accept the ability constraint, and to accept the institutional constraint presupposes that we accept both previous constraints. Adding the possibility of rejecting all three constraints, we get four distinct metatheoretical positions that theorists could take vis-à-vis the feasibility constraint on justice. (shrink)

In recent years, a number of philosophers have argued that much theorizing about the value of equality, and about justice more generally, has focused unduly on distributive issues and neglected the importance of egalitarian social relationships. As a result, relational egalitarian views, according to which the value of egalitarian social relations provides the grounds of the commitment that we ought to have to equality, have gained prominence as alternatives to more fundamentally distributive accounts of the basis of egalitarianism, and of (...) justice-based entitlements. In this paper, I will suggest that reflecting on the kind of explanation of a certain class of our justice-based entitlements that relational egalitarian considerations can offer raises doubts about the project, endorsed by at least some relational egalitarians, of attempting to ground all entitlements of justice in the value of egalitarian social relationships. I will use the entitlement to healthcare provision as my central example. The central claim that I will defend is that even if relational egalitarian accounts can avoid implausible implications regarding the extension of justice-based entitlements to health care, it is more difficult to see how they can avoid what seem to me to be implausible explanations of why individuals have the justice-based entitlements that they do. To the extent that I am correct that relational egalitarian views are committed to offering implausible explanations of the grounds of justice-based entitlements to healthcare, this seems to me to provide at least some support for a more fundamentally distributive approach to thinking about justice in healthcare provision. (shrink)

In the luck egalitarian literature, one influential formulation of luck egalitarianism does not specify whether equalities that do not reflect people’s equivalent exercises of responsibility are bad with regard to inequality. This equivocation gives rise to two competing versions of luck egalitarianism: asymmetrical and symmetrical luck egalitarianism. According to the former, while inequalities due to luck are unjust, equalities due to luck are not necessarily so. The latter view, by contrast, affirms the undesirability of equalities as well as inequalities insofar (...) as they are due to luck. The symmetrical view, we argue, is by far the more compelling, both by internal luck egalitarian standards and in light of the external rightist emphasis on choice and responsibility to which luck egalitarianism may partly be seen as a response. Our main case for the symmetrical view is that when some people, against a background of equal opportunities, do not exercise their responsibility to the same degree as others, they cannot justifiably call for equalizing measures to be put in place. Indeed, such measures would be positively unfair. The symmetrical view, accordingly, rejects compensation in such cases, whereas the asymmetrical view, implausibly, enjoins it. We also examine two objections to this argument. First, that this view fails to qualify as genuinely egalitarian, instead collapsing the notion of equality into the notion of desert. Second, that the opposing asymmetrical view, in contrast to the symmetrical view, can draw support from its compatibility with sufficientarian concerns. Both objections are rebutted. We conclude that luck egalitarians are best served by endorsing the symmetrical, luck-neutralizing stance. (shrink)

We defend a scalar theory of the relationship between material scarcity and justice. As scarcity increases beyond a specified threshold, we argue that deontological egalitarian constraints should be gradually relaxed and consequentialist considerations should increasingly determine distributions. We construct this theory by taking a bottom-up approach that is guided by principles of medical triage. Armed with this theory, we consider the range of conditions under which justice applies. We argue that there are compelling reasons for thinking that justice applies under (...) a far broader range of conditions than is standardly supposed, including those that could sensibly be labelled as conditions of extreme rather than moderate scarcity. (shrink)

In what follows, I consider two influential views about distributive justice: democratic equality and luck egalitarianism. In examining and criticizing these views, I attempt to extract elements from each of them for what I take to be important to building a complete conception of distributive justice. I then present and defend my own view, deliberative democratic equality, a view that can be described as a hybrid account of luck egalitarianism and democratic equality.

The strong correlation between people’s socioeconomic position and health within high income countries is a well-documented fact. A person’s occupation, income and education level tell us a lot about that person’s prospects on a long and healthy life, such that we can speak of a ‘social gradient in health’, or a ‘socioeconomic health gap’. This association is often perceived to be unjust. Therefore, it is generally thought that governments should aim to reduce socioeconomic health inequalities. However, this idea needs ethical (...) justification, for it is not evident if and why exactly these inequalities are unjust. For instance, are inequalities in health unjust per se? Or because the underlying socioeconomic inequalities are unjust? And does justice require equal health levels, or a minimum level of health? What complicates the issue, is that the width of the health gap, or the steepness of the social gradient, depends on what health measures are used. Overall, the more subjective the measure, the greater the inequalities appear to be. But are all these measures equally morally relevant? This dissertation aims to give a better understanding of these philosophical questions. It does so by investigating the question of what we should understand by health in the first part, after which it addresses the question of how to evaluate socioeconomic health inequalities in the light of justice. The introduction begins with a description of the phenomenon of socioeconomic health inequalities, and how it has been addressed by politicians, epidemiologists and philosophers in the past and today. The chapter continues by formulating the central question of the dissertation – that of which health inequalities should be focused in the light of a concern with social justice. It explicates how this dissertation contributes to answering that question, by discussing the potential relation between the conceptualisation of health and justice evaluations, and by discussing which questions are addressed in each of the following chapters. The chapter 2 addresses the question of how health is conceptualised in the philosophical and public heath literature, and how theoretical concepts of health differ. It proposes to approach health concepts as a Wittgensteinian family of thick concepts and argues that while theories on health generally argue in favour of one specific concept, a comparison of concepts shows that we may need different concepts of health given the variety of health practices. By explicating the differences between five concepts of health, this chapter argues that each captures aspects of health that all seem relevant when we talk and think about health. Classifying these concepts based on their distinctions reveals them as members of a conceptual family: each of the discussed concepts differs from the others in at least one respect and resembles the others in several respects. Moreover, the discussion of the concepts shows that ‘health’ always both describes a condition and values that condition at the same time. Having both descriptive and evaluative dimensions, we can see health concepts as ‘thick concepts’. Given this evaluative dimension, it is important to reflect on the question of what understanding of health guides specific practices. Moreover, the distinctions revealed by the classification can serve as a conceptual toolbox for reflection on the assumptions and purposes of health practices. How such reflection could work is illustrated by a brief exploration of what health aspects are focused upon in three specific health practices. Chapter 3 presents a study into the question of how health is conceptualised by ordinary citizens and to what extent conceptualisations of health differ between socioeconomic groups. By making use of the method of concept mapping, this study analyses how different socioeconomic groups formulate their own answers regarding the question ‘what does health mean to you?’. It presents concept maps of health for three different socioeconomic groups living in the city of Utrecht that reveal that all groups have a multidimensional understanding of health. An interpretation of the concept maps reveals nuanced differences between groups. The multiple aspects of health were also ranked by importance. It appears that each group assigned most importance to mental health. All in all, the study shows that people in lower socioeconomic groups are more likely to show a conceptualisation of health that refers to 1) the absence of health threats, 2) a person within his/her circumstances, 3) the value of functional notions, and 4) an accepting attitude towards life. Chapter 4 addresses the question of what the theoretical and empirical study to concepts of health could imply for health equity practices. It does so by exploring further the suggestions made in chapters 2 and 3. Regarding the question of which health aspects should guide health equity policies, this chapter discusses the question of whether we should primarily look at subjective or objective health measures, and whether a universal or relative standard of health should be central. While justice-related concerns of impartiality and equal treatment may seem to favour an objective perspective and a universal health standard, it appears that we have good reason to account for the subjective perspective as well. It is also argued that a concern for recognition and participatory parity gives room for relative health standards. Th room for relative health standards confronts us with the question of how to deal with mechanisms like adaptive preferences that the concept maps reveal. It proposes a way out, by arguing for society-relative health standards. Chapter 5 examines the question of whether inequalities in health should be evaluated ‘directly’, thus independently of a distribution of their social determinants. It proposes a sufficientarian perspective, such that the central question of evaluation is that of whether everyone is – or can be – healthy enough. By discussing two sufficientarian approaches to health and social justice – by Powers & Faden and by Nussbaum – this chapter distinguishes two ways of setting a threshold level for health. Both approaches appear to provide an unsatisfactory basis for justice evaluations and lead us away from direct evaluation if we try to settle health minima that are less arbitrary. In anticipation to chapters 6 and 7, it is argued that the perspective of sufficient health for relational equality escapes this arbitrariness: compared to that of a decent human life, it better helps to answer both the question of what socioeconomic health inequalities a society is due to avoid, and the question of when socioeconomic health inequalities are unjust considering their consequences. Chapter 6 discusses to what extent Daniels’s theory of health justice provides a satisfactory answer to the question of what health inequalities a society is due to avoid. Daniels proposes an indirect evaluative approach by arguing that we should evaluate socioeconomic health inequalities in the light of Rawls’s principles of justice as fairness. That is, if socioeconomic inequalities are in accordance with fair equality of opportunity and with the difference principle, the corresponding health inequalities would be just. It is shown that the suggestion that Rawls’s principles regulate the social determinants of health neglects that not all social determinants of health belong to society’s basic structure as conceived of by Rawls and are thereby not subjected to the principles of justice. To acknowledge the social mechanisms leading to socioeconomic health inequalities in their full complexity, it is argued that we should broaden our understanding of society’s structure in accordance with Young’s notion of social structural processes. This renders the question of what health inequalities a society is due to avoid into a question of what we can expect from the side of the various actors that uphold the social structures that produce socioeconomic health inequalities. Lastly, it is discussed how a shift to Young’s theory completes the shift to non-ideal theorising that seem already initiated by Daniels, and that with this, the distinction between direct and indirect evaluation dissolves. Chapter 7 discusses to what extent equality in health is of instrumental value for a society of free and equals. It thus takes up the idea proposed in chapter 5, that an evaluation of the consequences of health inequalities is also due. Taking relational equality as an evaluative framework reveals three ways in which inequalities in life expectancy threaten this ideal. That is, via unequal risks to stigmatisation, unequal risks to unemployment and the risk of unequal pension enjoyments. It is thereby shown that these risks are especially great for those lower down the socioeconomic strata. It thus concludes that equality in health is of instrumental value to relational equality. The chapter continues to argue that our instrumental approach opens a new perspective: to mitigate the identified injustices by changing society, rather than by reducing inequalities in health. This is argued to be an advantage in the light of the realistic assumption that of the socioeconomic health inequalities will persist. The paper thus offers a complementary approach to both the evaluation and the mitigation of the injustice of socioeconomic inequalities in health. The discussion chapter summarises the central findings of the analyses of health concepts and discusses questions regarding the philosophical and practical merits of comparing theoretical health concepts, the need for developing new health measures or concepts and the importance or nonsense of studying citizen’s views on health. Repeating this for the dissertation’s second part, the central findings of the chapters on justice evaluation are summarised and followed by a discussion of questions and issues that have remained unaddressed so far. Here, central points of discussion are my take on rules of distribution, the distinction of direct and indirect evaluation, the role of ideal and non-ideal theory, the idea of relational equality, and personal responsibility for health. The chapter concludes by noting that also in the light of justice evaluations, all commonly used health measures are relevant for justice. Therefore, my recommendations for policy and further research entail that inequalities in each of these measures deserve attention by both policymakers and researchers. Specifically, policymakers and researchers should give attention to how exactly each of these health inequalities come about, in such a way that a discussion about the question of who can be assigned responsibility to alleviate them is well-informed; and both should give attention to the effects of health inequalities on the opportunities for people to live on equal standing, in such a way that when these opportunities are diminished, actions can be considered to aim to restore relational equality. (shrink)

There is a deep divide amongst political philosophers of an egalitarian stripe. On the one hand, there are so-called distributive egalitarians, who hold that equality obtains within a political community when each of its members enjoys an equal share of the community’s resources. On the other hand, there are so-called social egalitarians, who instead hold that equality obtains within a political community when each of its members stands in certain relations to other members of the community, such non-domination and lack (...) of oppression, for example. In this paper, we have three aims. Our first aim is to cast doubt on the helpfulness of characterizing the debate in this way. Our second aim is to reconstruct this debate in alternative and more precise terms, so that disagreements between advocates of either side are easier to evaluate. Our third aim is to advance a hybrid account that integrates element from both views. (shrink)