Extremism about Demands is the view that morality is significantly more demanding than prevailing common-sense morality acknowledges. This view is not widely held, despite the powerful advocacy on its behalf by philosophers such as Peter Singer, Shelly Kagan, Peter Unger, and G.A. Cohen. Most philosophers have remained attracted to some version of Moderation about Demands, which holds that the behavior of typical well-off people is permissible, including the ways that such people tend to employ their economic and other resources. It (...) is difficult to resist the conclusion that proponents of Extremism have not taken sufficiently seriously the central convictions that motivate the Moderate view. -/- This dissertation offers an improved defense of Extremism about Demands. At its center is an argument that appeals dialectically to requirements of justice that Moderates themselves already implicitly accept. Specifically, I claim that any plausible set of Moderate moral principles will, when applied to a world like ours, yield demands on typical well-off people that far exceed the demands of common-sense morality. -/- My argument has two cruxes. The first is the idea that our concern for justice is at least partially grounded in a concern for individuals’ interests, broadly construed. The other is a principle that I call Injustice entails Obligations, which says that we are collectively subject to requirements of justice that, if fully complied with, would ensure the transition from current injustice to a just state of affairs. Any view that is compatible with both the interest-based view of (part of) our concern for justice and Injustice entails Obligations will, I argue, require sacrifices from typical well-off people that substantially exceed what prevailing common-sense morality requires of them. -/- Moderates typically emphasize the idea that each person has an important interest in pursuing the projects, plans, relationships, and commitments that are most important to her. But they also believe that acceptable Moderate principles will properly balance this idea with the idea that from a properly impartial perspective everyone, and everyone's interests, are equally morally important. Because Moderates accept the latter idea, they are already committed to thinking that in a just world, everyone would have a sufficient minimum share of society’s resources. I argue that even if we limit our focus to distributive justice in a single society such as the United States, and even if we assume that distributive justice requires only a sufficient minimum, the extent to which the status quo must be transformed in order for justice to be achieved is still too great to be compatible with Moderate demands on typical well-off people. -/- There are a number of ways to try to argue that Moderate principles and Injustice entails Obligations are compatible with Moderation about Demands. For instance, it might be argued that all or nearly all of the demands to sacrifice in order to promote justice can be assigned to the super-rich, rather than to typical well-off people. Or it might be argued that the sacrifices of a single well-off person cannot be required because they amount to a mere “drop in the bucket” relative to what needs to be done in order to fully achieve justice. I show that such arguments fail. -/- The argument that I consider in greatest detail derives from John Rawls’s view that the principles of justice apply to the institutions of the “basic structure of society,” and do not apply directly to the conduct of individuals. If this “Institutionalism” is right, then it cannot be the case that individuals are obligated to promote justice directly in the way that I suggest they are. Furthermore, it might seem that a view that assigns all of the burdens of promoting justice to the basic structure satisfies the imperative to transition from injustice to justice, since if the relevant institutions were to begin doing everything that the Rawlsian view says they ought to be doing, the requirements of justice would be met. I argue, however, that there is no understanding of Institutionalism on which it is itself consistent with the following desiderata: Moderate principles, and the associated interest-based view of (part of) the ground of our concern for justice; Injustice entails Obligations; and Moderate demands. So, Institutionalism cannot make Moderate principles and Injustice entails Obligations compatible with Moderate demands. -/- Moderate principles and Injustice entails Obligations, then, remain incompatible with Moderation about Demands. Since there are compelling reasons to accept both Moderate principles and In justice entails Obligations, I conclude that we must reject Moderation about Demands. The obligations that justice places on typical well-off people are substantially more extensive than is acknowledged by prevailing common-sense morality. (shrink)

New biotechnologies have the potential to both dramatically improve human well-being and dramatically widen inequalities in well-being. This paper addresses a question that lies squarely on the fault line of these two claims: When as a matter of justice are societies obligated to include a new biotechnology in a national healthcare system? This question is approached from the standpoint of a twin aim theory of justice, in which social structures, including nation-states, have double-barreled theoretical objectives with regard to human well-being. (...) The first aim is to achieve a sufficient level of well-being in each of six core dimensions. In the special case of healthcare systems, this aim is focally but not exclusively attentive to achieving health sufficiency as one of the core dimensions. The second aim is to combat the emergence and persistence of densely woven patterns of systematic disadvantage that tend to undermine the achievement of a sufficient level of health and the other core elements of well-being of some persons and groups. Judgments about entitlements to health related resources, including new biotechnologies, are made in light of a threshold notion of health sufficiency. What is enough or sufficient health? The answer that is defended here is that sufficient health is enough health for a decent human life, understood as enough health to live a full life course without preventable, significant functional disability or decrement in health, or treatable pain or suffering. When a state must include a new biotechnology in its national healthcare system is also influenced by ancillary concerns about the connection between health and other core dimensions of well-being. What counts as a significant functional impairment or health decrement is thus explicated, in part, in relation to the theory’s sufficiency aim for the other essential dimensions of well-being, and thus for a decent life, overall. Those elements of health that play a critical role in the experience of sufficient reasoning, affiliation, security, respect and self determination are especially important; any loss of health function or capacity that threatens the individual’s prospects for sufficiency in these other dimensions, including the relational egalitiarian concerns they entail, constitutes a significant functional impairment. Within national borders, individuals are thus entitled to those health-related goods and services that are essential for a sufficiency of each of the dimensions of well-being; with regard to self determination and respect, what is sufficient by way of guaranteed access to specific goods and services is going to depend on the implications of such access for where an individual stands in relation to her co-nationals. The content of any entitlement to health-related goods and services is also necessarily dynamic. What can be done for health and the other core dimensions of well-being as a function of technological innovation and diffusion is in constant flux. The paper concludes by considering the implications of this analysis for the conditions under which states are obligated to include access in their healthcare systems to one biotechnology, deep brain stimulation. (shrink)