G. A. Cohen conceptualizes socialism as luck egalitarianism constrained by a community principle. The latter mitigates certain inequalities to achieve a shared common life. This article explores the plausibility of the community constraint on inequality in light of two related problems. First, if it is voluntary, it fails as a response to “the abandonment objection” to luck egalitarianism, as it would not guarantee imprudent people sufficient resources to avoid deprivation and to function as equal citizens in a democratic society. Contra (...) Cohenite socialism, this appears unjust. Second, if it is instead enforced, coercive equalization beyond sufficiency-constrained luck egalitarianism, which is possibly necessary to achieve a shared common life, seems to require unjustified restrictions on liberty. I therefore argue that the constraint is most plausibly specified as requiring enforcement of sufficiency and only voluntary equalization thereafter. I also note, skeptically, why this constraint might be morally preferable to a purely sufficientarian alternative. (shrink)

This paper focuses on the research field of machine ethics and how it relates to a technological singularity—a hypothesized, futuristic event where artificial machines will have greater-than-human-level intelligence. One problem related to the singularity centers on the issue of whether human values and norms would survive such an event. To somehow ensure this, a number of artificial intelligence researchers have opted to focus on the development of artificial moral agents, which refers to machines capable of moral reasoning, judgment, and decision-making. (...) To date, different frameworks on how to arrive at these agents have been put forward. However, there seems to be no hard consensus as to which framework would likely yield a positive result. With the body of work that they have contributed in the study of moral agency, philosophers may contribute to the growing literature on artificial moral agency. While doing so, they could also think about how the said concept could affect other important philosophical concepts. (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)

This book chapter is not available in ORA, but you may download, display, print and reproduce this chapter in unaltered form only for your personal, non-commercial use or use within your organization from the ANU E Press website.

In this chapter we first discuss the main principles of justice and note the standard objections to them, which we believe necessitate a hybrid approach. The hybrid account we defend is primarily based on the distributive principle of sufficientarianism, which we interpret as the idea that each country should have the means to provide a minimally decent quality of life for each of its citizens. We argue that sufficientarian considerations give good reason to think that what we call the ‘ability (...) to pay objection’ should be taken much more seriously in this debate. Following this, our account emphasises what we believe are the two most important moral desiderata in any attempt to distribute responsibility for dealing with climate change: the ability to mitigate the problem and the making of culpable contributions to the problem. After noting that our proposal includes enough detail to be a useful start for policy makers, we defend our account against some potential objections. (shrink)

The conception of social justice presented and defended in Philippe Van Parijs, "Real Freedom for All" entails, among other implication, the justification of an unconditional basic income. It was the subject of seven critical comments that forms issue 22 and part of 23 of ANALYSE & KRITIK. In this article, Van Parijs offers a comprehensive reply.

This paper develops and explores a new framework for theorizing about the measurement and aggregation of well-being. It is a qualitative variation on the framework of social welfare functionals developed by Amartya Sen. In Sen’s framework, a social or overall betterness ordering is assigned to each profile of real-valued utility functions. In the qualitative framework developed here, numerical utilities are replaced by the properties they are supposed to represent. This makes it possible to characterize the measurability and interpersonal comparability of (...) well-being directly, without the use of invariance conditions, and to distinguish between real changes in well-being and merely representational changes in the unit of measurement. The qualitative framework is shown to have important implications for a range of issues in axiology and social choice theory, including the characterization of welfarism, axiomatic derivations of utilitarianism, the meaningfulness of prioritarianism, the informational requirements of variable-population ethics, the impossibility theorems of Arrow and others, and the metaphysics of value. (shrink)

Although thinkers of the past might have started from presumptions of fundamental difference and inequality between (say) the genders, or people of different races, this is no longer the case. At least in mainstream political philosophy, we are all now presumed to be, in some fundamental sense, basic equals. Of course, what follows from this putative fact of basic equality remains enormously controversial: liberals, libertarians, conservatives, Marxists, republicans, and so on, continue to disagree vigorously with each other, despite all presupposing (...) some kind of basic equality. They may argue about who gets what, how much, and why, but the starting point - that all people are in some sense deserving of prima facie equal consideration - has become an axiom of our moral and political thinking. But why? Why are we basic equals? The trouble is that as soon as one asks for an explanation of this foundational premise, it begins to look shaky. After all, on any conceivable metric human beings are notably unequal, and often to striking degrees. Philosophers in this area tend to talk of equal worth, but often without trying to specify what exactly that means. Philosophically, basic equality is neither acceptable nor rejectable. It is not rejectable because we appear to be, as a matter of fact, profoundly committed to the truth of the claim that we are all one another's basic equals. But to the extent that there appear to be no philosophical arguments for believing in the truth of basic equality, it is not acceptable either. The aim of this book is to try and show why basic equality is acceptable. To do so, however, it will also contend that we need to approach the question rather differently to how it has mostly been handled so far. What's required is an exercise in what Bernard Williams called 'impure philosophy': it must include insights from other areas of human intellectual endeavour, whether psychology and history or even what we learn from how we go about practicing basic equality in our collective lives. (shrink)

One way to think about capitalism-versus-socialism is to examine the extent to which capitalist economic institutions are compatible with the fulfillment of socialist ideals. The late G. A. Cohen has urged that the two are strongly incompatible. He imagines how it would make sense for friends to organize a camping trip, distills the socialist moral principles that he sees fulfilled in the camping trip model, and observes that these principles conflict with a capitalist organization of the economy. He adds that (...) these principles are ethically attractive, so if it is feasible to organize the economy on the camping trip model, we ought to do so. This essay argues to the contrary that for all that has been said, capitalist economic arrangements might be in the set of institutional arrangements that overall would best fulfill the camping trip principles, and anyway, the principles themselves ought to be rejected, so the question whether or not a capitalist set-up might satisfy these principles should not interest us. The grounds for rejecting the camping trip principles support a form of welfarist consequentialism that denies that equality of distribution of any sort is per se ethically desirable and also denies that liberal freedoms to live as one chooses are per se morally desirable. Equality and freedom should rather be regarded as in the light of possible means (or hindrances) to advancing good for people, fairly distributed. (shrink)

The article is a plea for ethicists to regard probability as one of their most important concerns. It outlines a series of topics of central importance in ethical theory in which probability is implicated, often in a surprisingly deep way, and lists a number of open problems. Topics covered include: interpretations of probability in ethical contexts; the evaluative and normative significance of risk or uncertainty; uses and abuses of expected utility theory; veils of ignorance; Harsanyi’s aggregation theorem; population size problems; (...) equality; fairness; giving priority to the worse off; continuity; incommensurability; nonexpected utility theory; evaluative measurement; aggregation; causal and evidential decision theory; act consequentialism; rule consequentialism; and deontology. (shrink)

The recent Covid-19 pandemic has brought a broad range of ethical problems to the forefront, raising fundamental questions about the role of government in response to such outbreaks, the scarcity and allocation of health care resources, the unequal distribution of health risks and economic impacts, and the extent to which individual freedom can be restricted. In this clear introduction to the topic Iwao Hirose explores these ethical questions and analyzes the central issues in the ethics of pandemic response and preparedness (...) such as: The general nature of pandemics and the ethics of preparedness Ethical questions about general goals of pandemic response and preparedness The distribution of scarce resources, e.g., ventilators, hospital beds, antiviral drugs and vaccines Restrictions on individual freedom Ethical questions in the wake of pandemics, including contact-tracing, vaccine passports and socioeconomic inequalities. With the use of real-life examples and a clear philosophical approach, The Ethics of Pandemics is a much-needed introduction to some of the most important ethical issues surrounding pandemics. It is essential reading for students of ethics, bioethics, and political philosophy and will also be of interest to those working in related areas such as public policy, public health, health law, nursing and life sciences. (shrink)

In this article, I assess the prospects for the limitarian thesis that someone has too much wealth if they exceed a specific wealth threshold. Limitarianism claims that there are good political and/or ethical reasons to prevent people from having such ‘surplus wealth’, for example, because it has no moral value for the holder or because allowing people to have surplus wealth has less moral value than redistributing it. Drawing on recent literature on distributive justice, I defend two types of limitarian (...) principles of justice. First, limitarian midlevel principles draw on the limitarian thesis to specify normative commitments for guiding institutional design and individual actions. Second, the limitarian presumption draws on that thesis to specify what a just allocation of wealth requires under epistemic constraints. Such a presumption says that without substantive reasons to the contrary, we should regard a distribution as unjust if some people’s wealth exceeds the limitarian threshold. Furthermore, I will argue that we must reject a possible but implausible interpretation of limitarianism as an ideal distributive pattern. Yet both as a midlevel principle and as a presumption, limitarianism can play an important role in theorizing about justice in the real world. (shrink)

Abstract Following Temkin's Inequality I take my point of departure in an individualistic approach according to which a situation is bad in respect of inequality to the extent individuals in it have egalitarian complaints. After having criticised some of Temkin's notions of inequality, I argue that there are two proper egalitarian conceptions, the Equal Share Conception and the Place Conception. The first concerns how much welfare an individual can claim to have in order to have what she should have in (...) virtue of equality. The second concerns an individual's egalitarian complaint in so far as it depends on her place in a situation's distribution of welfare. I argue that the first conception can be employed in a defence of Telic Egalitarianism against Derek Parfit's Levelling Down Objection and that the second one can explain why this objection may seem so convincing. I also argue that Telic Egalitarianism, understood according to the first conception, in one respect is preferable to Parfit's Priority View. (shrink)

I argue that the use of the separateness of persons in the debate between the priority view and the competing claims view is deeply flawed. In making the case, I argue for three points. First, that...

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)

I outline and defend two egalitarian theories, which yield distinctive and, I argue, complementary answers to why health-related inequalities matter: a brute luck egalitarian view, according to which inequalities due to unchosen, differential luck are bad because unfair, and a social egalitarian view, according to which inequalities are bad when and because they undermine people’s status as equal citizens. These views identify different objects of egalitarian concern: the brute luck egalitarian view directs attention to health-related well-being, while social egalitarianism focuses (...) on health-related capabilities that are central to a person’s status as a citizen. I argue that both views are correct and should jointly guide priority-setting in health. (shrink)

Interest in just war theory has boomed in recent years, as a revisionist school of thought has challenged the orthodoxy of international law, most famously defended by Michael Walzer [1977]. These revisionist critics have targeted the two central principles governing the conduct of war (jus in bello): combatant equality and noncombatant immunity. The first states that combatants face the same permissions and constraints whether their cause is just or unjust. The second protects noncombatants from intentional attack. In response to these (...) critics, some philosophers have defended aspects of the old orthodoxy on novel grounds. Revisionists counter. As things stand, the prospects for progress are remote. In this paper, we offer a way forward. We argue that exclusive focus on first-order moral principles, such as combatant equality and noncombatant immunity, has led revisionist and orthodox just war theorists to engage in “proxy battles.” Their first-order moral disagreements are at least partly traceable to second-order disagreements about the nature and purpose of political theory. These deeper disputes have been central to the broader discipline of political theory for several years; we hope that bringing them to bear on the ethics of war will help us move beyond the present impasse. (shrink)

Much of the philosophical literature on health inequalities seeks to establish the superiority of one or another conception of luck egalitarianism. In recent years, however, an increasing number of self-avowed egalitarian philosophers have proposed replacing luck egalitarianism with alternatives that stress the moral relevance of distinct relationships, rather than the moral relevance of good or bad luck. After briefly explaining why I am not attracted to luck egalitarianism, I seek in this chapter to distinguish and clarify three views that have (...) been characterized in the philosophical literature as forms of relational egalitarianism. I call these three relational views equality of treatment, equality of concern, and social egalitarianism. I will explain why each claims to be a form of egalitarianism and why these three views should not be seen as competitors. I will argue that each brand of relational egalitarianism describes a plausible plank of distributive justice that bears on the evaluation of health inequalities and on the political institutions that create, sustain, or exacerbate them. To illustrate this pluralistic relational egalitarian approach, I will draw on a case study by Horton and Barker (this volume) to discuss how each of the three planks might be brought to bear on the evaluation of oral health disparities among the children of migrant Latino farmworkers in California. (shrink)

În acest capitol îmi revine sarcina de a prezenta unul dintre cele mai influente și mai dinamice curente din filosofia politică actuală. Este vorba, desigur, despre curentul care dă titlul acestui capitol: egalitarianismul.

It is widely recognized that prioritizing health care resources by their relative cost-effectiveness can result in lower priority for the treatment of disabled persons than otherwise similar non-disabled persons. I distinguish six different ways in which this discrimination against the disabled can occur. I then spell out and evaluate the following moral objections to this discrimination, most of which capture an aspect of its unethical character: it implies that disabled persons' lives are of lesser value than those of non-disabled persons; (...) it constitutes “double jeopardy” or violates Frances Kamm's non-linkage principle; it conflicts with equality of opportunity; it conflicts with fairness, which requires ignoring (some/most) differential impacts of treatment; it wrongly gives lower priority to disabled persons for equally effective treatment; it conflicts with giving all persons an equal chance to reach their full potential; and, it is in conflict with giving priority to the worse off. (shrink)

This volume collects selected papers delivered at the 15th Conference of the International Society for Utilitarian Studies, which was held at Karlsruhe Institute of Technology in July 2018. It includes papers dealing with the past, present, and future of utilitarianism – the theory that human happiness is the fundamental moral value – as well as on its applications to animal ethics, population ethics, and the future of humanity, among other topics.

This book develops a novel approach to distributive justice by building a theory based on a concept of desert. As a work of applied political theory, it presents a simple but powerful theoretical argument and a detailed proposal to eliminate unmerited inequality, poverty, and economic immobility, speaking to the underlying moral principles of both progressives who already support egalitarian measures and also conservatives who have previously rejected egalitarianism on the grounds of individual freedom, personal responsibility, hard work, or economic efficiency. (...) By using an agnostic, flexible, data-driven approach to isolate luck and ultimately measure desert, this proposal makes equal opportunity initiatives both more accurate and effective as it adapts to a changing economy. It grants to each individual the freedom to genuinely choose their place in the distribution. It provides two policy variations that are perfectly economically efficient, and two others that are conditionally so. It straightforwardly aligns outcomes with widely shared, fundamental moral intuitions. Lastly, it demonstrates much of the above by modeling four policy variations using 40 years of survey data from the Panel Study of Income Dynamics. (shrink)

Nu cu foarte mult timp în urmă, grupul de teorie socială şi politică din cadrul proiectului POSDRU 89/1.5/S/56815 „Societatea bazată pe cunoaştere-cercetări, dezbateri, perspective”, a publicat, tot la editura Institutul European, lucrarea Concepte şi teorii social-politice. Volumul de faţă reprezintă un nou pas al grupului nostru de lucru în realizarea proiectului inaugurat prin publicarea acelei lucrări. Este vorba, reamintesc, despre proiectul elaborării unor volume care să-i ajute pe cei interesaţi în iniţierea (lor sau a altora) în teoria (şi în special (...) filosofia) politică, mai ales în dezvoltările sale conceptuale, argumentative şi problematologice recente. Desigur, nu am intenţionat în mod expres ca aceste volume să fie utile doar în această direcţie. Speranţa noastră a fost, dimpotrivă, ca ele să fie interesante şi pentru cercetătorii cu experienţă în investigarea şi dezbaterea temelor abordate în cadrul lor, mai ales pentru că unele capitole prezintă idei, argumente sau perspective originale, care, credem noi, merită atenţia critică a comunităţii cercetătorilor români. Menirea lor fundamentală rămâne totuşi, în intenţia noastră, cea introductivă. Aşa cum recunoşteam în cuvântul său înainte, Concepte şi teorii socialpolitice nu este deloc un volum exhaustiv. Teorii şi ideologii politice reprezintă, în bună măsură, şi o încercare de a compensa cumva acest „defect” al volumului în cauză. Desigur, nici publicarea lui nu ne permite să susţinem că am atins obiectivul oferirii unei introduceri cât mai complete în teoria/filosofia politică actuală. Deşi Teorii şi ideologii politice prezintă câteva dintre cele mai importante teorii sau ideologii politice contemporane, există multe altele care nu sunt prezentate (sau cel puţin nu sunt prezentate atât de detaliat pe cât ar fi meritat) între paginile sale. Mă refer aici, spre exemplu, la libertarianism, comunitarianism, cosmopolitism sau capabilism (ca teorie a dezvoltării umane). Ne consolăm însă în baza a trei argumente. Unul este acela că, aşa cum se poate observa cu uşurinţă din cuprinsul său, cartea de faţă prezintă totuşi un număr important dintre principalele teorii şi ideologii politice recente (unele dintre ele pentru prima dată în literatura românească de specialitate). Al doilea este acela că unele dintre teoriile sau ideologiile politice care nu sunt abordate aici au beneficiat deja de prezentări competente şi atente la noi (unele dintre ele chiar în Concepte şi teorii social-politice). În sfârşit, al treilea argument este acela că sperăm cu toţii că prezentul volum nu reprezintă ultimul nostru pas în realizarea obiectivului menţionat în debutul acestei intervenţii. Sperăm, altfel spus, să putem prezenta acele teorii sau ideologii politice care nu şi-au găsit locul între paginile lui sau ale celui precedent cu o altă ocazie. Ţin să precizez însă că volumul pe care îl introduc prin această intervenţie nu este întrutotul o continuare a celui precedent, deşi între ele există, desigur, destule afinităţi, relaţii şi continuităţi tematice. Mai exact, el nu ar putea fi descris totalmente neproblematic ca reprezentând „al doilea tom” al volumului Concepte şi teorii social-politice. Titlul său este menit să indice acest lucru. Dacă lucrarea anterioară era centrată pe prezentarea unora dintre principalele concepte ale teoriei/filosofiei social-politice contemporane, cartea de faţă prezintă câteva dintre principalele teorii sau ideologii dezvoltate şi apărate de politologii, filosofii, economiştii sau „ideologii” politici contemporani. Nici de această dată nu voi încerca să rezum principalele idei expuse sau metodologii utilizate de către autori în prezentarea teoriilor sau ideologiilor politice care se regăsesc între paginile ce urmează. Temeiul meu este acelaşi: acolo unde au considerat că este cazul, autorii capitolelor şi-au rezumat ei înşişi ideile prezentate sau/şi metodologiile utilizate. În plus, cititorul interesat să-şi facă o idee prealabilă despre conţinutul ideatic şi problematologic al cărţii dispune de un rezumat al ei (în limbile engleză şi franceză) în finalul său. În consecinţă, mă voi mulţumi să închei doar prin a exprima încă o dată speranţa noastră că această carte se va dovedi utilă celor cărora li se adresează cu preponderenţă. Sperăm, în alte cuvinte, ca ea să le fie de ajutor în înţelegerea şi evaluarea adecvată a teoriilor şi ideologiilor pe care le prezintă. Şi mai important, sperăm că ea îi va stimula să caute să aprofundeze cercetarea acestor teorii şi ideologii şi – mai ales – să iniţieze propriile investigaţii sistematice şi riguroase în această privinţă. Dezvoltarea politologiei şi a filosofiei politice în spaţiul românesc, ca să nu mai vorbim despre clarificarea şi fundamentarea cât mai completă şi adecvată a opţiunilor ideologice ale partidelor politice din România, au nevoie de acest lucru. (shrink)

Utilitarianism has a curious history. Its most celebrated founders—Jeremy Bentham and John Stuart Mill—were radical progressives, straddling the worlds of academic philosophy, political science, economic theory and practical affairs. They made innumerable recommendations for legal, social, political and economic reform, often (especially in Bentham’s case) described in fine detail. Some of these recommendations were followed, sooner or later, and many of their radical ideas have become close to articles of faith of western liberalism. Furthermore many of these recommendations were made (...) expressly to improve the condition of the deprived, or of oppressed groups. Yet the moral theory which inspired this reforming zeal is, at least officially, utilitarianism, and when we teach this theory to our students we feel it our duty to point out the horrors that could be justified by any theory which assesses the moral quality of actions in terms of the maximization of good consequences over bad. No consequence is so bad that it cannot, in principle, be outweighed by a large aggregation of smaller goods. Hence there are circumstances in which utilitarianism can require slavery, the punishment of the innocent, and redistribution of resources from the poor to the rich, or from the disabled and the sick to the able bodied and healthy. Indeed, in the right circumstances, it can justify pretty much anything you can think of. For all their intelligence and imagination neither Bentham nor Mill seemed to recognise or discuss these catastrophic possibilities. (shrink)

Well-being measurements are frequently used to support conclusions about a range of philosophically important issues. This is a problem, because we know too little about the intervals of the relevant scales. I argue that it is plausible that well-being measurements are non-linear, and that common beliefs that they are linear are not truth-tracking, so we are not justified in believing that well-being scales are linear. I then argue that this undermines common appeals to both hypothetical and actual well-being measurements; I (...) first focus on the philosophical literature on prioritarianism and then discuss Kahneman’s Peak-End Rule as a systematic bias. Finally, I discuss general implications for research on well-being, and suggest a better way of representing scales. (shrink)

It is difficult for prioritarians to explain the degree to which justice requires redress for misfortune in a way that avoids imposing unreasonably high costs on more advantaged individuals whilst also economising on intuitionist appeals to judgment. An appeal to hypothetical insurance may be able to solve the problems of cost and judgment more successfully, and can also be defended from critics who claim that resource egalitarianism is best understood to favour the ex post elimination of envy over individual endowments.u.

A standard criticism of act-utilitarianism is that it is only indirectly concerned with the distribution of welfare between individuals and, therefore, does not take adequate account of the separateness between individuals. In response a number of philosophers have argued that act-utilitarianism is only vulnerable to that objection because it adheres to a theory of the good which ignores non-welfarist sources of intrinsic value such as justice. Fred Feldman, for example, argues that intrinsic value is independently generated by the receipt of (...) welfare and the degree to which receipt accords with the demands of justice, and that an action is right insofar as it maximizes the sum of both those sources of value. In response it is argued that justicized consequentialism only blocks the objection at the expense of presupposing deontological constraints. In addition, it is argued that the value of justice cannot be explained non-deontically and, therefore, that the proposed theory is not consequentialist all the way down. (shrink)

In Self‐Ownership, Freedom, and Equality, G.A. Cohen argues that libertarianism does not follow from respect for freedom, and that libertarianism cannot be grounded on self‐ownership. Cohen's arguments are, for the most part, compelling. That leaves the libertarian philosopher the options of either moving leftwards—for example, along the lines of Philippe Van. Parijs's Real Freedom for All—or embracing some form of consequentialism. Either way, the result is the abandonment of characteristically libertarian political philosophy.

Prioritarianism can usefully be seen as a corrective to both egalitarianism and utilitarianism. It allegedly corrects for egalitarianism insofar as it tends toward equality but seems immune to the Leveling Down Objection. It allegedly corrects for utilitarianism insofar as it emphasizes improving peoples' lives but is distribution-sensitive, favoring benefiting those who are worse off over those who are better off, other things equal. The best way to understand the view and assess its prospects is to see whether on closer examination (...) it can indeed avoid the pitfalls of the two more traditional views it might replace. What emerges from such a closer examination is that prioritarianism must be very carefully specified to avoid the Leveling Down Objection. More significantly, to clearly avoid problems associated with utilitarianism, prioritarianism must be formulated in deontic rather than telic terms. It is not clear, however, that such a deontic prioritarianism has any advantages over deontic egalitarianism. (shrink)

Suppose that you must make choices that may influence the well-being and the identities of the people who will exist, though not the number of people who will exist. How ought you to choose? This paper answers this question. It argues that the currency of distributive ethics in such cases is a combination of an individual’s final well-being and her expected well-being conditional on her existence. It also argues that this currency should be distributed in an egalitarian, rather than a (...) prioritarian, manner. (shrink)

Limited health literacy is a pervasive and independent risk factor for poor health outcomes. Despite decades of reports exhibiting that the healthcare system is overly complex, unneeded complexity remains commonplace and endangers the lives of patients, especially those with limited health literacy. In this article, we define health literacy and describe the empirical evidence associating health literacy and poor health outcomes. We recast the issue of poor health literacy from within the ethical perspective of the least well-off and argue that (...) poor health outcomes deriving from limited health literacy ought to be understood as a fundamental injustice of the healthcare system. We offer three proposals that attempt to rectify this injustice, including: universal precautions that presume limited health literacy for all healthcare users; expanded use of technology supported communication; and clinical incentives that account for limited health literacy. (shrink)

One major way of arguing for the moral attractiveness of luck egalitarianism is indirect; it consists in showing that the view follows from competing views on distributive justice which one actually endorses. Kasper Lippert-Rasmussen (KLR) claims that luck egalitarianism is indirectly supported in this way by Rawls’s intuitive argument for the difference principle. That argument begins by asserting that the impact of social and natural contingencies on distributive shares is unjust. After clarifying the notion of indirect support, I argue against (...) KLR’s claim. Whether the argument goes on to support luck egalitarianism is a matter of interpretation which can only be decided by looking closer at what Rawls has to say about the difference principle than KLR’s own treatment of the argument allows. In its most plausible reading, the intuitive argument veers away from luck egalitarianism in favor of a non-egalitarian view of the difference principle as a principle of compensating advantage. On this view, inequality due to bad luck is not in any respect unjust when the least advantaged cannot be made better off under alternative arrangements. In conclusion I explain why there are good reasons of fairness to understand the difference principle in this way. (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)

Nagel' s pessimistic conclusion that current welfare state arrangements approximate to the most pragmatically effective way of reconciling the demands of morality and of an egalitarian liberalism, while not removing a deep seated incoherence between these view, can be resisted. The objective/subjective dichotomy, in this case applied via the agent-neutral/agent-relative distinction, is identified as his problematic assumption: understood in Hegelian terms as the "placing" of different categories of reason, even a minimal realism makes it difficult to understand how embedding agent-relativity (...) alongside the agent-neutral can be understood as adding to the relevant values, just by moving from a more particular to a less particular conception of the world. This transition also cannot be seen as giving us insight into the intrinsicality of certain values, as that would be to renege on the idea that the subjective point of view is still a point of view on value and one that is expanded, not renounced. It is argued that the standard objection that contractualism is fatally circular is even more plausible in the case of its use as a theory of political legitimacy and Nagel's use of it is quite open about this circularity. Criticising Nagel's philosophical anthropology allows one to develop his positive arguments for egalitarianism; the development of civic virtue, from a perspective in which "the personal" acknowledges the demands of others in one's political community, leads to a political egalitarianism located in a distinct political morality independent of a moralised politics. (shrink)

This paper aims to illuminate some issues in the equality, priority, or what debate. I characterize egalitarianism and prioritarianism, respond to the view that we should care about sufficiency or compassion rather than equality or priority, discuss the levelling down objection, and illustrate the significance of the distinction between prioritarianism and egalitarianism, establishing that the former is no substitute for the latter. In addition, I respond to Bertil Tungodden's views regarding the Slogan, the levelling down objection, the Pareto Principle, leximin, (...) the principle of personal good, strict moderate egalitarianism, the Hammond Equity Condition, the intersection approach, and non-aggregative reasoning. (shrink)

According to prioritarianism, an influential theory of distributive justice, we have a stronger reason to benefit people the worse off these people are. Many authors have adopted a consequentialist version of prioritarianism. On this account, we have a consequentialist reason to benefit the worse off because the state of affairs where the worse off gains a given amount of utility is more valuable than the state of affairs where the better off gains roughly the same amount of utility. In this (...) paper, we argue that the consequentialist approach to prioritarianism is problematic. However, it doesn't follow that the prioritarian doctrine per se is groundless. We then suggest that we can make sense of prioritarianism by appeal to a contractualist approach. (shrink)

This essay argues that culpability and responsibility are independent notions, even though some of the same facts make us both responsible and culpable. Responsibility for one’s conduct is grounded in the strength of the agential connection between oneself and one’s conduct. Culpability for one’s conduct is the vices that give rise to that conduct. It then argues that responsibility and culpability for causing a threat are each grounds of liability to defensive harm independent of the other.

Many philosophers think that we should use a lottery to decide who gets a good to which two persons have an equal claim but which only one person can get. Some philosophers think that we should save identified persons from harm even at the expense of saving a somewhat greater number of statistical persons from the same harm. I defend a principled way of justifying both judgements, namely, by appealing to the decreasing marginal moral value of survival chances. I identify (...) four desiderata that, I contend, any such justification should satisfy, and explain how my account meets these desiderata, unlike some previous accounts. (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)

This paper examines the fairness of avoidable inequalities in health. It contrasts two approaches to this question, a direct approach and an indirect approach. Most of the discussion focuses on the indirect approach advocated by Daniels, Kennedy and Kawachi (2000). Their argument that avoidable inequalities in health are not unfair when their causes are otherwise fair is criticised on two counts. First, it encounters a surprising difficulty when one attends carefully to the point at which ethics intersects with epidemiology here. (...) Second, it fails to address the fundamental issue, which is whether any version of the direct approach is valid. (shrink)

Gopal Sreenivasan, 201 West Duke Building, Box 90743, Durham NC USA 27708. Email: gopal.sreenivasan{at}duke.edu ' + u + '@ ' + d + ' '/ /- ->This paper reviews the epidemiological debate between the relative income hypothesis and the absolute income hypothesis. The dispute between these rival hypotheses has to do with whether an adequate account of the relationship between income and life expectancy requires the definition of ‘income’ to include any comparative element. I discuss the evidence offered for the (...) relative hypothesis, as well as two important criticisms that have been levelled against this evidence. I also offer some critical reflections on the debate from a philosophical standpoint concerned with the ethics of population health. Both hypotheses agree that a redistribution of income towards the worst off will improve their life expectancy. CiteULike Connotea Del.icio.us What's this? (shrink)

This paper examines accounts of the moral wrongness of killing persons in addition to determining what conclusions, if any, can be drawn from the morality of killing persons about the equality of persons, and vice versa. I will argue that a plausible way of thinking about the moral wrongness of killing implies that the permissibility of killing innocent, nonthreatening persons depends on a person’s age. I address objections to this conclusion and discuss some potential implications of the view.

We revisit classical Utilitarianism by connecting and generalizing two ideas. The first is that there is a representation theorem possible for hedonic value similar to, but also importantly different from, the one provided by von Neumann and Morgenstern to measure decision utility. The idea is to use objective time, in place of objective chance, to measure hedonic value. This representation for hedonic value delivers a stronger kind of scale than von Neumann–Morgenstern utility, a ratio scale rather than merely an interval (...) scale. The second idea is that measurement on a ratio scale allows the meaningful aggregation of utilities over a group. This is aggregation by product rather than sum. Aggregation by product is known to have interesting Prioritarian consequences. Aggregation becomes complicated when the two approaches are mixed, when hedonic value is mixed with uncertainly. It becomes problematic when pain as well as pleasure is taken into account. (shrink)