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)

Population axiology is the study of the conditions under which one state of affairs is better than another, when the states of affairs in ques- tion may differ over the numbers and the identities of the persons who ever live. Extant theories include totalism, averagism, variable value theories, critical level theories, and “person-affecting” theories. Each of these the- ories is open to objections that are at least prima facie serious. A series of impossibility theorems shows that this is no coincidence: (...) it can be proved, for various sets of prima facie intuitively compelling desiderata, that no axiology can simultaneously satisfy all the desiderata on the list. One’s choice of population axiology appears to be a choice of which intuition one is least unwilling to give up. (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)

Until very recently, normative theorizing in ethics was frequently conducted without even mentioning uncertainty. Just a few years ago, Sven Ove Hansson described this state of affairs with the slogan: “Ethics still lives in a Newtonian world.” In the new Oxford Handbook of Philosophy and Probability, David McCarthy writes that “mainstream moral philosophy has not been much concerned with probability,” understanding probability as “the best-known tool for thinking about uncertainty.” This special predilection for certainty in ethics was surprising since most (...) decisions or evaluations are made both by individuals and policy-makers through the fog of a widely understood uncertainty that includes risk, ignorance, indeterminacy. Therefore, the main task of this special issue is to encourage philosophers to rethink the standard paradigm in ethics by redirecting discussions about ethical questions to problems involving different kinds of uncertainty when an individual or a policy maker does not have access to or knowledge about. (shrink)

According to the Competing Claims View we decide between alternatives by looking at the competing claims held by affected individuals. The strength of these claims is a function of two features: how much they stand to benefit by each alternative, and how badly off they would be in its absence. The view can be, and is, endorsed by both egalitarians and prioritarians. For the former the second condition will concern looking at how badly off the person is relative to others, (...) whereas for the latter it will be how badly off she is in absolute terms. In this paper I want to argue that neither should be endorsed. The egalitarian version of CCV breaks down when attempting to assess the competing claims of possible persons who may never exist. Also, the view, on at least one plausible interpretation, leads to intransitive judgements. The prioritarian version of CCV, in turn, is vulnerable to its own unique objection, namely delivering an anti-prioritarian and rather implausible verdict in certain Single Person Cases. (shrink)

This paper offers a novel account of how complaints of unfairness arise in risky distributive cases. According to a recently proposed view in distributive ethics, the Competing Claims View, an individual has a claim to a benefit when her well-being is at stake, and the strength of this claim is determined by the expected gain to the individual’s well-being, along with how worse off the individual is compared to others. If an individual is at a lower level of well-being than (...) another, their claim to a given benefit is stronger. On this view, the strength of individuals’ claims are a function of their comparative well-being levels. In this paper, I instead argue that competing claims obtain only when a particular relationship obtains between the fates of individuals: that one individual’s gain is at the expense of another. This is a particular complaint that obtains when the fates of individuals are tied together in such a way that inequality that is to the detriment of the person who is worse off is guaranteed to obtain. I demonstrate that this complaint arises only when individuals are exposed to a particular type of risk that allows some to gain only if others lose. As such, I propose that complaints of unfairness occur less frequently than we might think if we take the Competing Claims View to be true. A purely comparative view is unable to account for this unique complaint of unfairness. I argue that this complaint is not only independently plausible, but can serve as a foundation for a more general account of competing claims complaints. (shrink)

How should we choose between uncertain prospects in which different possible people might exist at different levels of wellbeing? Alex Voorhoeve and Marc Fleurbaey offer an egalitarian answer to this question. I give some reasons to reject their answer and then sketch an alternative, which I call person-affecting prioritarianism.

I present a new argument for the repugnant conclusion. The core of the argument is a risky, intrapersonal analogue of the mere addition paradox. The argument is important for three reasons. First, some solutions to Parfit’s original puzzle do not obviously generalize to the intrapersonal puzzle in a plausible way. Second, it raises independently important questions about how to make decisions under uncertainty for the sake of people whose existence might depend on what we do. And, third, it suggests various (...) difficulties for leading views about the value of a person’s life compared to her nonexistence. (shrink)

When our choice affects some other person and the outcome is unknown, it has been argued that we should defer to their risk attitude, if known, or else default to use of a risk‐avoidant risk function. This, in turn, has been claimed to require the use of a risk‐avoidant risk function when making decisions that primarily affect future people, and to decrease the desirability of efforts to prevent human extinction, owing to the significant risks associated with continued human survival. I (...) raise objections to the claim that respect for others' risk attitudes requires risk‐avoidance when choosing for future generations. In particular, I argue that there is no known principle of interpersonal aggregation that yields acceptable results in variable population contexts and is consistent with a plausible ideal of respect for others' risk attitudes in fixed population cases. (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)

One widely used method for allocating health care resources involves the use of cost-effectiveness analysis (CEA) to rank treatments in terms of quality-adjusted life-years (QALYs) gained. CEA has been criticized for discriminating against people with disabilities by valuing their lives less than those of non-disabled people. Avoiding discrimination seems to lead to the ’QALY trap’: we cannot value saving lives equally and still value raising quality of life. This paper reviews existing responses to the QALY trap and argues that all (...) are problematic. Instead, we argue that adopting a moderate form of prioritarianism avoids the QALY trap and disability discrimination. (shrink)

Journal of Political Philosophy, Volume 30, Issue 3, Page 370-394, September 2022.

In a recent paper, I argued that the mere risk of climate-related harm was itself a harm, since it undermined the security of individuals subject to that risk. In his commentary, Mintz-Woo argues that my account of the value of security is mistaken. On his view, the value of belief-relative security is already well captured by standard theories of wellbeing, and the value of fact-relative security is illusory. In the following, I attempt to respond to his concerns. First, I argue (...) contrary to Mintz-Woo that the literature on the cognitive effect on poverty is relevant to an assessment of the value of belief-relative security. Second, I introduce a distinction between ex ante and ex post perspectives on justice, and show that straightforward prioritarian commitments motivate an ex ante concern for fact-relative security. (shrink)

Distributive theories evaluate distributions of goods based on candidate recipients’ characteristics, e.g. how well off candidates are, how deserving they are, and whether they fare below sufficiency. But such characteristics vary across possible worlds, so distributive theories may differ in terms of the world which for them settles candidates’ characteristics. This paper examines how distributive theories differ in terms of whether candidate recipients’ relevant characteristics are grounded in the possible world that would take place if the distributor does not intervene (...) (call it the “input” world) or if they are grounded in each possible world that the distributor can bring about through different decisions (call each an “output” world). We illustrate the importance of this distinction in relation to one distributive theory, prioritarianism. As we show, both input and output versions of prioritarianism are plausible interpretations of the literature, and there are good reasons to take input prioritarianism seriously. Ultimately, however, we argue that input prioritarianism should be rejected. (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)

While ordinary decision theory focuses on empirical uncertainty, real decision-makers also face normative uncertainty: uncertainty about value itself. From a purely formal perspective, normative uncertainty is comparable to (Harsanyian or Rawlsian) identity uncertainty in the 'original position', where one's future values are unknown. A comprehensive decision theory must address twofold uncertainty -- normative and empirical. We present a simple model of twofold uncertainty, and show that the most popular decision principle -- maximising expected value (`Expectationalism') -- has different formulations, namely (...) Ex-Ante Expectationalism, Ex-Post Expectationalism, and hybrid theories. These alternative theories recommend different decisions, reasoning modes, and attitudes to risk. But they converge under an interesting (necessary and sufficient) condition. (shrink)

Policy-makers must sometimes choose between an alternative which has somewhat lower expected value for each person, but which will substantially improve the outcomes of the worst off, or an alternative which has somewhat higher expected value for each person, but which will leave those who end up worst off substantially less well off. The popular ex ante Pareto principle requires the choice of the alternative with higher expected utility for each. We argue that ex ante Pareto ought to be rejected (...) because it conflicts with the requirement that, when possible, one ought to decide as one would with full information. We apply our argument in an analysis of US policy on screening for breast cancer. -/- . (shrink)

Population axiology concerns how to evaluate populations in terms of their moral goodness, that is, how to order populations by the relations “is better than” and “is as good as”. The task has been to find an adequate theory about the moral value of states of affairs where the number of people, the quality of their lives, and their identities may vary. So far, this field has largely ignored issues about uncertainty and the conditions that have been discussed mostly pertain (...) to the ranking of risk-free outcomes. Most public policy choices, however, are decisions under uncertainty, including policy choices that affect the size of a population. Here, we shall address the question of how to rank population prospects—that is, alternatives that contain uncertainty as to which population they will bring about—by the relations “is better than” and “is as good as”. We start by illustrating how well-known population axiologies can be extended to population prospect axiologies. And we show that new problems arise when extending population axiologies to prospects. In particular, traditional population axiologies lead to prospect-versions of the problems that they praised for avoiding in the risk-free settings. Finally, we identify an intuitive adequacy condition that, we contend, should be satisfied by any population prospect axiology, and show how given this condition, the impossibility theorems in population axiology can be extended to (non-trivial) impossibility theorems for population prospect axiology. (shrink)

We give two social aggregation theorems under conditions of risk, one for constant population cases, the other an extension to variable populations. Intra and interpersonal welfare comparisons are encoded in a single ‘individual preorder’. The theorems give axioms that uniquely determine a social preorder in terms of this individual preorder. The social preorders described by these theorems have features that may be considered characteristic of Harsanyi-style utilitarianism, such as indifference to ex ante and ex post equality. However, the theorems are (...) also consistent with the rejection of all of the expected utility axioms, completeness, continuity, and independence, at both the individual and social levels. In that sense, expected utility is inessential to Harsanyi-style utilitarianism. In fact, the variable population theorem imposes only a mild constraint on the individual preorder, while the constant population theorem imposes no constraint at all. We then derive further results under the assumption of our basic axioms. First, the individual preorder satisfies the main expected utility axiom of strong independence if and only if the social preorder has a vector-valued expected total utility representation, covering Harsanyi’s utilitarian theorem as a special case. Second, stronger utilitarian-friendly assumptions, like Pareto or strong separability, are essentially equivalent to strong independence. Third, if the individual preorder satisfies a ‘local expected utility’ condition popular in non-expected utility theory, then the social preorder has a ‘local expected total utility’ representation. Fourth, a wide range of non-expected utility theories nevertheless lead to social preorders of outcomes that have been seen as canonically egalitarian, such as rank-dependent social preorders. Although our aggregation theorems are stated under conditions of risk, they are valid in more general frameworks for representing uncertainty or ambiguity. (shrink)

This thesis consists of several independent papers in population ethics. I begin in Chapter 1 by critiquing some well-known 'impossibility theorems', which purport to show there can be no intuitively satisfactory population axiology. I identify axiological vagueness as a promising way to escape or at least mitigate the effects of these theorems. In particular, in Chapter 2, I argue that certain of the impossibility theorems have little more dialectical force than sorites arguments do. From these negative arguments I move to (...) positive ones. In Chapter 3, I justify the use of a 'veil of ignorance', starting from three more basic normative principles. This leads to positive arguments for various kinds of utilitarianism - the best such arguments I know. But in general the implications of the veil depend on how one answers what I call 'the risky existential question': what is the value to an individual of a chance of non-existence? I chart out the main options, and raise some puzzles for non-comparativism, the view that life is incomparable to non-existence. Finally, in Chapter 4, I consider the consequences for population ethics of the idea that what is normatively relevant is not personal identity, but a degreed relation of psychological connectedness. In particular, I pursue a strategy based in population ethics for understanding the controversial 'time-relative interests' account of the badness of death. (shrink)

The spectre of the repugnant conclusion and the search for a population axiology that avoids it has endured as a focus of population ethics. This is in part because the repugnant conclusion is often interpreted as a defining problem for totalism, while the implications of averagism and related views are taken to illustrate the theoretical cost of avoiding the repugnant conclusion. However, we show that this interpretation cannot be sustained unless one focuses only on a special case of the repugnant (...) conclusion: namely, the subset of instances of the repugnant conclusion where there is no portion of the population unaffected by the choice between population outcomes (as in Derek Parfit’s original illustration). To avoid an inappropriate focus on only this proper subset of instances of the repugnant conclusion, we formulate a general characterization of the repugnant conclusion. We then prove formally that all leading welfarist axiologies imply this conclusion, including averagism and Ng’s Theory X0 , including probabilistic and ‘very repugnant’ variants that involve the addition of negative lives. We then prove that the full range of axiologies considered by population ethics each imply an extended version of the repugnant conclusion, including axiologies that are incomplete, intransitive, rank-dependent, person-affecting, and/or pluralist. The upshot is that the repugnant conclusion does not ultimately tell against any approach to axiology, and the methodological requirement to avoid the repugnant conclusion should be dropped from population axiology. (shrink)

Utilitarianism, it has been said, is not sensitive to the distribution of welfare. In making risky decisions for others there are multiple sensitivities at work. I present examples of risky decision-making involving drug allocations, charitable giving, breast-cancer screening and C-sections. In each of these examples there is a different sensitivity at work that pulls away from the utilitarian prescription. Instances of saving fewer people at a greater risk to many is more complex because there are two distributional sensitivities at work (...) that pull in opposite directions from the utilitarian calculus. I discuss objections to these sensitivities and conclude with some reflections on the value of formal modelling in thinking about societal risk. (shrink)

I critically examine a common liberal egalitarian view about the justification for, and proper content of, mandatory health insurance. This view holds that a mandate is justified because it is the best way to ensure that those in poor health gain health insurance on equitable terms. It also holds that a government should mandate what a representative prudent individual would purchase for themselves if they were placed in fair conditions of choice. I argue that this common justification for a mandate (...) is incomplete. A further reason for mandated insurance is that it helps secure social egalitarian public goods that would be underprovided if insurance were optional. I also argue that rather than mandating what a representative individual would choose for themselves, we should design the mandatory package by appealing to a pluralistic egalitarian view, which cares about improving people’s well-being, reducing unfair inequality, and maintaining egalitarian social relations. (shrink)