The doctor-patient relationship -- Consent, choice, and refusal : adults with capacity -- Treating adults who lack capacity -- Children and young people -- Confidentiality -- Health records -- Contraception, abortion, and birth -- Assisted reproduction -- Genetics -- Caring for patients at the end of life -- Euthanasia and physician assisted suicide -- Responsibilities after a patient's death -- Prescribing and administering medication -- Research and innovative treatment -- Emergency situations -- Doctors with dual obligations -- Providing treatment and (...) care in detention settings -- Education and training -- Teamwork, referral, delegation, and shared care -- Public health dimensions of medical practice -- Reducing risk, clinical error, and poor performance. (shrink)

Though the revised edition of A Theory of Justice, published in 1999, is the definitive statement of Rawls's view, so much of the extensive literature on Rawls's theory refers to the first edition. This reissue makes the first edition once again available for scholars and serious students of Rawls's work.

A belief that the government does have broad authority to protect and improve health, coupled with an understanding that collective action is often necessary to address public health challenges effectively, is central to the public health mindset. But many are questioning whether this vision of a strong government role is applicable to non-communicable disease threats and the social determinants of health. Arguments about public health paternalism are playing a role in political opposition to new law and policy interventions and in (...) legal challenges aimed at striking down existing public health laws. This article explores the forces behind the cultural and political resonance of concerns about public health paternalism, “personal responsibility,” and the “nanny state” and attempts to outlines a potential path forward from here. (shrink)

In June 2012, New York City Mayor Michael Bloomberg announced his plans for a ban on the sale of sugary beverages in containers larger than 16 ounces. Shortly thereafter, the Center for Consumer Freedom took out a full-page ad in the New York Times featuring Bloomberg photo-shopped into a matronly dress with the tag line “New Yorkers need a Mayor, not a Nanny.” On television, the CATO Institute's Michael Cannon declared, “This is the most ridiculous sort of nanny state-ism; [i]t’s (...) none of the mayor's business how much soda people are drinking.” And in newspapers around the country, editorial pages featured headlines such as “Gulp! Yet Another Intrusion of the Nanny State.” Just like that, the public debate about this measure became focused on government overreach, while the public health problem of obesity faded into the background. (shrink)

Everyone wants to be healthy, but many of us decline to act in healthy ways. Should these choices have any bearing on the ethics of clinical practice and health policy? How may personal responsibility for health be manipulated in health policy debates.

According to luck egalitarianism, inequalities are justified if and only if they arise from choices for which it is reasonable to hold agents responsible. This position has been criticised for its purported harshness in responding to the plight of individuals who, through their own choices, end up destitute. This paper aims to assess the Harshness Objection. I put forward a version of the objection that has been qualified to take into account some of the more subtle elements of the luck (...) egalitarian approach. Revising the objection in this way suggests that the Harshness Objection has been overstated by its proponents: because luck egalitarians are sensitive to the influence of unequal brute luck on individuals’ choices, it is unlikely that there will be any real world cases in which the luck egalitarian would not have to provide at least partial compensation. However, the Harshness Objection still poses problems for the luck egalitarian. First, it is not clear that partial compensation will be sufficient to avoid catastrophic outcomes. Second, the Harshness Objection raises a theoretical problem in that a consistent luck egalitarian will have to regard it as unjust if any assistance is provided to the victim of pure option luck, even if such assistance could be provided at no cost. I consider three strategies the luck egalitarian could pursue to accommodate these concerns and conclude that none of these strategies can be maintained without either violating basic luck egalitarian principles or infringing upon individual liberty. (shrink)

In the article by Kristin Voigt in the April 2013 issue of Cambridge Quarterly of Healthcare Ethics, quotation marks around certain phrases were deleted.

The notion of individual responsibility has gained prominence in recent debates about health care. First, responsibility has been proposed as a rationing criterion; second, some policies use rewards and sanctions to encourage individuals to ‘take responsibility’ for their health; finally, acting responsibly within the health care system is portrayed as a requirement of reciprocity. The aim of this paper is two-fold. First, I assess these different kinds of appeal to individual responsibility from the perspective of equality. The literature has identified (...) important concerns about equality and fairness with proposals to use individual responsibility as a rationing criterion; I suggest that there are similar concerns about incentive schemes and reciprocity-based appeals to individual responsibility. The analysis will draw on luck egalitarian accounts of equality, which emphasise the importance of individual responsibility. This allows me to pursue the second objective for paper: to reconsider the luck egalitarian perspective on these different appeals to responsibility. Applying the arguments of recent contributions to the luck egalitarian literature to the health arena suggests that luck egalitarians need not support the use of responsibility as a rationing criterion, and they can also identify problems with incentives and reciprocity-based arguments. However, the language of individual responsibility and its prominence in public debates may have implications for individuals’ health and well-being, which raises challenging issues for luck egalitarians as they attempt to apply their theory to the real world. (shrink)

In this book Larry Temkin examines the concepts of equality and inequality, and addresses one particular question in depth: how can we judge between different sorts of inequality? When is one inequality worse than another? Temkin shows that there are many different factors underlying and influencing our egalitarian judgments and that the notion of inequality is surprisingly complex. He looks at inequality as applied to individuals and to groups, and at the standard measures of inequality employed by economists and others, (...) and considers whether inequality matters more in a poor society than a rich one. The arguments of non-egalitarians are also examined. Temkin's book presents a new way of thinking about equality and inequality which challenges the assumptions of philosophers, welfare economists, and others concerned with these notions on a practical as well as a theoretical level. (shrink)

Can outcome equality (say, in welfare) ever be unjust? Despite the extensive inquiry into the nature of luck egalitarianism in recent years, this question is curiously under-explored. Leading luck egalitarians pay little attention to the issue of unjust equalities, and when they do, they appear not to speak in one voice. To facilitate the inquiry into the potential injustice of equalities, the paper introduces two rival interpretations of egalitarianism: the responsibility view, which may condemn equalities as unjust (when they reflect (...) unequal levels of personal responsibility); and, the non-responsibility view, which does not. It then teases out the implications of these two views, in the hope of establishing that the latter is at least as plausible as the former. The paper thus establishes that the egalitarian ideal can be plausibly formulated in a way that condemns only (certain) inequalities but never equalities, and that this formulation is both coherent and attractive. (shrink)

Health, Luck, and Justice is the first attempt to systematically apply luck egalitarianism to the just distribution of health and health care.

Although the responsibility for health debate has intensified in several ways between Norman Daniels’ 1985 Just healthcare and Just health: meeting health needs fairly of 2008, comparatively little space is dedicated to the issue in Just health, and Daniels notes repeatedly that his account “says nothing about personal responsibility for health”. Daniels considers health responsibility mainly in a particular luck-egalitarian version which he rejects because of its potentially unfeasible, penalising and inhumane character. But I show that he nonetheless acknowledges and (...) endorses explicitly other dimensions of health responsibility. I develop a wider, more nuanced and less punitive concept of health responsibility, which expands Daniels’ brief consideration and is compatible with the overall approach set out in Just health. In its application to preventative medicine and health promotion in particular, the concept is suited to support and complement the notion that “health is special”, which is central in Just health. The concept of health responsibility as co-responsibility specifies the subjects and objects of health responsibilities. It permits the attribution of responsibility without blame and disconnects the question of assigning responsibility from decisions about entitlement to treatment or different status in prioritisation decisions. This approach secures conceptual plausibility and clarity of the concept of health responsibility, is of use in policy making, and can help reduce political tensions. (shrink)

Bonuses, as incentives or rewards for health -related behavior, feature prominently in German social health insurance. Their goal is centered around promoting personal responsibility, but reducing overall health -care expenditure and enabling competition between sickness funds also play a role. The central position of personal responsibility in German health -care policy is described, and a framework is offered for an analysis of the ethical issues raised by policies seeking to promote responsibility. The framework entails seven tests relating to: solidarity; equality (...) and equity; intrusiveness; attributability and opportunity of choice; evidence, rationale, and feasibility; affected third parties; and coherence. It is contended that a focus on tests, in particular from within contractualism, is the most appropriate way of addressing the question of health responsibility in pluralistic societies. However, taken by themselves, the tests also allow an identification of the key ethical issues by particular policies, which are illustrated by applying the framework to particular bonus polices. (shrink)

Reflections about the role of human choice in determining personal health occur in the writings of practitioners and laymen throughout history. The Greek and Roman writers emphasized the effect of life's activities. During the Middle Ages and Renaisance, disease continued to be seen as a consequence of disorder of the bodily humors, which were under the individual's control. The rise of the paternalistic national regimes in Europe produced the view that society had the responsibility to maintain health. Jacksonian egalitarianism led (...) to a reaction against the agressive therapies of established professional experts, a view furthered by the Thomsonian belief that people should wrest control of their health away from orthodox physicians. Among the twentieth century reactions was the movement to urge people to have doctors evaluate laypersons' health. By the 1970s a movement emerged emphasizing again personal responsibility, which, in turn, produced a concern that this was merely "victim-blaming". Views on the role of lay people in determining personal health are heavily influenced by prevailing social, political, and moral climates. Keywords: "responsibility for health: social, personal, or professional?", "causes of illness", "self-reliant health care", historical influences, responsibility for health, "victim-blaming" CiteULike Connotea Del.icio.us What's this? (shrink)

In recent works, Shlomi Segall suggests and defends a luck egalitarian approach to justice in health. Concurring with G. A. Cohen’s mature position he defends the idea that people should be compensated for “brute luck”, i.e. the outcome of actions that it would be unreasonable to expect them to avoid. In his defense of the luck egalitarian approach he seeks to rebut the criticism raised by Norman Daniels that luck egalitarianism is in some way too narrow and in another too (...) wide to uphold justice in health and health care distribution. He points out that a pluralistic outline of luck egalitarianism taking into account the moral requirement of meeting everyone’s basic needs can avoid this line of criticism. In this article I argue against the application of such pluralistic luck egalitarianism in matters of health distribution. First of all, Segall has not shown that luck egalitarianism handles well health distributions above a threshold of basic needs. Secondly, his way of avoiding Elizabeth Anderson’s abandonment objection is theoretically problematic. Finally, I argue that luck egalitarianism in general fails to acknowledge the moral foundation of health and health care as a basic human entitlement. Thus I conclude that luck egalitarianism fails to take health needs seriously and that it cannot therefore uphold justice in health. (shrink)

John Rawls's work has greatly contributed to rehabilitating equality as a basic social value, after decades of utilitarian hegemony,particularly in normative economics, but Rawls also emphasized that full equality of welfare is not an adequate goal either. This thesis was echoed in Dworkin's famous twin papers on equality, and it is now widely accepted that egalitarianism must be selective. The bulk of the debate on ‘Equality of What?’ thus deals with what variables ought to be submitted for selection and how (...) this selection ought to be carried out. (shrink)

According to all-luck egalitarianism, the differential distributive effects of both brute luck, which defines the outcome of risks which are not deliberately taken, and option luck, which defines the outcome of deliberate gambles, are unjust. Exactly how to correct the effects of option luck is, however, a complex issue. This article argues that (a) option luck should be neutralized not just by correcting luck among gamblers, but among the community as a whole, because it would be unfair for gamblers as (...) a group to be disadvantaged relative to non-gamblers by bad option luck; (b) individuals should receive the warranted expected results of their gambles, except insofar as individuals blamelessly lacked the ability to ascertain which expectations were warranted; and (c) where societal resources are insufficient to deliver expected results to gamblers, gamblers should receive a lesser distributive share which is in proportion to the expected results. Where all-luck egalitarianism is understood in this way, it allows risk-takers to impose externalities on non-risk-takers, which seems counterintuitive. This may, however, be an advantage as it provides a luck egalitarian rationale for assisting ‘negligent victims’. (shrink)

S. L. Hurley's ambitious work brings these two areas of lively debate into overdue contact with each other.

The principle that each individual is entitled to an equal opportunity to benefit from any public health care system, and that this entitlement is proportionate neither to the size of their chance of benefitting, nor to the quality of the benefit, nor to the length of lifetime remaining in which that benefit may be enjoyed, runs counter to most current thinking about the allocation of resources for health care. It is my contention that any system of prioritisation of the resources (...) available for healthcare or of rationing such resources must be governed by this principle. -/- This can have apparently paradoxical conclusions in that it can seem wasteful to give someone with a very slim chance of a lifesaving treatment the same priority as someone with a much better chance. In an important and thoughtful recent paper, Julian Savulescu has concentrated on this apparent weakness and has argued for a particular conception of the good or benefit to be achieved by a healthcare system which purports to demonstrate the inadequacies of an equal opportunities approach to prioritisation and to replace it with an altogether better account. This paper will show that a rational ‘reasons based consequentialism’ is more in line with the equal opportunities approach, which I defended some time ago in these pages, than with that of Savulescu. I shall then examine more closely the conception of equal opportunities in health care and show that if we give weight to an individual's reasons, and what is expected to be good for them, we will opt for exactly the equality based account of distributive justice that I have recommended. (shrink)

The increasing awareness of personal health responsibility had led to the claim that patients with ‘self-inflicted’ conditions have less of a right to treatment at the public's expense than patients whose conditions arose from ‘uncontrollable’ causes. This paper suggests that regardless of any social decision as to the limits and scope of individual responsibility for health, the moral framework for discussing this issue is equality. In order to reach a consensus, discourse should be according to the common basis of all (...) theories of justice, Aristotle's formal principle of justice: ‘equals must be treated equally and unequals must be treated unequally, in proportion to the relevant inequality’. This paper deals with the question of whether and under what circumstances risk-taking behaviour could be regarded as a ‘relevant inequality’ with respect to the right to health care. Following a discussion of the relevant inequalities in health care, the conclusion is reached that the fact that the condition was avoidably caused by the patient and is therefore his or her fault can not be regarded necessarily as a relevant inequality. Therefore, the issue is one of societal support for health care; after defining relevant inequalities in this respect, the paper attempts to apply them to self-inflicted conditions. This analysis reveals that, in theory, it may be just to restrict societal support in such cases. However, the application of this conclusion requires proof of many factual claims—for which there is often very limited evidence. (shrink)

In Chapter 6 (“Why the Aim to Neutralize Luck Cannot Provide a Basis for Egalitarianism”) of her Justice, Luck, and Knowledge, Susan Hurley defends two claims: that “the aim to neutralize luck [does not] contribute to identifying and specifying what egalitarianism is”, and that it also provides no “independent non‐question‐begging reason or justification for egalitarianism” (p. 147). In the present response, I reject the first of Hurley's claims, and I show that the second, while true, lacks polemical force. I said, (...) in “On the Currency of Egalitarian Justice” (Ethics, 1989), that. (shrink)

John Rawls's work (1971) has greatly contributed to rehabilitating equality as a basic social value, after decades of utilitarian hegemony,particularly in normative economics, but Rawls also emphasized that full equality of welfare is not an adequate goal either. This thesis was echoed in Dworkin's famous twin papers on equality (Dworkin 1981a,b), and it is now widely accepted that egalitarianism must be selective. The bulk of the debate on ‘Equality of What?’ thus deals with what variables ought to be submitted for (...) selection and how this selection ought to be carried out. (shrink)

Unhealthy lifestyle contributes significantly to the burden of disease. Scarce medical resources that could alternatively be spent on interventions to prevent or cure sufferings for which no one is to blame, are spent on prevention or treatment of disease that could be avoided through individual lifestyle changes. This may encourage policy makers and health care professionals to opt for a criterion of individual responsibility for medical suffering when setting priorities. The following article asks whether responsibility-based reasoning should be accepted as (...) relevant for fair and legitimate healthcare rationing. The luck-egalitarian argument that inequalities in health expectancies that derive from unchosen features of people’s circumstances are unjust and should be compensated, while inequalities that reflect personal choices of lifestyle may not, is discussed. It seems that while a backward-looking interpretation of individual responsibility cannot be relevant as a criterion of priority setting, a forward-looking conception of responsibility may be approved.Within all modern societies healthcare authorities are facing difficult priority setting problems. Various criteria for rationing medical intervention have been proposed due to scarcity of resources. Until now, individual responsibility for medical suffering has been given little attention in the public or in academic debate. This is about to change. As Alexander Cappelen and Ole Norheim have pointed out in a recent article in this journal, unhealthy lifestyle contributes increasingly to the burden of disease. A better understanding of the responsibility argument is important for the assessment of policies aimed at meeting this challenge.1 In this article the following question is addressed: should responsibility-based arguments be accepted as relevant to meeting healthcare rationing fairly and legitimately? I will argue that while a backward-looking conception of individual responsibility should not be endorsed, a forward-looking notion of responsibility may be approved. (shrink)

In this stimulating work of political philosophy, acclaimed philosopher G. A. Cohen sets out to rescue the egalitarian thesis that in a society in which distributive justice prevails, peopleâes material prospects are roughly equal. Arguing against the Rawlsian version of a just society, Cohen demonstrates that distributive justice does not tolerate deep inequality. In the course of providing a deep and sophisticated critique of Rawlsâes theory of justice, Cohen demonstrates that questions of distributive justice arise not only for the state (...) but also for people in their daily lives. The right rules for the macro scale of public institutions and policies also apply, with suitable adjustments, to the micro level of individual decision-making. Cohen also charges Rawlsâes constructivism with systematically conflating the concept of justice with other concepts. Within the Rawlsian architectonic, justice is not distinguished either from other values or from optimal rules of social regulation. The elimination of those conflations brings justice closer to equality. (shrink)

In his Tanner Lecture of 1979 called ‘Equality of What?’ Amartya Sen asked what metric egalitarians should use to establish the extent to which their ideal is realized in a given society. What aspect of a person’s condition should count in a fundamental way for egalitarians, and not merely as cause of or evidence of or proxy for what they regard as fundamental?

Individuals who become ill as a result of personal lifestyle choices often shift the monetary costs of their healthcare needs to the taxpaying public or to fellow members of a private insurance pool. Some argue that policies permitting such cost shifting are unfair. Arguments for this view may seem to draw support from luck egalitarian accounts of distributive justice. This essay argues that the luck egalitarian framework provides no such support. To allocate healthcare costs on the basis of personal responsibility (...) would arbitrarily and publicly burden socially detectable risk-takers while undetectable risk-takers continue to get a free ride. That problem is unavoidable even on the assumption that distributive institutions outside the healthcare sector are fully just. In actual, farfrom-just societies, imposing personal liability for the costs of voluntary risk taking would be wrong for an additional reason. Doing so would tend to magnify existing distributive injustices. These conclusions draw attention to two common ‘moral fallacies of the second best’ that can arise when applying ideal normative theory to matters of institutional design and in real-world policy contexts. (shrink)

This paper examines what would be a fair distribution of the right to emit greenhouse gases. It distinguishes between views that treat the distribution of this right on its own (Isolationist Views) and those that treat it in conjunction with the distribution of other goods (Integrationist Views). The most widely held view treats adopts an Isolationist approach and holds that emission rights should be distributed equally. This paper provides a critique of this 'equal per capita' view, and the isolationist assumptions (...) on which it depends. It examines four arguments for this view, finding each wanting. It then presents two general challenges to the 'equal per capita' view, and, indeed, any views which treat the distribution of greenhouse gas emissions in isolation from other goods. It concludes by outlining and defending an alternative (Integrationist) approach to the distribution of rights to emit greenhouse gases. (shrink)

Whether it is fair to use personal responsibility of patients for their own health as a rationing criterion in healthcare is a controversial matter. A host of difficulties are associated with the concept of personal responsibility in the field of medicine. These include, in particular, theoretical considerations of justice and such practical issues as multiple causal factors in medicine and freedom of health behaviour. In the article, personal responsibility is evaluated from the perspective of several theories of justice. It is (...) argued that in a healthcare system based on both equality of opportunity and solidarity, responsible health behaviour can—in principle—be justifiably expected. While the practical problems associated with personal responsibility are important, they do not warrant the common knee-jerk refusal to think more deeply about responsibility for health as a means of allocating healthcare resources. In conclusion, the possibility of introducing personal responsibility as a fair rationing criterion is briefly sketched. (shrink)

Combatting chronic, lifestyle-related disease has become a healthcare priority in the developed world. The role personal responsibility should play in healthcare provision has growing pertinence given the growing significance of individual lifestyle choices for health. Media reporting focussing on the ‘bad behaviour’ of individuals suffering lifestyle-related disease, and policies aimed at encouraging ‘responsibilisation’ in healthcare highlight the importance of understanding the scope of responsibility ascriptions in this context. Research into the social determinants of health and psychological mechanisms of health behaviour (...) could undermine some commonly held and tacit assumptions about the moral responsibility of agents for the sorts of lifestyles they adopt. I use Philip Petit's conception of freedom as ‘fitness to be held responsible’ to consider the significance of some of this evidence for assessing the moral responsibility of agents. I propose that, in some cases, factors outside the agent's control may influence behaviour in such a way as to undermine her freedom along the three dimensions described by Pettit: freedom of action; a sense of identification with one's actions; and whether one's social position renders one vulnerable to pressure from more powerful others. (shrink)

This article examines how a just society must address the needs of its imprudent members. I defend compulsory insurance as an answer to this question. It has been assumed that compulsory insurance can only be justified on paternalistic grounds. I argue that this assumption is incorrect, and defend non-paternalistic compulsory insurance. To display the merits of NPCI, I identify a trilemma that arises for views about how to address the needs of the imprudent, including libertarian and so-called ‘ luck -egalitarian’ (...) views. I then suggest that NPCI enables us to escape the trilemma. (shrink)

abstract This article defends luck egalitarianism as an interpretation of the egalitarian ideal against two major criticisms levelled against it by Elizabeth Anderson — that it is trapped in the distributive paradigm, and that it treats the victims of bad option luck too harshly to be considered an egalitarian theory. Against the first criticism, I argue that luck egalitarianism will condemn non‐material inequalities and injustices if an appropriate conception of well‐being is adopted. I demonstrate this by showing how the approach (...) is sensitive to the five faces of oppression developed by Iris Young. Although the second criticism is more troubling, it does not defeat luck egalitarianism, either. I will show that few of the inequalities that arise in the real world result from option luck. Further, if cases do occur, rather than abandoning the theory, the best response is to combine luck egalitarianism with another egalitarian principle that will ensure that the basic needs of all citizens are satisfied. The paper concludes by defending the appeal of the distinction between option luck and brute luck, in light of the preceding discussion. (shrink)

Lifestyle diseases constitute an increasing proportion of health problems and this trend is likely to continue. A better understanding of the responsibility argument is important for the assessment of policies aimed at meeting this challenge. Holding individuals accountable for their choices in the context of health care is, however, controversial. There are powerful arguments both for and against such policies. In this article the main arguments for and the traditional arguments against the use of individual responsibility as a criterion for (...) the distribution of scarce health resources will be briefly outlined. It is argued that one of the most prominent contemporary normative traditions, liberal egalitarianism, presents a way of holding individuals accountable for their choices that avoids most of the problems pointed out by the critics. The aim of the article is to propose a plausible interpretation of liberal egalitarianism with respect to responsibility and health care and assess it against reasonable counter-arguments. (shrink)

In her recent, provocative essay “What Is the Point of Equality?”, Elizabeth Anderson argues against a common ideal of egalitarian justice that she calls “ luck egalitarianism” and in favor of an approach she calls “democratic equality.”1 According to the luck egalitarian, the aim of justice as equality is to eliminate so far as is possible the impact on people’s lives of bad luck that falls on them through no fault or choice of their own. In the ideal luck egalitarian (...) society, there are no inequalities in people’s life prospects except those that arise through processes of voluntary choice or faulty conduct, for which the agents involved can reasonably be held responsible. Anderson asserts that the adherents of luck egalitarianism, which can be elaborated in many different ways, include John Roemer, Erik Rakowski, Thomas Nagel, Ronald Dworkin, Gerald Cohen, Richard Arneson, and Philippe Van Parijs.2 In contrast, according to the democratic equality conception, justice as equality requires an end to oppressive social relationships. In the ideal society of democratic equality, the social conditions of everyone’s freedom are secured, each stands to every other in a relationship of fundamental equality, including equal respect, and all have real freedom to participate in democratic self-government. (shrink)

In their celebrated essay “The Right to Privacy,” legal scholars Samuel Warren and Louis Brandeis identified as the generic privacy value “the right to be let alone.” This same phrase occurs in Justice Brandeis's dissent inOlmstead v. U.S.(1927). This characterization of privacy has been found objectionable by philosophers acting as conceptual police. For example, moral philosopher William Parent asserts that one can wrongfully fail to let another person alone in all sorts of ways—such as assault—that intuitively do not qualify as (...) violations of privacy and thus cannot be violations of the right to privacy. (shrink)

Twelve contributors discuss critical issues affecting medical ethics. Topics include: the normative principles of medical ethics, concepts of health and disease, the physician-patient relationship, human experimentation, informed consent, genetics, ethical issues in organ transplantation, and moral.

Train crashes cause, on average, a handful of deaths each year in the UK. Technologies exist that would save the lives of some of those who die. Yet these technical innovations would cost hundreds of millions of pounds. Should we spend the money? How can we decide how to trade off life against financial cost? Such dilemmas make public policy is a battlefield of values, yet all too often we let technical experts decide the issues for us. Can philosophy help (...) us make better decisions? Ethics and Public Policy: A Philosophical Inquiry is the first book to subject important and controversial areas of public policy to philosophical scrutiny. Jonathan Wolff, a renowned philosopher and veteran of many public committees, such as the Gambling Review Body, introduces and assesses core problems and controversies in public policy from a philosophical standpoint. Each chapter is centred on an important area of public policy where there is considerable moral and political disagreement. Topics discussed include: Can we defend inflicting suffering on animals in scientific experiments for human benefit? What limits to gambling can be achieved through legislation? What assumptions underlie drug policy? Can we justify punishing those who engage in actions that harm only themselves? What is so bad about crime? What is the point of punishment? Other chapters discuss health care, disability, safety and the free market. Throughout the book, fundamental questions for both philosopher and policy maker recur: what are the best methods for connecting philosophy and public policy? Should thinking about public policy be guided by an ‘an ideal world’ or the world we live in now? If there are ‘knock down’ arguments in philosophy why are there none in public policy? Each chapter concludes with ‘Lessons for Philosophy’ making this book not only an ideal introduction for those coming to philosophy, ethics or public policy for the first time, but also a vital resource for anyone grappling with the moral complexity underlying policy debates. (shrink)

Kok-Chor Tan addresses three key questions in political philosophy: Where does distributive equality matter? Why does it matter? And among whom does it matter? He argues for an institutional site for egalitarian justice, a luck-egalitarian ideal of why equality matters, and a global scope for distributive justice.

Setting out to defend luck egalitarianism in matters of justice in health, Shlomi Segall outlines a pluralistic version of the luck egalitarian framework allowing egalitarian justice to be traded-off against other moral requirements. The suggested pluralism enables luck egalitarian justice to coexist with a concern for meeting everyone’s basic needs thereby avoiding Elizabeth Anderson’s ‘abandonment objection’. In this article, however, we present three objections to Segall’s luck egalitarian justice in health. Firstly, the account is vulnerable to the common objection that (...) luck egalitarianism becomes too expansive, and that Segall’s defence against this is inadequate. Secondly, Segall’s pluralist attempt to balance luck egalitarian justice and other moral requirements ends up compromising its own ideal of justice. Due to the fact that resource scarcity is the reality of health and health care distribution, this problem would often arise in actual health policy. Finally, the account has a way of intensifying blameworthy behaviour which seems contrary to luck egalitarian principles. Based on these three objections, we conclude that Segall’s luck egalitarian account of justice in health must either be rejected or qualified further. (shrink)