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?

Several attempts have been made to apply the choice-sensitive theory of distributive justice, luck egalitarianism, in the context of health and healthcare. This article presents a framework for this discussion by highlighting different normative decisions to be made in such an application, some of the objections to which luck egalitarians must provide answers and some of the practical implications associated with applying such an approach in the real world. It is argued that luck egalitarians should address distributions of health rather (...) than healthcare, endorse an integrationist theory that combines health concerns with general distributive concerns and be pluralist in their approach. It further suggests that choice-sensitive policies need not be the result of applying luck egalitarianism in this context. (shrink)

We propose a principle of sustainability to complement established principles used for justifying healthcare resource allocation. We argue that the application of established principles of equal treatment, need, prognosis and cost-effectiveness gives rise to what we call negative dynamics: a gradual depletion of the value possible to generate through healthcare. These principles should therefore be complemented by a sustainability principle, making the prospect of negative dynamics a further factor to consider, and possibly outweigh considerations highlighted by the other principles. We (...) demonstrate how this principle may take different forms, and show that a commitment to sustainability is supported by considerations internal to the ethical principles already guiding healthcare resource allocation. We also consider two objections. The first of these, we argue, is either based on implausible assumptions or begs the question, whereas the second can be adequately accommodated by the principle we propose. (shrink)

s admirable new book, Justice, Luck, and Knowledge , brings together recent developments in the fields of responsibility and egalitarian justice. This article focuses on Hurley’s critique of luck-neutralizing egalitarianism. The article concludes that the bad-luck-neutralizing aim serves better as a justificatory basis for egalitarianism than the more general luck-neutralizing aim. Since the former does not simply assume that we should aim for equality, Hurley has not demonstrated (nor indeed does she claim to have shown) that this concern cannot form (...) the justificatory basis of egalitarianism in a non-question-begging way. This, however, does not detract from the fact that Hurley’s book provides a very insightful discussion of the relationship between luck and justice. Key Words: Hurley • Dworkin • Cohen • luck • justice • egalitarianism. (shrink)

How should we decide which inequalities between people are justified, and which are unjustified? One answer is that such inequalities are only justified where there is a corresponding variation in responsible action or choice on the part of the persons concerned. This view, which has become known as 'luck egalitarianism', has come to occupy a central place in recent debates about distributive justice. This book is the first full length treatment of this significant development in contemporary political philosophy. Each of (...) its three parts addresses a key question concerning the theory. Which version of luck egalitarian comes closest to realizing luck egalitarian objectives? Does luck egalitarianism succeed as a view of egalitarian justice? And is it sound as an account of distributive justice in general? The book provides a distinctive answer to each of these questions, along the way engaging with the leading theorists identified in the literature as luck egalitarians, such as Richard Arneson, G. A. Cohen, and Ronald Dworkin, as well as the most influential critics, including Elizabeth Anderson, Marc Fleurbaey, Susan Hurley, Samuel Scheffler, and Jonathan Wolff. (shrink)