What is a just way of spending public resources for health and health care? Several significant answers to this question are under debate. Public spending could aim to promote greater equality in health, for example, or maximize the health of the population, or provide the worst off with the best possible health. Another approach is to aim for each person to have "enough" so that her health or access to health care does not fall under a critical level. This latter (...) approach is called sufficientarian. Sufficientarian approaches to distributive justice are intuitively appealing, but require further analysis and assessment. What exactly is sufficiency? Why do we need it? What does it imply for the just distribution of health or healthcare? This volume offers fresh perspectives on these critical questions. Philosophers, bioethicists, health policy-makers, and health economists investigate sufficiency and its application to health and health care in fifteen original contributions. (shrink)

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)

Principles of sufficiency are widely discussed in debates about distributive ethics. However, critics have argued that sufficiency principles are vulnerable to important objections. This paper seeks to clarify the main claims of sufficiency principles and to examine whether they have something distinctive and plausible to offer. The paper argues that sufficiency principles must claim that we have weighty reasons to secure enough and that once enough is secured the nature of our reasons to secure further benefits shifts. Having characterized sufficientarianism (...) in this way, the paper shows that the main objections to the view can be avoided; that we can examine the plausibility of sufficiency principles by appealing to certain reasons that support a shift; and that we should be optimistic about the prospects for sufficientarianism because many of our strongest reasons seem to be of this sort. This shift, I claim, is the overlooked grain of truth in sufficientarianism. (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)

Relational views of equality put forward a social and political ideal of equality that aims at being a better interpretation of what social justice requires than the prevailing distributive conceptions of equality, especially luck egalitarian views. Yet it is unclear what social justice as relational equality demands in distributive terms; Elizabeth Anderson's view seems to vacate a large part of the terrain of distributive justice in favor of a minimalist, sufficiency view. Against that, this paper argues that relational equality, properly (...) understood, requires setting stringent limits to distributive inequality, for both intrinsic and instrumental reasons. First, the relational egalitarian conception of society as a cooperative enterprise among equals gives rise to a presumption of equality in socially produced goods (and bads); inequalities in these goods have to be justified by justice-relevant reasons. Second, relational egalitarianism also delivers instrumental reasons to limit inequalities in income, wealth, and opportunities, because such inequalities may generate both opportunities for domination and inegalitarian status norms that threaten the social bases of self-respect of the worse off. (shrink)

The core of this book is a novel theory of distributive justice premised on the fundamental moral equality of persons. In the light of this theory, Rakowski considers three types of problems which urgently require solutions-- the distribution of resources, property rights, and the saving of life--and provides challenging and unconventional answers. Further, he criticizes the economic analysis of law as a normative theory, and develops an alternative account of tort and property law.

We created paired moral dilemmas with minimal contrasts in wording, a research strategy that has been advocated as a way to empirically establish principles operative in a domain‐specific moral psychology. However, the candidate “principles” we tested were not derived from work in moral philosophy, but rather from work in the areas of consumer choice and risk perception. Participants were paradoxically less likely to choose an action that sacrifices one life to save others when they were asked to provide more reasons (...) for doing so (Experiment 1), and their willingness to sacrifice lives depended not only on how many lives would be saved, but on the number of lives at risk (Experiment 2). The latter effect was also found in a within‐subjects design (Experiment 3). These findings suggest caution in the use of artificial dilemmas as a key testbed for revealing principled bases for moral judgment. (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)

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)

Luck egalitarianism is a family of egalitarian theories of distributive justice that aim to counteract the distributive effects of luck. This article explains luck egalitarianism's main ideas, and the debates that have accompanied its rise to prominence. There are two main parts to the discussion. The first part sets out three key moves in the influential early statements of Dworkin, Arneson, and Cohen: the brute luck/option luck distinction, the specification of brute luck in everyday or theoretical terms and the specification (...) of advantage as resources, welfare, or some combination of these. The second part covers three later developments: the democratic egalitarian critique of luck egalitarianism, the luck egalitarian acceptance of pluralism, and luck egalitarian doubts about the significance of the brute luck/option luck distinction. (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)

Critics of luck egalitarianism have claimed that, far from providing a justification for the public insurance functions of a welfare state as its proponents claim, the view objectionably abandons those who are deemed responsible for their dire straits. This article considers seven arguments that can be made in response to this ‘abandonment objection’. Four of these arguments are found wanting, with a recurrent problem being their reliance on a dubious sufficientarian or quasi-sufficientarian commitment to provide a threshold of goods unconditionally. (...) Three arguments succeed, showing that luck egalitarians have good reasons for assisting ‘negligent victims’ on account of changes that may occur in an individual between the time of their choice and their subsequent disadvantage, bad option luck, and doubts about free will and responsibility. Luck egalitarianism is therefore shown to offer strong support for public insurance. (shrink)

While there is much evidence for the influence of automatic emotional responses on moral judgment, the roles of reflection and reasoning remain uncertain. In Experiment 1, we induced subjects to be more reflective by completing the Cognitive Reflection Test prior to responding to moral dilemmas. This manipulation increased utilitarian responding, as individuals who reflected more on the CRT made more utilitarian judgments. A follow-up study suggested that trait reflectiveness is also associated with increased utilitarian judgment. In Experiment 2, subjects considered (...) a scenario involving incest between consenting adult siblings, a scenario known for eliciting emotionally driven condemnation that resists reasoned persuasion. Here, we manipulated two factors related to moral reasoning: argument strength and deliberation time. These factors interacted in a manner consistent with moral reasoning: A strong argument defending the incestuous behavior was more persuasive than a weak argument, but only when increased deliberation time encouraged subjects to reflect. (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)

In recent years there has been a good deal of discussion of equality’s place in the best account of distribution or distributive justice. One central question has been whether egalitarianism should give way to a principle requiring us to give priority to the worse off. In this article, I shall begin by arguing that the grounding of equality is indeed insecure and that the priority principle appears to have certain advantages over egalitarianism. But I shall then claim that the priority (...) principle itself is ungrounded and that the priority principle should itself give way to a sufficiency principle based — indirectly, via the notion of an impartial spectator — on compassion for those who are badly off. (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?

This article proposes an analysis of the doctrine of sufficiency. According to my reading, the doctrine's basic positive claim is ‘prioritarian’: benefiting x is of special moral importance where (and only where) x is badly off. Its negative claim is anti-egalitarian: most comparative facts expressed by statements of the type ‘x is worse off than y’ have no moral significance at all. This contradicts the ‘classical’ priority view according to which, although equality per se does not matter, whenever x is (...) worse off than y, at least some priority should be assigned to helping x. Section I elaborates and defends this reconstruction of the doctrine of sufficiency, and section II shows that the privileged utility level presumed within the sufficiency framework exists. (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)

In the luck egalitarian literature, one influential formulation of luck egalitarianism does not specify whether equalities that do not reflect people’s equivalent exercises of responsibility are bad with regard to inequality. This equivocation gives rise to two competing versions of luck egalitarianism: asymmetrical and symmetrical luck egalitarianism. According to the former, while inequalities due to luck are unjust, equalities due to luck are not necessarily so. The latter view, by contrast, affirms the undesirability of equalities as well as inequalities insofar (...) as they are due to luck. The symmetrical view, we argue, is by far the more compelling, both by internal luck egalitarian standards and in light of the external rightist emphasis on choice and responsibility to which luck egalitarianism may partly be seen as a response. Our main case for the symmetrical view is that when some people, against a background of equal opportunities, do not exercise their responsibility to the same degree as others, they cannot justifiably call for equalizing measures to be put in place. Indeed, such measures would be positively unfair. The symmetrical view, accordingly, rejects compensation in such cases, whereas the asymmetrical view, implausibly, enjoins it. We also examine two objections to this argument. First, that this view fails to qualify as genuinely egalitarian, instead collapsing the notion of equality into the notion of desert. Second, that the opposing asymmetrical view, in contrast to the symmetrical view, can draw support from its compatibility with sufficientarian concerns. Both objections are rebutted. We conclude that luck egalitarians are best served by endorsing the symmetrical, luck-neutralizing stance. (shrink)

A common question asked among egalitarians involves the extent to which responsibility should play a deciding factor in assessing the acceptability of inequalities. So-called luck egalitarians agree that instances of genuine choice are decisive in attributing responsibility for disadvantage, and in justifying unequal distributions of social goods. In this exciting new contribution to this literature, the author explores the correct place to locate the cut between choice and chance. In doing so, he lays out a novel approach for identifying inequalities (...) for which it is fair to hold one responsible, and those for which it is not. The argument--which builds on a thread of intellectual history that runs through Marx and Mill into more contemporary thinkers like Cohen and Rawls--provides a compelling case for rejecting a highly influential theory of strong property rights that has been inherited from Locke, and which we find in contemporary defenses of strong entitlements such as Robert Nozick's. The result is an egalitarian position which treats responsibility seriously, while maintaining our liberal commitments to impartiality and non-arbitrariness in the distribution of rights and responsibilities in contemporary society. (shrink)

Some people are worse off than others. Does this fact give rise to moral concern? Egalitarianism claims that it does, for a wide array of reasons. It is one of the most important and hotly debated problems in moral and political philosophy, occupying a central place in the work of John Rawls, Thomas Nagel, G. A. Cohen and Derek Parfit. It also plays an important role in practical contexts such as the allocation of health care resources, the design of education (...) and tax systems, and the pursuit of global justice. Egalitarianism is a superb introduction to the problem of contemporary egalitarian theories. It explains how rival theories of egalitarianism evaluate distributions of people’s well-being, and carefully assesses the theoretical structure of each theory. It also examines how egalitarian theories are applied to the distribution of health and health care, thus bringing a deceptively complex philosophical debate into clear focus. Beginning with a brief introduction to basic terminology, Iwao Hirose examines the following topics: Rawlsian egalitarianism luck egalitarianism telic egalitarianism prioritarianism sufficientarianism equality and time equality in health and health care. Including chapter summaries, annotated further reading and a glossary, this is an ideal starting point for anyone studying distributive justice for the first time, and will also be of interest to more advanced students and researchers in philosophy, economics, political theory, public policy, and public health. (shrink)