With much of the world's population facing restricted access to adequate medical care, how to allocate scarce health-care resources is a pressing question for governments, hospitals, and individuals. How do we decide where funding for health-care programs should go? Tannsjo here approaches the subject from a philosophical perspective, balancing theoretical treatments of distributive ethics with real-world examples of how health-care is administered around the world today. Tannsjo begins by laying out several popular ethical theories-utilitarianism, which recommends maximizing the best overall (...) outcome; egalitarianism, which recommends smoothing out the differences between people as much as possible; and the maximin/leximin theory, which urges people to give absolute priority to those who are worst off. Tannsjo shows how, in abstract thought experiments, these theories come into conflict with each other and reveal puzzling implications. He goes on to argue, however, that when we consider health-care in the real-world, these theories all agree on a central point: in a well-ordered welfare state, more resources should be directed to the care and cure of people suffering from mental illness, and less to the marginal life extension of elderly patients. Tannsjo's book thus recommends a shift in spending to increase fairness and overall utility-while also recognizing that this kind of dispassionate suggestion, with its purely economic foundation, is unlikely to take hold in policy. Tannsjo's analysis is a case study in how ethical theories can sometimes lead to rational conclusions and recommendations that we are not prepared to accept. (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)

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)

Telic sufficientarians hold that there is something special about a certain threshold level such that benefiting people below it, or raising them above it, makes an outcome better in at least one respect. The article investigates what fundamental value might ground that view. The aim is to demonstrate that sufficientarianism, at least on this telic version, is groundless and as such indefensible. The argument is advanced in three steps: first, it is shown that sufficientarianism cannot be grounded in a personal (...) value. Neither, secondly, is it committed to the person-affecting view, the view that says that nothing can be better if there is no one for whom it is better. This, in itself, is of interest because some sufficientarians reject egalitarianism precisely for its alleged incompatibility with the person-affecting view. Sufficientarians' disavowal of the person-affecting view implies that their view, similarly to egalitarianism, must be anchored in some impersonal value. But crucially, and this is the third step of the argument, there is no apparent value that can fit that role. We must conclude, then, that telic sufficientarianism is groundless. (shrink)

Telic sufficientarianism is the view that it is better, other things equal, if people are lifted above some sufficiency threshold of special moral importance. In a recent contribution, Shlomi Segall has raised the following objection to this position: The telic ideal of sufficiency can neither be grounded on any personal value, nor any impersonal value. Consequently, sufficientarianism is groundless. This article contains a rejoinder to this critique. Its main claim is that the value of autonomy holds strong potential for grounding (...) sufficiency. It argues, firstly, that autonomy carries both personal value for its recipient as well as impersonal value, and that both of these values are suitable for grounding sufficiency. It thus follows that we should reject both and. Secondly, although autonomy is presumably the strongest candidate for grounding sufficiency, the article provides some counterargument to Segall's rejection of the other candidates — the impersonal value of virtue; the personal value for the allocator; and the personal value for others. If the arguments are sound, they show that we need not worry about sufficientarianism being groundless. (shrink)

University of Alberta Forthcoming in Utilias Consider Lives for Headaches: there is some number of headaches such that the relief of those headaches is sufficient to outweigh the good life of an innocent person. Lives for Headaches is unintuitive, but difficult to deny. The argument leading to Lives for Headaches is valid, and appears to be constructed out of firmly entrenched premises. In this paper, I advocate one way to reject Lives for Headaches; I defend a form of lexical superiority (...) between values. Based on an inquiry into the notion of human well-being, I argue that no amount of headaches is sufficient to outweigh the disvalue of the loss of a good life. Though this view has been thought subject to devastating objections, these objections are not dispositive against the form of value superiority I advance here. (shrink)

In this paper, I present and explore an alternative to a standard prioritarian axiology. Equality-tempered prioritarianism holds that the value of welfare increases should be balanced against the value of equality. However, given that, under prioritarianism, the value of marginal welfare benefits decreases as the welfare of beneficiaries increases, equality-tempered prioritarianism holds that the intrinsic value of equality will be sufficient to alter a prioritarian verdict only in cases in which welfare benefits are granted to the very well-off. I argue (...) that this view, suitably refined, solves a persistent problem for prioritarianism, and is superior to alternatives. (shrink)

Many assume that theories of distributive justice must obviously take people’s lifetimes, and only their lifetimes, as the relevant period across which we distribute. Although the question of the temporal subject has risen in prominence, it is still relatively underdeveloped, particularly in the sphere of health and healthcare. This paper defends a particular view, “momentary sufficientarianism,” as being an important element of healthcare justice. At the heart of the argument is a commitment to pluralism about justice, where theorizing about just (...) principles demands paying attention to the role particular goods play in our lives. This means that different approaches to the temporal subject—as well as other relevant issues—may be appropriate for different goods, including different goods within healthcare. In particular, the paper discusses two central goods targeted by healthcare: life-saving and pain relief. The view is offered as complementary to, rather than competitive with, lifetime approaches. As such, the paper finishes by considering how a pluralist approach, which engages both with people’s lives as a whole and with their states at particular moments, can reconcile the potentially competing claims in healthcare that emerge from these two perspectives. (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)

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)

If an array of goods is for sale on a market, one’s wealth, the tradeable resources one owns, determines what one can purchase from this array. One’s income is the increment in wealth one acquires over a given period of time. In any society, we observe some people having more wealth and income, some less. At any given time, in some societies average wealth is greater than in others. Across time, we can observe societies becoming richer or poorer and showing (...) more or less equal distributions of wealth among their members. Does it matter from an ethical standpoint whether some people have more income and wealth than others? Does securing a more equal distribution of income and wealth either constitute the achievement of something that is intrinsically morally desirable or serve as a reliable means to the achievement of some intrinsic moral value? If we suppose that justice demands equalizing the income of wealth of persons in many circumstances, what principles of justice generate this demand? (shrink)

A common presupposition in contemporary moral and political philosophy is that individuals should be provided with some basic threshold of goods, capabilities, or well-being. But if there is such a basic minimum, how should this be understood? Dale Dorsey offers an underexplored answer: that the basic minimum should be characterized not as the achievement of a set of capabilities, or as access to some specified bundle of resources, but as the maintenance of a minimal threshold of human welfare. In addition, (...) Dorsey argues that though political institutions should be committed to the promotion of this minimal threshold, we should reject approaches that seek to cast the basic minimum as a human right. His book will be important for all who are interested in theories of political morality. (shrink)