One of the central debates within contemporary Anglo-American political philosophy concerns how to formulate an egalitarian theory of distributive justice which gives coherent expression to egalitarian convictions and withstands the most powerful anti-egalitarian objections. This book brings together many of the key contributions to that debate by some of the world’s leading political philosophers: Richard Arneson, G.A. Cohen, Ronald Dworkin, Thomas Nagel, Derek Parfit, John Rawls, T.M. Scanlon, and Larry Temkin.

In a recent article, Michael Otsuka and Alex Voorhoeve argue that prioritarianism fails to account for the shift in moral significance in gains to individuals in interpersonal as compared to intrapersonal cases. In this article, I show that the priority view escapes this objection but in a way that deprives it of (some of) its anti-egalitarian stance. Despite Otsuka and Voorhoeve, prioritarianism, rightly understood, provides consistent and attractive recommendations in both single- and multi-person cases. Yet prioritarians, the article goes on (...) to show, cannot do so while availing themselves of the leveling down objection (LDO) to egalitarianism. They may not do so because similarly to egalitarianism, prioritarianism also must reject the principle of personal good. That is, egalitarians and prioritarians may sometime recommend certain actions and outcomes even when these are better for no one. Prioritarians may survive the Otsuka–Voorhoeve critique, but to do so they must abandon their anti-egalitarian stance (or at the very least, the LDO). (shrink)

Derek Parfit has argued that prioritarianism “naturally” has global scope, i.e. naturally applies to everyone, irrespective of his or her particular national, state or other communal affiliation. In that respect, it differs from e.g. egalitarianism. In this article, I critically assess Parfit's argument. In particular, I argue that it is difficult to draw conclusions about the scope of prioritarianism simply from an inspection of its structure. I also make some suggestions as to what it would take to argue that prioritarianism (...) has either global or merely domestic scope. (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 article discusses the relation between prioritarian and egalitarian principles, whether and why we need to appeal to both kinds of principle, how prioritarians can answer various objections, especially those put forward by Michael Otsuka and Alex Voorhoeve, the moral difference between cases in which our acts could affect only one person or two or more people, veil of ignorance contractualism and utilitarianism, what prioritarians should claim about cases in which the effects of our acts are uncertain, the relative moral (...) importance of actual and expectable benefits, whether people should sometimes be given various chances of receiving benefits, and principles that appeal to competing claims. (shrink)

People condemn inequalities for many reasons. For example, many who have no concern with distribution per se criticize inequalities in health care, because these inequalities lessen the benefits provided by the resources that are devoted to health care. Others who place no intrinsic value on distribution believe that a just society must show a special concern for those who are worst off. Some people, on the other hand, do place an intrinsic value on equality of distribution, regardless of its contribution (...) to other goals. Derek Parfit and Larry Temkin call these people "egalitarians." I shall always employ quotation marks when referring to "egalitarians" in this special sense, because, as I shall argue, this terminology is misleading. One of its unhappy implications is that almost all egalitarians are not "egalitarians.". (shrink)

Moral egalitarianism will depend on one of two basic ideas. The first is the idea of equality itself. We might believe that it is a good thing if different people have equal shares of resources, or if their lives score equally well in terms of whatever makes lives valuable, at least if there is no reason based on some other moral value for one person to do better than the other. Equality is a relationship between the lives of different people. (...) This version of egalitarianism claims that the existence of the relationship makes an outcome better. It attributes value to relations between lives rather than to the content of lives. (shrink)

DEREK PARFIT is senior research fellow at All Souls College, Oxford. He regularly teaches there and is also afŠliated with New York University and Harvard. He was educated at Oxford and was a Harkness Fellow at Columbia and Harvard. He has been a visiting professor at Princeton, Temple, Rice, and the University of Colorado at Boulder, and is a fellow of the British Academy and of the American Academy of Arts and Sciences. He has made major contributions to our understanding (...) of personal identity, philosophy of the mind, and ethics, and he is thought to be one of the most important moral philosophers of the past century. His many academic articles include “Personal Identity” (1971), “Overpopulation and the Quality of Life” (1986), “The Unimportance of Identity” (1995), and “Equality and Priority” (1997). Rationality and Morality and Rediscovering Reasons are forthcoming from Oxford University Press. His book Reasons and Persons (1984) has been described by Alan Ryan of The Sunday Times as “something close to a work of genius.”. (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)

One theory about rationality is the Self-interest Theory, or S. S claims that what each of us has most reason to do is whatever would be best for himself. And it is irrational for anyone to do what he knows would be worse for himself. When morality conflicts with self-interest, many people would reject the Self-interest Theory. But most of these people would accept one of the claims that S makes. This is the claim that we should not care less (...) about our further future, simply because it is further in the future. We should not, for example, postpone pains at the foreseen cost of making them much worse. In our concern for our own self-interest, we should give equal weight to all the parts of our future. In this paper I shall discuss how a Self-interest Theorist should defend this claim. (shrink)

Derek Parfit has argued that (Teleological) Egalitarianism is objectionable by breaking a person-affecting claim to the effect that an outcome cannot be better in any respect - such as that of equality - if it is better for nobody. So, he presents the Priorty View, i.e., the policy of giving priority to benefiting the worse-off, which avoids this objection. But it is here argued, first, that there is another person-affecting claim that this view violates. Secondly, Egalitarianism can be construed as (...) person-affecting in a weaker sense. Thirdly, it is possible to construct a Relational version of the Priority View which incorporates the Egalitarian value of just equality in this sense. Two reasons are given for why this Relational View and Egalitarianism are superior to the Parfitian Absolute Priority View. However, no attempt is made to abjudicate between the first two views, the main point being that they both accept the value of just equality in the same sense. (shrink)

Should priority in the allocation of organs be given to those who have previously donated or declared their willingness to do so? This article examines the Israeli priority rule in light of two prominent critiques of priority rules, pertaining to failure to reciprocate and unfairness. The scope and content of these critiques are interpreted from the perspective of equality of opportunity. Because the Israeli priority rule may be reasonably criticized for unfairness and failing to reward certain behaviors, the article develops (...) an adjusted priority rule, which removes and adjust the elements in the Israeli priority rule deemed problematic. However, such a priority rule is complex to the extent that it may fail to increase donation rates and furthermore introduce new concerns of fairness, as the better off may be better able to navigate the complex adjusted priority rule. (shrink)

Suppose that you must make choices that may influence the well-being and the identities of the people who will exist, though not the number of people who will exist. How ought you to choose? This paper answers this question. It argues that the currency of distributive ethics in such cases is a combination of an individual’s final well-being and her expected well-being conditional on her existence. It also argues that this currency should be distributed in an egalitarian, rather than a (...) prioritarian, manner. (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)

John Rawls’s thesis that a certain package of basic liberties should be given lexical priority is of great interest for legal and political philosophy, but it has received relatively little defense from Rawls or his supporters. In this paper, I examine three arguments for the thesis: the first is based on the two ‘moral powers’; the second, on the social bases of self-respect; and the third, on a Kantian notion of autonomy. I argue none of these accounts successfully establishes 1) (...) the distinct claim of lexical priority, 2) for the complete package of basic liberties, on the basis of reasons that are appropriately public. In turn, I propose an alternative argument, in support of those two claims, based on the social or ‘relational’ conception of equality. (shrink)

In this dissertation, I discuss two distributive principles in moral philosophy: Derek Parfit's Prioritarianism and Egalitarianism. I attempt to defend a version of Egalitarianism, which I call Weighted Egalitarianism. Although Parfit claims that Egalitarianism is subject to what he calls the Levelling Down Objection, I show that my proposed Weighted Egalitarianism is not subject to the Objection, and that it gives priority to the worse off people. The real difference between the two principles lies in how the weight of each (...) person's well-being is determined. Prioritarianism assumes that there is a moral scale of the goodness of well-being, independently of distributions of people's well-being. I raise two objections to this claim: firstly, it is hard to believe that the choice of the level of well-being affects our distributive judgement; secondly, it is hard to believe that there is such a moral scale independently of distributions of people's well-being. On the other hand, Weighted Egalitarianism claims that the weight is given by the rank order position of the person in the ranking by well-being level. This means that, in Weighted Egalitarianism, the goodness of a distribution is an increasing, linear function of people's well-being. Weighted Egalitarianism is not affected by the choice of the level of people's well-being. Nor does it require require the moral scale of the goodness of well-being independently of distributions of people's well-being. Leximin, which might be a version of Prioritarianism, avoids my objections. But it is hard to support Leximin, because it rules out the trade off between the better off and the worse off. I conclude that Weighted Egalitarianism is more acceptable than Prioritarianism. (shrink)

A feminist ethics that bases morality on dependence or vulnerability challenges the moral priority of uniform over disparate treatment. Persons with disabilities resist equality's homogenization of moral personhood. But displacing equality in favor of caring or trust reprises the repression of those already marginalized. The ethics of difference proves an ineffective remedy for the negative consequences attendant on how historically marginalized groups are different. An historicized conception of equality resolves the dilemma.

There is an incompatibility between the deflationist approach to truth, which makes truth transparent on the basis of an antecedent grasp of meaning, and the traditional endeavour, exemplified by Davidson, to explicate meaning through of truth. I suggest that both parties are in the explanatory red: deflationist lack a non-truth-involving theory of meaning and Davidsonians lack a non-deflationary account of truth. My focus is on the attempts of the latter party to resolve their problem. I look in detail at Davidson's (...) more recent work and suggest that it seeks to articulate a primitive notion of truth that may balance between a notion that collapses into deflationism and one that is wholly subsumed under a general theory of interpretation. I conclude that this tightrope walk is ultimately unsuccessful. Equally, however, some reasons are provided for thinking that deflationism might be equally unsuccessful with its problem. 'Truth or meaning?' remains an open question. (shrink)

This article provides a systematic analysis of the proposal to use Covid‐19 vaccination status as a criterion for admission of patients with Covid‐19 to intensive care units (ICUs) under conditions of resource scarcity. The general consensus is that it is inappropriate to use vaccination status as a criterion because doing so would be unjust; many health systems, including the UK National Health Service, are based on the principle of equality of access to care. However, the analysis reveals that there are (...) several unique features of Covid vaccination status in the context of a pandemic that make this issue disanalogous to cases (such as lung cancer caused by smoking) discussed previously. First, there is equality in access to care at the point of vaccination; the unvaccinated refuse the offer of preventive care when they decline vaccination, weakening their claim to ongoing care if they become ill (this is qualitatively different from ‘poor lifestyle choices’ such as smoking). Second, the decision of one person to refuse vaccination substantially increases the risk that they will become seriously ill and need ICU care; the person who chooses not to get vaccinated thus potentially increases the pressure on intensive care bed provision, as well as increasing the risk that he or she will infect others who in turn might end up needing ICU care. Third, justice cuts both ways, and giving unvaccinated patients equal priority may itself be unjust when other patients have reduced their risk of ending up on the ICU by getting vaccinated. (shrink)

I argue that prioritarianism cannot be assessed in abstraction from an account of the measure of utility. Rather, the soundness of this view crucially depends on what counts as a greater, lesser, or equal increase in a person’s utility. In particular, prioritarianism cannot accommodate a normatively compelling measure of utility that is captured by the axioms of John von Neumann and Oskar Morgenstern’s expected utility theory. Nor can it accommodate a plausible and elegant generalization of this theory that has been (...) offered in response to challenges to von Neumann and Morgenstern. This is, I think, a theoretically interesting and unexpected source of difficulty for prioritarianism, which I explore in this article. (shrink)

Adult education has long been the Cinderella of the education system. This is not helped by the fact that there is currently an impasse between employers, government and individuals over who should finance such training. So what, if anything, can philosophers do to help resolve the normative question of who ought to pay, setting aside for the moment the practical question of how this might be put into effect? An important strand of contemporary egalitarian philosophy argues that equality of opportunity (...) for education should be implemented in such a way that children with the same level of talent and the same willingness to make an effort have the same opportunity to attain skills and qualifications such that they are each able (at the onset of adult life) to compete effectively with others for advantageous positions and rewards in society. But what about children or teenagers who drop out of education or make such little effort that they achieve wholly inadequate exam results? Should they be offered second and third chances for free education as adults funded by the state? A case is made for lifelong as opposed to one-off equality of opportunity for education on a number of grounds, including efficiency, utility, the value of choice, the social bases of self-respect and responsibility-catering prioritarianism. This last view supports lifelong access to education (for reasons of priority) but with the additional (responsibility-catering) stipulation that adults should contribute at least some of the costs themselves in so far as they are accountable for not making enough effort the first time around. (shrink)

This chapter contains sections titled: Distinguishing Different Kinds of Egalitarianism Equality, Fairness, Luck, and Responsibility Equality of What? The Subsistence Level, Sufficiency, and Compassion Prioritarianism and the Leveling Down Objection19 Equality or Priority? Illustrating Egalitarianism's Distinct Appeal Conclusion Notes.

Adult education has long been the Cinderella of the education system. This is not helped by the fact that there is currently an impasse between employers, government and individuals over who should finance such training. So what, if anything, can philosophers do to help resolve the normative question of who ought to pay, setting aside for the moment the practical question of how this might be put into effect? An important strand of contemporary egalitarian philosophy argues that equality of opportunity (...) for education should be implemented in such a way that children with the same level of talent and the same willingness to make an effort have the same opportunity to attain skills and qualifications such that they are each able (at the onset of adult life) to compete effectively with others for advantageous positions and rewards in society. But what about children or teenagers who drop out of education or make such little effort that they achieve wholly inadequate exam results? Should they be offered second and third chances for free education as adults funded by the state? A case is made for lifelong as opposed to one-off equality of opportunity for education on a number of grounds, including efficiency, utility, the value of choice, the social bases of self-respect and responsibility-catering prioritarianism. This last view supports lifelong access to education (for reasons of priority) but with the additional (responsibility-catering) stipulation that adults should contribute at least some of the costs themselves in so far as they are accountable for not making enough effort the first time around. (shrink)

Adult education has long been the Cinderella of the education system. This is not helped by the fact that there is currently an impasse between employers, government and individuals over who should finance such training. So what, if anything, can philosophers do to help resolve the normative question of who ought to pay, setting aside for the moment the practical question of how this might be put into effect? An important strand of contemporary egalitarian philosophy argues that equality of opportunity (...) for education should be implemented in such a way that children with the same level of talent and the same willingness to make an effort have the same opportunity to attain skills and qualifications such that they are each able (at the onset of adult life) to compete effectively with others for advantageous positions and rewards in society. But what about children or teenagers who drop out of education or make such little effort that they achieve wholly inadequate exam results? Should they be offered second and third chances for free education as adults funded by the state? A case is made for lifelong as opposed to one-off equality of opportunity for education on a number of grounds, including efficiency, utility, the value of choice, the social bases of self-respect and responsibility-catering prioritarianism. This last view supports lifelong access to education (for reasons of priority) but with the additional (responsibility-catering) stipulation that adults should contribute at least some of the costs themselves in so far as they are accountable for not making enough effort the first time around. (shrink)

When decisionally incapable patients need a surrogate to make medical decisions for them, sometimes the patient has not appointed a healthcare agent and there is intractable disagreement among potential surrogates of equal priority, legal rank, or relation to the patient (e.g., child vs. child, sibling vs. sibling). There is no ethical, legal, or professional consensus about how to identify the appropriate surrogate in such circumstances. This article presents a case study involving an elderly female patient whose four children disagree about (...) whether to continue life-sustaining treatment for their mother, along with an ethical analysis of various strategies for selecting the appropriate surrogate in cases of conflicting equal-rank family members. It critically examines three different strategies—chance, majority rules, and quality of relationship with the patient—and defends the third approach. (shrink)

The classical liberal doctrine of free expression asserts the priority of speech as an extension of the freedom of thought. Yet its critics argue that freedom of expression, itself, demands the suppression of the so-called “silencing speech” of racists, sexists, and so on, as a threat to the equal expressive rights of others. This essay argues that the claim to free expression must be distinguished from claims to equal speech. The former asserts an equal right to express one’s thoughts without (...) interference; the latter the right to address others, and to receive a hearing and consideration from them, in turn. I explore the theory of equal speech in light of the ancient Athenian practice of isegoria and argue that the equality demanded is not distributive but relational: an equal speaker’s voice should be counted as “on a par” with others. This ideal better captures critics’ concerns about silencing speech than do their appeals to free expression. Insofar as epistemic and status-harms provide grounds for the suppression and exclusion of some speech and speakers, the ideal of equal speech is more closely connected with the freedom of association than of thought. Noticing this draws attention to the continuing—and potentially problematic—importance of exclusion in constituting effective sites of equal speech today. (shrink)

BackgroundThe idea that individuals are responsible for their health has been the focus of debate in the theoretical literature and in its concrete application to healthcare policy in many countries. Controversies persist regarding the form, substance and fairness of allocating health responsibility to the individual, particularly in universal, need-based healthcare systems.ObjectiveTo examine how personal health responsibility has been framed and rationalised in Norwegian key policy documents on priority setting.MethodsDocuments issued or published by the Ministry of Health and Care Services between (...) 1987 and 2018 were thematically analysed. We developed a predefined conceptual framework that guided the analysis. The framework included: the subject and object of responsibility, the level of conceptual abstraction, temporality, normative justificatory arguments and objections to the application of personal health responsibility.ResultsAs an additional criterion, personal health responsibility has been interpreted as relevant if: the patient’s harmful behaviour is repeated after receiving treatment, and if the success of the treatment is conditional on the patient’s behavioural change. When discussed as a retrospective criterion, considerations of reciprocal fairness have been dominant. When discussed as a prospective criterion, the expected benefit of treatment justified its relevance.ConclusionPersonal health responsibility appears to challenge core values of equality, inclusion and solidarity in the Norwegian context and has been repeatedly rejected as a necessary criterion for priority setting. However, the responsibility criterion seems to have some relevance in particular priority setting decisions. (shrink)

There has been much discussion about how to obtain legitimacy at macro-level priority setting in health care by use of fair procedures, but how should we consider priority setting by individual clinicians or health workers at the micro-level? Despite the fact that just health care totally hinges upon their decisions, surprisingly little attention seems being paid to the legitimacy of these decisions. This paper addresses the following question: what are the conditions that have to be met in order to ensure (...) that individual claims on health care are well aligned with an overall concept of just health care? Drawing upon a distinction between individual and aggregated needs, I argue that even though we assume the legitimacy of macro-level guidelines, this legitimacy is not directly transferable to decisions at micro-level simply by adherence to the guidelines’ recommendation. Further, I argue that individual claims are subject to the formal principle of equality and the demands of vertical and horizontal equity in a way that gives context- and patient-related equity concerns precedence over equity concerns captured at the macro-level. I conclude that if we aim to achieve just health care, we need to develop a complementary framework for legitimising individual judgment of patients’ claims on health care resources. Moreover, I suggest the basic structure of such a framework. (shrink)

This paper has been about the question of what there is most reason to doin situations in which either there are no moral considerations to be takeninto account or the moral considerations to be taken into account are equally balanced. I have assessed all Parfit's arguments for concluding that the Present-aim Theory is right and the Self-interest Theory wrong aboutthis question. In § III, I showed how Parfit's argument from personal identity leads not to the abandonment of the Self-interest Theory, (...) but merely to a revision of it. In § IV, I argued that a premiss relied on by Parfit's argument from incomplete relativity - the premiss that theoretical and practical reason are relevantly similar - is too weak to support the conclusion that knowingly doing what is against one's long- term self-interest is rational (when no moral considerations are in play). In § V, I addressed Parfit's argument that we must reject the Self-interest Theory because we believe that it is rational to care more about certain things (such as achievement) than about one's overall welfare. I suggested that he misdescribed what we believe: for what we really believe is that it is not irrational to care more about these things than about either having the most pleasant life possible or having the life with the strongest desires fulfilled. This thought is consistent with Objective List versions of the Self- interest Theory. In § VI, I suggested Parfit's argument from our bias towards the future might be answered by making a second revision to the Self-interest Theory. Therefore, for all Parfit has argued, a version of the Self-interest Theory might be the most plausible theory of what we have most reason to do when moral considerations do not decide the issue.21. (shrink)

In their paper ‘Why It Matters That Some Are Worse Off Than Others: An Argument against the Priority View’, Michael Otsuka and Alex Voorhoeve argue that prioritarianism is mistaken. I argue that their case against prioritarianism has much weaker foundations than it might at first seem. Their key argument is based on the claim that prioritarianism ignores the fact of the ‘separateness of persons’. However, prioritarianism, far from ignoring that fact, is a plausible response to it. It may be that (...) prioritarianism disregards the fact of the ‘unity of the individual’. But even if this is true, that doesn’t straightforwardly tell against prioritarianism as a view about distributive justice. In the end, Otsuka and Voorhoeve’s argument relies on a non-decisive intuition that they appeal to early in their paper. Their conclusion, as a result, is not compelling. (shrink)

The coronavirus disease 2019 (COVID-19) pandemic has motivated medical ethicists and several task forces to revisit or issue new guidelines on allocating scarce medical resources. Such guidelines are relevant for the allocation of scarce therapeutics and vaccines and for allocation of ICU beds, ventilators, and other life-sustaining treatments or potentially scarce interventions. Principles underlying these guidelines, like saving the most lives, mitigating disparities, reciprocity to those who assume additional risk (eg, essential workers and clinical trial participants), and equal access may (...) compete with one another. We propose the use of a “categorized priority system” (also known as a “reserve system”) as an improvement over existing allocation methods, particularly because it may be able to achieve disparity mitigation better than other methods. (shrink)

Vaccines, when available, will prove to be crucial in the fight against Covid-19. All societies will face acute dilemmas in allocating scarce lifesaving resources in the form of vaccines for Covid-19. The author proposes The Value of Lives Principle as a just and workable plan for equitable and efficient access. After describing what the principle entails, the author contrasts the advantage of this approach with other current proposals such as the Fair Priority Model.

Well-stated modern political or democratic theory is rights-based. Meaningful democracy rests as a precondition on the equal rights of citizens. This idea stems from Rousseau’s distinction between a general will*one which is impersonal and tends toward equality, that is, the equal basic rights of citizens*and a transitory will of all. For instance, absent equal basic rights, one might imagine a possible world in which what I have called a self-undermining series of wills of all, or the results of socalled majority (...) rule, disenfranchises the population. In the USA, one might think, contrahistorically, of a regime in which the women, as a majority, disenfranchise the men, the Black, Latin, and Asian women disenfranchise the White women, and by a series of reductions by further ‘majorities,’ three people still have the suffrage, two of whom disenfranchise one. Based on Rousseau, John Rawls’ Theory of Justice thus emphasizes the priority of the equal liberty principle over an economic difference principle.1 The difference principle permits those inequalities which also benefit the least advantaged. But the priority of the equal liberty principle rules out any inequality, otherwise beneficial to the least advantaged, which enables the rich to control the government. This priority makes equal basic rights the inescapable precondition for any decent majority rule or distribution of income. Note that in principle, such a regime may be international*even a democracy of demoi in James Bohman’s phrase - rather than national. (Published: 5 February 2010) Citation: Ethics & Global Politics, Vol. 3, No. 1, 2010, pp. 55-70. DOI: 10.3402/egp.v3i1.4854. (shrink)

Some of us believe in giving priority to people who are badly off in designing social policies and in acting ourselves to help others. As Thomas Nagel puts it, the badly off should be first in the queue when benefits are distributed. This idea is one way of explaining moral views that are called ‘egalitarian.’ Egalitarian moral views can depend either on the idea of valuing equality itself or on the idea of giving priority to the interests of the badly (...) off. This paper is concerned with the second kind of egalitarianism.The purest form of the idea explains the priority in this way: a benefit for someone badly off can be more important morally, or can have more value, than a benefit of the same size for someone better off. This is to suppose that the priority in question cannot be explained by thinking in utilitarian terms and accepting the principle of diminishing marginal utility. (shrink)

Global health is at a crossroads. The 2030 Agenda for Sustainable Development has come with ambitious targets for health and health services worldwide. To reach these targets, many more billions of dollars need to be spent on health. However, development assistance for health has plateaued and domestic funding on health in most countries is growing at rates too low to close the financing gap. National and international decision-makers face tough choices about how scarce health care resources should be spent. Should (...) additional funds be spent on primary prevention of stroke, treating childhood cancer, or expanding treatment for HIV/AIDS? Should health coverage decisions take into account the effects of illness on productivity, household finances, and children's educational attainment, or just focus on health outcomes? Does age matter for priority setting or should it be ignored? Are health gains far in the future less important than gains in the present? Should higher priority be given to people who are sicker or poorer? Global Health Priority-Setting provides a framework for how to think about evidence-based priority-setting in health. Over 18 chapters, ethicists, philosophers, economists, policy-makers, and clinicians from around the world assess the state of current practice in national and global priority setting, describe new tools and methodologies to address establishing global health priorities, and tackle the most important ethical questions that decision-makers must consider in allocating health resources. (shrink)

Explicit forms of rationing have already been implemented in some countries, and many of these prioritization systems resort to Norman Daniels’ “accountability for reasonableness” methodology. However, a question still remains: is “accountability for reasonableness” not only legitimate but also fair? The objective of this paper is to try to adjust “accountability for reasonableness” to the World Health Organization’s holistic view of health and propose an evolutionary perspective in relation to the “normal” functioning standard proposed by Norman Daniels. To accomplish this (...) purpose the authors depart from the “normal” functioning standard to a model that promotes effective opportunity for everyone in health care access, because even within the “normal” functioning criteria some treatments and medical interventions should have priority upon others. Equal opportunity function is a mathematical function that helps to hierarchize moral relevant necessities in health care according to this point of view. It is concluded, first, that accountability for reasonableness is an extremely valuable tool to address the issue of setting limits in health care; second, that what is called in this paper “equal opportunity function” might reflect how accountability for reasonableness results in fair limit-setting decisions; and third, that this methodology must be further specified to best achieve fair limit-setting decisions. Indeed, when resources are especially scarce the methodology suggested in this paper might allow not only prioritizing in an “all or nothing” basis but can contribute to a hierarchy system of priorities in health care. (shrink)

This book explores the relation between agape (or Christian charity) and social justice. Timothy Jackson defines agape as the central virtue in Christian ethical thought and action and applies his insights to three concrete issues: political violence, forgiveness, and abortion. Taking his primary cue from the New Testament while drawing extensively from contemporary theology and philosophy, Jackson identifies three features of Christian charity: unconditional commitment to the good of others, equal regard for others' well-being, and passionate service open to self-sacrifice (...) for the sake of others. Charity, prescribed by Jesus for his disciples and named by Saint Paul as the "greatest" theological virtue, is contrasted with various accounts of justice. Jackson argues that agape is not trumped by justice or other goods. Rather, agape precedes justice: without the work of love, society would not produce persons capable of merit, demerit, and contract, the elements of most modern conceptions of justice. Jackson then considers the implications of his ideas for several questions: the nature of God, the relation between Christian love and political violence, the place of forgiveness, and the morality of abortion. Arguing that agapic love is to be construed as a gift of grace as well as a divine commandment, Jackson concludes that love is the "eternal life" that makes temporal existence possible and thus the "first" Christian virtue. Though foremost a contribution to Christian ethics, Jackson's arguments and the issues he takes up will find a broader readership. (shrink)

State provision of “merit goods” and of narrowly targeted cash payments has higher priority than large universal cash grants. Analysis of the Swedish budget shows that advanced countries do not have the taxing capacity to do both at once. Other problems with cash payments schemes include the disincentive to work for pay, reducing taxpaying capacity, and retrograde effects on gender equality. After the achievement of a welfare state, rises over time in productivity may gradually open up room in the national (...) budget for universal cash payments. (shrink)

Given resource constraints in healthcare, demands justice and equity require the constant development of material principles for resource distribution. In many cases, such material principles are formulated as mid-level principles, well-adapted to handle healthcare distribution but suffering from aspects outside the healthcare context that affect their application. In healthcare, factors outside the healthcare system will sometimes affect patients’ equal opportunity to receive treatment and achieve health. Examples of such factors might include an individual’s economic means, the cost of drugs, geography, (...) etc. This article explores whether the formal equality principle could help us address such problems. It is argued that the traditional (thin) formal equality principle can aid in priority setting, both as a heuristic tool to aid in consistency and also in handling under-determined cases. However, it appears to be too ‘thin’ to handle problems caused by factors outside the healthcare context. In the article, I explore a more robust version of the formal equality principle and argue that such a principle can be used to address such cases. However, even a more comprehensive formal equality principle will need to consider whether some other actors have a moral responsibility to address the problem or whether the issue could be solved more effectively by others. Furthermore, such a principle needs to consider whether the opportunity cost of achieving ‘thick’ formal equality is acceptable, given the material principles of distribution. (shrink)

How do we know if people are equal? Contemporary philosophers consider a number of issues when determining if the goals of egalitarian distributive justice have been achieved: defining the metric of equality; determining whether the goal is equality, or simply priority or sufficiency; establishing whether there should be conditions, e.g. bad brute luck, for the amelioration of inequality. In all this, most egalitarians contend that what is to be equalized is not people’s actual shares of the good in question, but (...) rather, the opportunities to have such shares. I counter this view with an ‘egalitarian flourishing’ approach that, in seeking to make people equal in actual well-being, takes exception to the role of opportunity in contemporary argument. The flourishing view means a focus on outcomes, on how people live, in order to enable people to live equally flourishing lives. I argue that if we consider the complex dynamics of choice and circumstance, the role of nonmaterial considerations and the ideal of an egalitarian community, equality of opportunity proves to be an inadequate approach to the realization of the egalitarian ideal. (shrink)

Recognising and responding to injustices that benefit us is a pervasive problem of contemporary life, and arguably a mark of moral seriousness in anyone who presumes to take moral stands at all. In response, a number of authors have defended the view that such benefits normally bring with them prima facie obligations of compensation. This ‘wrongful-benefits’ approach has considerable intuitive plausibility, much of it founded in the financial metaphor that gives it an appearance of precision. Yet while the compensation scenario (...) works reasonably well in one-off cases such as receiving stolen property, it yields incoherent results when facing ongoing structural injustices. In such cases ‘innocence’ is ambiguous and our status as beneficiaries and victims is complex. In contrast, solidarity — understood as a principle of equity requiring that we side with the least well off — provides a better account of duties to respond to structural injustice. In solidarity the agent follows the lead of organised out-groups and defers to their judgment about collective actions to overcome injustice. Solidarity leads us to support the organised group that suffers from the greatest inequity. Solidarity does not use a financial metaphor and thus it neither requires full disgorgement, nor absolves us of further action when we reach the point of net-zero benefit. Rather, solidarity is a principal means for ordinary citizens to promote equity by affirming the equal status of the victims, and to atone for having benefited from injustice, whether they did so willingly or otherwise. (shrink)

Liberal nationalism is a boundary‐making project, and a feature of this boundary‐making enterprise is the belief that the compatriots have a certain priority over strangers. For this reason it is often thought that liberal nationalism cannot be compatible with the demands of global egalitarianism. In this essay, I examine the sense in which liberal nationalism privileges compatriots, and I argue that, properly understood, the idea of partiality for compatriots in the context of liberal nationalism is not at odds with global (...) equal concern for all persons. In particular, I argue that the three central goals and aspirations of liberal nationalism—promoting individual autonomy and cultural identity, the realization of deliberative democracy, and the aspiration for social justice within the state—do not entail or require a form of compatriot partiality that is inconsistent with the demands of global egalitarian justice. (shrink)

In a world of limited resources, competition between the young and old prompt difficult questions of justice. In countries with public pension and health care systems, or with aging populations, there is often a concern that members of different generations are not always treated fairly. Dennis McKerlie's monograph examines justice between age-groups with the ultimate goal of a new theory of justice that effectively grapples with those questions. In the realm of public policy and medical ethics this is an important (...) and timely topic, but surprisingly one that has received relatively little attention from moral philosophers. McKerlie develops a comprehensive view of fairness between age groups that applies the egalitarian values of equality, or priority for the badly off, to temporal parts of lives -- not just to complete lives. (shrink)

What we think about equality as a value will influence how we think genetic interventions should be regulated. In this paper I utilise the taxonomy of equality put forth by Derek Parfit and apply this to the issue of genetic interventions. I argue that Telic Egalitarianism is untenable and that Deontic Egalitarianism collapses into the Priority View. The Priority View maintains that it is morally more important to benefit those who are worse off. Once this precision has been given to (...) the concerns egalitarians have a number of diverse issues must be considered before determining what the just regulation of genetic interventions would be. Consideration must be given to the current situation of the current situation of the least advantaged, the fiscal realities behind genetic interventions, the budget constraints on other programmes egalitarians believe should receive scarce public funds and the interconnected nature of genetic information. These considerations might lead egalitarians to abandon what they take to be the obvious policy recommendations for them to endorse regarding the regulation of genetic therapies and enhancements. (shrink)

Three common assumptions of both liberal theory and political debate are the autonomy of the family, the principle of merit, and equality of life chances. Fishkin argues that even under the best conditions, commitment to any two of these principles precludes the third._“A brief survey and brilliant critique of contemporary liberal political theory…. A must for all political theory or public policy collections.” –_Choice_ “The strong points of Fishkin’s book are many. He raises provocative issues, locates them within a broader (...) theoretical framework, and demonstrates an urgent need for liberals to set certain priorities. His main message—that liberalism has radical implications for ordinary life—needs to be heard by many.” --Virginia L. Warren, _Michigan Law Review_ “A highly original and powerfully argued book…. Fishkin is undoubtedly right, and his warning needs to be taken seriously…. This is not a book that catechizes us about what we should believe concerning the practicalities of distributive justice. It is a book that advises us about how we need to think about beliefs that are already popular dogmas, in the interest of making sense.” –James Gaffney, _America_ James S. Fishkin_ is associate professor of political science at Yale University. He is also the author of _The Limits of Obligation_ and _Beyond Subjective Morality_. (shrink)

In a world of limited resources, competition between the young and old prompt difficult questions of justice. In countries with public pension and health care systems, or with aging populations, there is often a concern that members of different generations are not always treated fairly. Dennis McKerlie's monograph examines justice between age-groups with the ultimate goal of a new theory of justice that effectively grapples with those questions. In the realm of public policy and medical ethics this is an important (...) and timely topic, but surprisingly one that has received relatively little attention from moral philosophers. McKerlie develops a comprehensive view of fairness between age groups that applies the egalitarian values of equality, or priority for the badly off, to temporal parts of lives -- not just to complete lives. (shrink)