This paper defends the acts/omissions distinction which underpins the present law on euthanasia, from various criticisms, and aims to show that it is supported by fundamental principles. After rejecting arguments that deny the coherence and/or legal relevance of the distinction, the discussion proceeds to focus on the causal relationship between the doctor and the patient's death in each case. Although previous analyses, challenging the causal efficacy of omissions generally, are shown to be deficient, it is argued that in certain cases (...) of causing death by omission the causal authorship of the doctor lapses. The final part of the paper examines why this should be morally significant and proposes an answer in terms of the principle of equality. Assuming all other factors are equal, the infringement of this principle provides an additional reason against actively killing a patient, which is not present in cases of passively letting die. (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)

The principle of equal consideration of interests is a very popular principle in animal ethics. Peter Singer employs it to ground equal treatment and solve the problem of the basis of equality, namely the problem of why we should grant equal treatment despite the variability of people’s features. In this paper, I challenge Singer’s argument because ECOI does not provide plausible grounds to presume that the interests of diverse individuals are actually equal. Analyzing the case of pain (...) and the interest in not suffering in particular, I contend that there are some insurmountable epistemic and axiological problems in accounting for the equality of interests. Besides criticizing ECOI as a basis of equality, I argue that we need to rely on an equality of moral status. I conclude by providing some considerations on the relation between equality and the principle of proportionality. (shrink)

© 2016 Informa UK Limited, trading as Taylor & Francis Group. Within the umbrella of equal recognition, several principles of linguistic justice can be distinguished. A first, the per-capita principle, mandates prorating language recognition based on a per-capita distribution. A second, the equal-services principle, prescribes upholding the official languages as the languages in which the state speaks and in which public services are provided, irrespective of changing numbers of speakers. Alan Patten defends the prorated per-capita principle. I (...) argue for the equal-services principle, which practically will often amount to a form of linguistic maximin: the more vulnerable the language, the more numerous the resources. (shrink)

Should people who perform equal work receive equal pay? Most would say ‘yes’, at least insofar as this question is understood to be asking whether employers should be permitted to discriminate against employees on the basis of race or sex. But suppose the employees belong to all of the same traditionally protected groups. Is (what I call) nondiscriminatory unequal pay for equal work wrong? Drawing an analogy with price discrimination, I argue that it is not intrinsically wrong, but it can (...) be deceptive, in which case it is wrong. (shrink)

Despite the attention equality before the law has received, both laudatory and critical, peculiarly little has been done to precisely define it. The first ambition of this paper is to remedy this, by exploring the various ways in which a principle of equality before the law can be understood and suggest a concise definition. With a clearer understanding of the principle in hand we are better equipped to assess traditional critique of the principle. Doing so (...) is the second ambition of this paper. I will argue that traditional criticisms are unpersuasive, but that there is a different, powerful argument against equality before the law. The third ambition of the paper is to argue that there is a sense, overlooked by both proponents and critics, in which the principle still captures something important, albeit at the cost of shifting from intrinsic to instrumental value. (shrink)

Are there distinctively political values? Certain egalitarians seem to think that equality is one such value. Scheffler 's contribution to the symposium seeks to articulate a division of moral labour between norms of personal morality and the principles of justice that regulate social institutions, and using this suggests that the egalitarian critique of Rawls can be deflected. In this paper, instead, I question the status of equality as an intrinsic value. I argue that an egalitarianism which focuses on (...) the status of equality as valuable in itself embraces a theory of value with the worst elements of utilitarianism while leaving behind any of the intuitive appeal that utilitarianism has. In its place I press that we need a political conception of egalitarianism which stresses the role of equality as a political ideal without presupposing any values with which we engage beyond those found in the norms of personal morality. (shrink)

This paper attempts to identify a principle of equal treatment that gives specific structure to our widely shared judgments about the circumstances in which we have moral reason to object to the differential adverse treatment of others. I formulate what I call a “substantive” principle of equal treatment (to be distinguished from principles of formal equality) that describes a moral constraint on the reasons we can have for picking out individuals for differentially adverse action. I argue that (...) this constraint is violated when an action, in view of its rationale, expresses lesser respect for the moral status of an individual under some differentiating description, compared to the respect reserved to another class of individuals who are not picked out by that description. I show that this substantive demand of equal treatment is not morally otiose and reveal the fallacy underlying accounts that have concluded otherwise. (shrink)

The desire to defend a state against attacks by a non-state actor requires thinking about counter-attacking without violating the sovereign equality of the territorial state because targeting a non-state actor on the territory of that state may violate its sovereignty. This paper evaluates the main views on self-defense by states against non-state actors by studying the Just War Theory and argues that self-defense against a non-state actor is allowed if the counter-attack complies with the principle of sovereign (...) class='Hi'>equality. Sovereign equality is the prohibition of states from dominion over other states because states are equal to one another. This principle can be respected by allowing self-defense against non-state actors to occur only if the state consented to the use of force on its territory or if that state is incapable of controlling or unwilling to control the non-state actor. (shrink)

A principle claiming equal entitlement to continued life has been strongly defended in the literature as a fundamental social value. We refer to this principle as ‘equal value of life'. In this paper we argue that there is a general incompatibility between the equal value of life principle and the weak Pareto principle and provide proof of this under mild structural assumptions. Moreover we demonstrate that a weaker, age-dependent version of the equal value of life (...) class='Hi'>principle is also incompatible with the weak Pareto principle. However, both principles can be satisfied if transitivity of social preference is relaxed to quasi-transitivity. Footnotes1 The authors are grateful to Luc Bovens, Kristian Schultz Hansen, Søren Holm, Franz Huber, Wiebke Kuklys, Gabriella Pigozzi, and two anonymous referees for detailed and very helpful comments on earlier versions of this paper. Any errors and shortcomings are the responsibility of the authors alone. (shrink)

It is hypothesised and argued that “the four principles of medical ethics” can explain and justify, alone or in combination, all the substantive and universalisable claims of medical ethics and probably of ethics more generally. A request is renewed for falsification of this hypothesis showing reason to reject any one of the principles or to require any additional principle(s) that can’t be explained by one or some combination of the four principles. This approach is argued to be compatible with (...) a wide variety of moral theories that are often themselves mutually incompatible. It affords a way forward in the context of intercultural ethics, that treads the delicate path between moral relativism and moral imperialism. Reasons are given for regarding the principle of respect for autonomy as “first among equals”, not least because it is a necessary component of aspects of the other three. A plea is made for bioethicists to celebrate the approach as a basis for global moral ecumenism rather than mistakenly perceiving and denigrating it as an attempt at global moral imperialism. (shrink)

The idea that healthcare should become more person-centred is extremely influential. By using recent English policy developments as a case study, this article aims to critically analyse an important element of person-centred care, namely, the belief that to treat patients as persons is to think that care should be ‘co-produced’ by formal healthcare providers and patients together with unpaid carers and voluntary organizations. I draw on insights from political philosophy to highlight overlooked tensions between co-production and values like equality (...) and liberty. Regarding equality, I argue that co-production compounds both problems of gender inequality in the distribution of care labour and the challenges associated with securing equal access to care. Turning to liberty, I identify important commonalities between co-production and republicanism in political philosophy, given their shared insistence on common citizens’ civic virtue. Then, I use against co-production some liberal arguments against republicanism, to highlight a problem of over-demandingness. In bringing my argument to a close, however, I wish to caution against hastily rejecting co-production as a policy programme. (shrink)

In the 1970s feminist scholars rediscovered J. S. Mill's writings on sexual equality. The new feminist appraisal confronted traditional Mill scholarship which had tended either to neglect Mill's writings on women or to concentrate on Harriet Taylor's influence on Mill's views on sexual equality. But even the most cursory review of the writings of feminist scholars reveals a lack of consensus.

1.1.1 In a recent series of papers, G.A. Cohen has presented an egalitarian interpretation of the Difference Principle (hereafter, DP).1 According to this principle—first introduced by Rawls in A Theory of Justice2—inequalities in the distribution of primary goods3 are legitimate only to the extent that they maximize the prospects of the least advantaged members of society. Cohen argues that, once it is properly applied, DP does not legitimate any departure from equality. According to him, the distribution that (...) maximizes the prospects of the least advantaged is the equal distribution. Cohen has offered two kinds of argument in support of the egalitarian conclusion. According to the first argument, differential incentives are not necessary in order to maximize efficiency. According to the second argument, principles of distributive justice apply not only to the basic structure of society but also to the choices made by individuals within those rules. Therefore, talented people should not seek to maximize the gains they can get on the market, thereby making more social product available for the less well off. 4 In this paper, I focus only on Cohen’s first argument. The interesting feature of this argument is that it is presented as an internal criticism of Rawls’ theory of justice. My present concern is to understand to what extent the DP embodies an idea of equality and it is thus amenable to the egalitarian interpretation. I will argue that the first argument fails and that DP allows for the inequalities generated by the use of incentives. The assessment of the second argument merits a separate discussion that I intend to take up in a sequel to this paper. For the time being, I take not stance on the effect of the refutation of the first egalitarian argument on the success of the second one. In this work, I am rather concerned with articulating a novel.. (shrink)

The kinematical principle of Equal Passage Times (EPT) was introduced by Winnie in his 1970 derivation of the relativistic coordinate transformations compatible with arbitrary synchrony conventions in one-dimensional space. In this paper, the claim by Winnie and later Giannoni that EPT is a direct consequence of the relativity principle is questioned. It is shown that EPT, given Einstein's 1905 postulates, is equivalent to the relativistic (synchrony independent) clock retardation principle, and that for standard synchrony it reduces to (...) an isotropy condition for contraction (and dilation) effects. (shrink)

What kinds of principles of justice should a cosmopolitan support? In recent years some have argued that a cosmopolitan should endorse a Global Difference Principle. It has also been suggested that a cosmopolitan should support a Principle of Global Equality of Opportunity. In this paper I examine how compelling these two suggestions are. I argue against a Global Difference Principle, but for an alternative Needs-Based Minimum Floor Principle (where these are not co-extensive, as I explain). (...) Though I support a negative version of the Global Equality of Opportunity Principle, I argue that a more positive version of the ideal remains elusive. (shrink)

The question of whether or not either elderly people or those whose life expectancy is short have commensurately reduced claims on their fellows, have, in short, fewer or less powerful rights than others, is of vital importance but is one that has seldom been adequately examined. Despite ringing proclamations of justice and equality for all, the fact is that most societies discriminate between citizens on the basis both of age and life expectancy.

Democratic equality challenges both utilitarianism and classical liberal and libertarian thought which continues to exert a major influence in the politics of many capitalist countries. This chapter aims to clarify the content of, and motivation for, democratic equality. Section 1 begins with an outline of democratic equality. It introduces and clarifies, in a preliminary way, two key elements of democratic equality: the notion of fair equality of opportunity and the difference principle. Section 2 explains (...) why Rawls considers democratic equality a better account of what justice requires than rival accounts. Sections 3 and 4 briefly review some outstanding interpretative and normative issues within democratic equality. Section 4 also looks at the question of how far democratic equality can properly incorporate the just claims of sick and disabled people. Democratic equality incorporates a principle of productive reciprocity, however, this incorporation of productive reciprocity in democratic equality remains rather undeveloped. (shrink)

The question of whether or not either elderly people or those whose life expectancy is short have commensurately reduced claims on their fellows, have, in short, fewer or less powerful rights than others, is of vital importance but is one that has seldom been adequately examined. Despite ringing proclamations of justice and equality for all, the fact is that most societies discriminate between citizens on the basis both of age and life expectancy.

This article analyzes the change in interpretation of the principles of freedom and equality in liberal thought in Russian in the early twentieth century. From the classical negative understanding...

피터 싱어는 쾌고감수능력이 있는 동물들을 고통스럽도록 다루면서, 쾌고감수능력이 없는 가장자리 인간들의 생명을 그들이 단지 인간이라는 생물 종의 구성원이라는 이유 하나만으로 신성시하는 것은 종차별주의라고 비판했다. 그의 이런 비판의 배후에는 이익평등고려의 원칙에 대한 확고한 신념이 있다. 필자는 이 논문에서 이익평등고려의 원칙을 세가지 측면에서 비판하고 있다. 첫째로, 이익평등고려의 원칙은 우리의 직관적인 도덕적 진리와 상충한다. 둘째로, 그 원칙은 동물과 비교해서 인간의 이익을 평등하게 고려하지 못하고 있다. 셋째로 싱어는 이익평등고려의 원칙에 근거한 자신의 동물해방론이 인간의 지위를 낮추는 것이 아니라 동물의 지위를 높이는 것이라고 주장하는데, 이 역시 (...) 잘못이다. (shrink)

BackgroundIn precision medicine biomarkers stratify patients into groups that are offered different treatments, but this may conflict with the principle of equal treatment. While some patient characteristics are seen as relevant for unequal treatment and others not, it is known that they all may influence treatment decisions. How biomarkers influence these decisions is not known, nor is their ethical relevance well discussed.MethodsWe distributed an email survey designed to elicit treatment preferences from Norwegian doctors working with cancer patients. In a (...) forced-choice conjoint analysis pairs of hypothetical patients were presented, and we calculated the average marginal component effect of seven individual patient characteristics, to estimate how each of them influence doctors’ priority-setting decisions.ResultsA positive biomarker status increased the probability of being allocated the new drug, while older age, severe comorbidity and reduced physical function reduced the probability. Importantly, sex, education level and smoking status had no significant influence on the decision.ConclusionBiomarker status is perceived as relevant for priority setting decisions, alongside more well-known patient characteristics like age, physical function and comorbidity. Based on our results, we discuss a framework that can help clarify whether biomarker status should be seen as an ethically acceptable factor for providing unequal treatment to patients with the same disease. (shrink)

ABSTRACTIn The Netherlands, the public funding of a number of health care services is controversial. What can we learn from this about the moral concerns that underlie these judgements? And, if there is anything to learn, can we use this improved understanding to scrutinise the adequacy of particular decisions concerning the public funding of health care services? In the present paper, I will analyse three cases: corrective surgey, In Vitro Fertilisation and liver transplantation. I will summarise the arguments that have (...) been used to support or to challenge the public funding of these services. I will then assess the merits of Daniels’fair equality of opportunity account of justice in health care. Can this account improve our understanding of the moral concerns underlying our judgements about the public funding of these services? Can it serve to scrutinise the adequacy of particular decisions that are made concerning the public funding of health care services? My answer to both questions will be a qualified yes. Daniels’account can provide guidance, but not because we can deductively infer from it what is right and what is wrong. Instead, I will argue for a more casuistic use of the concept of fair equality of opportunity. (shrink)

Raanan Gillon is a noted defender of the four principles approach to healthcare ethics. His general position has always been that these principles are to be considered to be both universal and prima facie in nature. In recent work, however, he has made two claims that seem to present difficulties for this view. His first claim is that one of these four principles, respect for autonomy, has a special position in relation to the others: he holds that it is first (...) among equals. We argue that this claim makes little sense if the principles are to retain their prima facie nature. His second claim is that cultural variation can play an independent normative role in the construction of our moral judgments. This, he argues, enables us to occupy a middle ground between what he sees as the twin pitfalls of moral relativism and moral imperialism. We argue that there is no such middle ground, and while Gillon ultimately seems committed to relativism, it is some form of moral imperialism that will provide the only satisfactory construal of the four principles as prima facie universal moral principles. (shrink)

ABSTRACT In The Netherlands, the public funding of a number of health care services is controversial. What can we learn from this about the moral concerns that underlie these judgements? And, if there is anything to learn, can we use this improved understanding to scrutinise the adequacy of particular decisions concerning the public funding of health care services? In the present paper, I will analyse three cases: corrective surgey, In Vitro Fertilisation and liver transplantation. I will summarise the arguments that (...) have been used to support or to challenge the public funding of these services. I will then assess the merits of Daniels’fair equality of opportunity account of justice in health care. Can this account improve our understanding of the moral concerns underlying our judgements about the public funding of these services? Can it serve to scrutinise the adequacy of particular decisions that are made concerning the public funding of health care services? My answer to both questions will be a qualified yes. Daniels’account can provide guidance, but not because we can deductively infer from it what is right and what is wrong. Instead, I will argue for a more casuistic use of the concept of fair equality of opportunity. (shrink)