Prioritarianism pertains to the generic idea that it matters more to benefit people, the worse off they are, and while prioritarianism is not uncontroversial, it is considered a generally plausible and widely shared distributive principle often applied to healthcare prioritisation. In this paper, I identify social justice prioritarianism, severity prioritarianism and age-weighted prioritarianism as three different interpretations of the general prioritarian idea and discuss them in light of the effect of pandemic consequences on healthcare priority setting. On this analysis, the (...) paper arrives at the following three conclusions: that we have strong prioritarian reasons for special concern about the vulnerable and socially disadvantaged in reference to pandemic effects, that severity of illness is an important factor in identifying the worse off in priority setting but that this must not over-ride the special priority to the socially disadvantaged and that the maximisation rationale of the age-weighted view runs against the core prioritarian idea, and the age-weighted prioritarianism is thus unfitting as a prioritarian response to the COVID-19 case. (shrink)

Relational egalitarianism is a theory of justice according to which people must relate as equals. In this article, we develop relational sufficientarianism – a view of justice according to which people must relate as sufficients. We distinguish between three versions of this ideal, one that is incompatible with relational egalitarianism and two that are not. Building on this, we argue that relational theorists have good reason to support a pluralist view that is both egalitarian and sufficientarian.

According to luck egalitarianism, it is unjust if some are worse off than others through no fault or choice of their own. The most common criticism of luck egalitarianism is the ‘harshness objection’, which states that luck egalitarianism allows for too harsh consequences, as it fails to provide justification for why those responsible for their bad fate can be entitled to society's assistance. It has largely gone unnoticed that the harshness objection is open to a number of very different interpretations. (...) We present four different interpretations of the harshness objection in which the problem pertains to counterintuitive implications, badness of outcome, disproportionality, or inconsistency, respectively. We analyse and discuss appropriate luck egalitarian replies. Disentangling these different versions clarifies what is at the heart of this dispute and reveals the point of the harshness objection. We conclude that only the inconsistency version involves a durable problem for luck egalitarianism. (shrink)

In this paper, I ask what is wrong with sufficiency. I formulate a generic sufficiency principle in relation to which I discuss possible problems for sufficientarianism. I argue against the arbitrariness–concern, that sufficiency theory need only to identify a possible space for determining a plausible threshold, and I argue against the high–low threshold dilemma concern, that multiple-threshold views can solve this dilemma. I then distinguish between currency-pluralist and currency-monist multiple-threshold views and test them against two different versions of the widely (...) shared ‘ignorance of inequality objection’ to sufficientarianism—a benefit-driven and a burden-driven version. I argue that currency-pluralist sufficiency views are better capable of responding to the former than currency-monist views. However, I show that no existing sufficiency view can provide a plausible response to the burden-driven version. Hence, I conclude that the problem of unequal distribution of burdens above the thresholds represents an overlooked threat to the sufficiency view, in any version. (shrink)

Many policies hinge on determining whether someone’s situation is due to luck or choice. In political philosophy, this prevalence is mirrored by luck egalitarian theories. But overemphasizing the distinction between luck and choice will lead to tensions with the value of moral agency, on which the distinction is grounded. Here, we argue that the two most common contemporary critiques of luck egalitarianism, holding it to be harsh and disrespectful are best understood as illustrating exactly this tension. Elaborating on this conflict, (...) we argue that it should lead us to modify how luck and choice are used in theories of justice. (shrink)

Many policies hinge on determining whether someone’s situation is due to luck or choice. In political philosophy, this prevalence is mirrored by luck egalitarian theories. But overemphasizing the distinction between luck and choice will lead to tensions with the value of moral agency, on which the distinction is grounded. Here, we argue that the two most common contemporary critiques of luck egalitarianism, holding it to be harsh and disrespectful are best understood as illustrating exactly this tension. Elaborating on this conflict, (...) we argue that it should lead us to modify how luck and choice are used in theories of justice. (shrink)

This article identifies value‐satiability sufficientarianism as a distinctive version of the sufficiency view, which has been ignored in the literature on distributive justice. This is unfortunate because value‐satiability sufficientarianism is much better equipped than alternative sufficiency views to cope with the standard objections against sufficiency. Most often, sufficientarianism refers to satiability as a feature of moral principles and reasons. But value‐satiability sufficientarianism also invokes satiability in the space of value‐theory, as it determines the sufficiency threshold at the point where justice‐relevant (...) values have been completely fulfilled. The article gives examples of how this view is widely apparent in the literature, and it provides some reasons in its favour. It then presents the two standard objections against sufficientarianism – the threshold objection and the indifference objection – and argues that these critiques do not apply to value‐satiability sufficientarianism. The general argument of the article therefore proves sufficientarianism more difficult to refute than is commonly credited. (shrink)

This paper discusses limitarianism in light of three popular objections to the redistribution of extreme wealth: (i) that such redistribution legitimizes envy, which is a morally objectionable attitude; (ii) that it disincentivizes the wealthy to invest and work, leading to a diminished social product, and, thereby, making everyone worse-off; and (iii) that it undercuts the pursuit and achievement of human excellence by depriving successful people of resources through which they may otherwise excel. We argue that these objections fail to undermine (...) limitarianism. An elaborated defence against them, rather, reveals how the Standard Defence of limitarianism may be expanded and strengthened by relying explicitly on the importance of preventing a society of envy, avoiding harm to non-rich citizens, and ensuring that humans are given the opportunities to excel in ways that go beyond those that allow for the amassment of wealth. (shrink)

Age rationing is a central issue in the health care priority‐setting literature, but it has become ever more salient in the light of the Covid‐19 outbreak, where health authorities in several countries have given higher priority to younger over older patients. But how is age rationing different under outbreak circumstances than under normal circumstances, and what does this difference imply for ethical theories? This is the topic of this paper. The paper argues that outbreaks such as that of Covid‐19 involve (...) special circumstances that change how age should influence our prioritization decisions, and that while this shift in circumstances poses a problem for consequentialist views such as utilitarianism and age‐weighted consequentialism, contractualism is better equipped to cope with it. The paper then offers a contractualist prudential account of age rationing under outbreak circumstances. (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)

In recent works, Shlomi Segall suggests and defends a luck egalitarian approach to justice in health. Concurring with G. A. Cohen’s mature position he defends the idea that people should be compensated for “brute luck”, i.e. the outcome of actions that it would be unreasonable to expect them to avoid. In his defense of the luck egalitarian approach he seeks to rebut the criticism raised by Norman Daniels that luck egalitarianism is in some way too narrow and in another too (...) wide to uphold justice in health and health care distribution. He points out that a pluralistic outline of luck egalitarianism taking into account the moral requirement of meeting everyone’s basic needs can avoid this line of criticism. In this article I argue against the application of such pluralistic luck egalitarianism in matters of health distribution. First of all, Segall has not shown that luck egalitarianism handles well health distributions above a threshold of basic needs. Secondly, his way of avoiding Elizabeth Anderson’s abandonment objection is theoretically problematic. Finally, I argue that luck egalitarianism in general fails to acknowledge the moral foundation of health and health care as a basic human entitlement. Thus I conclude that luck egalitarianism fails to take health needs seriously and that it cannot therefore uphold justice in health. (shrink)

Setting out to defend luck egalitarianism in matters of justice in health, Shlomi Segall outlines a pluralistic version of the luck egalitarian framework allowing egalitarian justice to be traded-off against other moral requirements. The suggested pluralism enables luck egalitarian justice to coexist with a concern for meeting everyone’s basic needs thereby avoiding Elizabeth Anderson’s ‘abandonment objection’. In this article, however, we present three objections to Segall’s luck egalitarian justice in health. Firstly, the account is vulnerable to the common objection that (...) luck egalitarianism becomes too expansive, and that Segall’s defence against this is inadequate. Secondly, Segall’s pluralist attempt to balance luck egalitarian justice and other moral requirements ends up compromising its own ideal of justice. Due to the fact that resource scarcity is the reality of health and health care distribution, this problem would often arise in actual health policy. Finally, the account has a way of intensifying blameworthy behaviour which seems contrary to luck egalitarian principles. Based on these three objections, we conclude that Segall’s luck egalitarian account of justice in health must either be rejected or qualified further. (shrink)

Torbjörn Tännsjö has written a clear and thought-provoking book on healthcare priority setting. He argues that different branches of ethical theory—utilitarianism, egalitarianism, and prioritarianism—are in general agreement on real-world healthcare priorities, and that it is human irrationality that stands in the way of complying with their recommendations. While I am generally sympathetic to the overall project and line of argumentation taken by the book, this paper raises two concerns with Tännsjö’s argument. First, that he is wrong to set aside deontic (...) constraints as irrelevant or as pointing in the same direction as consequentialism. Secondly, that his argument against prioritarianism in favor of utilitarianism is insufficient and under-developed. Given these problems, I conclude that we should welcome Tännsjö’s contribution but with these qualifications in mind. (shrink)

A comprehensive understanding of the ethics of the COVID-19 pandemic priorities must be sensitive to the influence of social inequality. We distinguish between ex-ante and ex-post relevance of social inequality for COVID-19 disadvantage. Ex-ante relevance refers to the distribution of risks of exposure. Ex-post relevance refers to the effect of inequality on how patients respond to infection. In the case of COVID-19, both ex-ante and ex-post effects suggest a distribution which is sensitive to the prevalence social inequality. On this basis, (...) we provide a generic fairness argument for the claim that welfare states ought to favour a healthcare priority scheme that gives particular weight to protecting the socially disadvantaged. (shrink)

It is generally accepted that morally justified healthcare rationing must be non-discriminatory and cost-effective. However, given conventional concepts of cost-effectiveness, resources spent on disabled people are spent less cost-effectively, ceteris paribus, than resources spent on non-disabled people. Thus, it is reasonable to assume that standard cost-effectiveness discriminates against the disabled. Call this thedisability discrimination problem.Part of the disability discrimination involved in cost-effectiveness stems from the way in which health-related quality of life is accounted for and measured. This paper offers and (...) defends a patient-sensitive account of health-related quality of life, which can effectively make cost-effectiveness less discriminatory against the disabled and thus more morally justified. (shrink)

This paper explores the role individual responsibility plays in contemporary political theory. It argues that the standard luck egalitarian view—the view according to which distributive justice is ensured by holding people accountable for their exercise of responsibility in the distribution of benefits and burdens—obscures the more fundamental value of being responsible. The paper, then, introduces an account of ‘self-creative responsibility’ as an alternative to the standard view and shows how central elements on which this account is founded has been prominently (...) defended in the history of Western political thought but are comparatively neglected in contemporary political theory. Relying on this account, the paper argues that society should hold persons responsible when, and only when, doing so enables them to lead responsible lives, and only on the condition that doing so does not infringe other persons’ equivalently valuable ability to lead responsible lives. The account of self-creative responsibility, the paper concludes, plausibly captures the intuitive attraction of holding responsible while respecting the value of being responsible. (shrink)

Much research has studied the importance of play for children’s development. However, questions of its political importance and our public institutions’ duties to protect it have been largely neglected. This article argues that childhood play is politically important due to having both intrinsic and instrumental value, and it suggests that the duty to protect the capability for play in childhood falls especially on the public health system. If this argument succeeds, it follows that we have stronger duties toward our children (...) than we currently believe. (shrink)

The capability approach, originated by Amartya Sen is among the most comprehensive and influential accounts of justice that applies to issues of health and health care. However, although health is always presumed as an important capability in Sen’s works, he never manages to fully explain why health is distinctively valuable. This paper provides an explanation. It does this by firstly laying out the general capability-based argument for health justice. It then discusses two recent attempts to justify why health is distinctively (...) valuable from within a capability framework – these are Sridhar Venkatapuram’s conception of health as the central human meta-capability and, respectively, Norman Daniels’ embrace of the capability metric in his use of Rawls’ principle of fair equality of opportunity. The paper argues that none of these accounts succeed in providing a plausible justification of the value of health. Finally, the paper suggests an alternative more complex justification, closely tied to different but central element of the capability view, that captures the core intuitions of both Venkatapuram and Daniels’ accounts but without being vulnerable to the objections raised against each of them. This, the paper concludes, provides a promising ground on which the capability view on health justice should be founded. (shrink)

Many consider play a natural part of childhood, and although there is disagreement in the literature on what essentially defines “play” in childhood, philosophical theories of play tend to support this initial consideration. But is childhood play also something we owe each other within a framework of educational justice? This is a question yet to be addressed. In this paper, I answer this question affirmatively. I take off from a generic account of educational justice and argue that childhood play should (...) be considered a central entitlement of this account. I then argue in line with the capability approach that if we ought to protect childhood play, it should be children’s capability for play rather than the functioning of play that needs protection. I end by offering an account of the capability for childhood play. (shrink)

Name der Zeitschrift: Jahrgang: 13 Heft: 2 Seiten: 190-206.

This article claims that the protection of children’s capability for play is a central social-political goal. It provides the following three-premise argument in defense of this claim: we have strong and wide-ranging normative reasons to be concerned with clusters of social deficiency; particular fertile functionings play a key role for tackling clusters of social deficiency; and finally the capability for childhood play is a crucial, ontogenetic prerequisite for the development of those particular fertile functionings. Thus, in so far as we (...) consider it a central political goal to tackle social deficiency, we should be concerned with protection of childhood play capability. This conclusion raises new insights on the importance – for global development policy as well as for welfare states’ aim to secure social justice – of protecting children’s capability to engage in playful activities. (shrink)

Ageism is the view that it is of greater moral value to allocate health care resources to younger people than to older people. In medical ethics, it is well-known that standard interpretations of distributive principles such as utilitarianism and egalitarianism imply some form of ageism. At times, ethicists argue as if practical complications are the only or main reason for not abiding to ageism. In this article, we argue that inferences to ageism from such distributive principles tend to commit what (...) we call the anticipation-blindness fallacy: A much too narrow focus on life quality benefits of health care treatments inclines us to overlook the importance of life quality benefits of health care safety, that is the mere trust in and expectation of being treated and cared for as one grows old. This is a key omission because health safety has value for a much larger population and for much longer time. Taking health safety into account therefore has important implications as for how ageist we ought to be. (shrink)

This paper argues in defence of sufficientarianism that there is a general flaw in the most common critiques against it. The paper lays out sufficientarianism and presents the problems of indifference, of outweighing priority, and of discontinuity. Behind these problems is a more general objection to the abruptness of the sufficiency threshold relying upon an assumption regarding arithmeticism about value. The paper argues that sufficientarians need not accept arithmeticism about value and that the commonly held critiques of sufficientarianism are in (...) fact instances of the numbers fallacy pertaining to the construction of numerical counterexamples that gain intuitive traction from ‘empty numbers’ – numbers without meaningful content in reference to the view under investigation. The paper concludes that we should remain sceptical about such use of numerical counterexamples, and while this does not by itself prove sufficientarianism correct, it is an important and novel contribution to its justification. (shrink)

The work of prominent analytical Marxist G. A. Cohen provides a vision of socialism which has distributive justice and community at its core. While Cohen's view of distributive justice has been hugely influential, much less has been said about community. This article argues that community plays three distinct roles in Cohen's socialism. One is as an independent value, the second is as a necessary adjacent counterpart to justice, which serves both to restrict and facilitate distributive equality, and the third is (...) as a critique of the liberal contractualist view of humanity. We argue that each of these are distinct and valuable elements in Cohen's thought, each of which must be recognized to understand the range and implications of Cohen's socialism. (shrink)

Since his contribution to the field of personal identity in 1738 Hume’s theory has been debated thoroughly. Throughout the years there have been multiple critiques of Hume’s theory, but despite the fact that all of these generally appear unsatisfactory, Hume’s theory of personal identity is far from being a popular one in the field. I believe the blame partly falls on Hume himself. Hume’s appendix to Treaties is most often read as expressing a deep concern regarding his own theory, and (...) this concern, I believe, is to blame for his theory never gaining the respect it deserves. After all, why should we listen to Hume if he himself found his theory lacking? It is, however, a mistake to judge Hume’s theory of personal identity, based on the appendix to Treaties. The appendix is far too ambiguity for any real conclusion and it offers nothing that cannot be found in the original chapter on personal identity from Treaties. (shrink)