The available resources for global health assistance are far outstripped by need. In the face of such scarcity, many people endorse a principle according to which highest priority should be given to the worst off. However, in order for this prioritarian principle to be useful for allocation decisions, policy-makers need to know what it means to be badly off. In this article, we outline a conception of disadvantage suitable for identifying the worst off for the purpose of making health resource (...) allocation decisions. According to our total advantage view: the worst off are those who have the greatest total lifetime disadvantage; advantage foregone due to premature death should be treated in the same way as other ways of being disadvantaged at a time; how badly off someone is depends on the actual outcomes that will befall her without intervention, not her prospects at a time; and all significant forms of disadvantage count for determining who is worst off, not just disadvantage relating to health. We conclude by noting two important implications of the total advantage view: first, that those who die young are among the globally worst off, and second, that the epidemiological shift in the global burden of disease from communicable to non-communicable diseases should not lead to a corresponding shift in global health spending priorities. (shrink)

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)

I here settle a recent dispute between two rival theories in distributive ethics: Restricted Prioritarianism and the Competing Claims View. Both views mandate that the distribution of benefits and burdens between individuals should be justifiable to each affected party in a way that depends on the strength of each individual’s separately assessed claim to receive a benefit. However, they disagree about what elements constitute the strength of those individuals’ claims. According to restricted prioritarianism, the strength of a claim (...) is determined in ‘prioritarian’ fashion by both what she stands to gain and her absolute level of well-being, while, according to the competing claims view, the strength of a claim is also partly determined by her level of well-being relative to others with conflicting interests. I argue that, suitably modified, the competing claims view is more plausible than restricted prioritarianism. (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)

I discuss Ingmar Persson’s recent argument that the Levelling Down Objection could be worse for prioritarians than for egalitarians. Persson’s argument depends upon the claim that indifference to changes in the average prioritarian value of benefits implies indifference to changes in the overall prioritarian value of a state of affairs. As I show, however, sensible conceptions of prioritarianism have no such implication. Therefore prioritarians have nothing to fear from the Levelling Down Objection.

Prioritarianism holds that improvements in someone's life are morally more valuable, the worse off the person would otherwise be. The doctrine is impartial, holding that a gain in one person's life counts exactly the same as an identical gain in the life of anyone equally well off. If we have some duty of beneficence to make the world better, prioritarianism specifies the content of the duty. Unlike the utilitarian, the prioritarian holds that we should not only seek to (...) increase human well-being, but also distribute it fairly across persons, by tilting in favor of the worse off. A variant version adds that we should also give priority to the morally deserving – to saints over scoundrels. The view is a standard for right choice of individual actions and public policies, offering a distinctive alternative to utilitarianism, sufficiency and egalitarianism. (shrink)

Tännsjö’s book Setting Health-Care Priorities defends the view that there are three main normative theories in the domain of distributive justice, and that these theories are both highly plausible in themselves, and practically convergent in their normative conclusions. All three theories point to a somewhat radical departure from the present distribution of medical resources: in particular, they suggest redirecting resources from marginal life extension to the care of mentally ill patients. In this paper I wish to argue, firstly, that (...) class='Hi'>prioritarianism should not be considered as an amendment to utilitarianism, as it is in Tännsjö’s view, but as a distinctive fourth option. This can best be appreciated if we focus on a reading of the theory that emphasizes its derivation from egalitarianism and its attempt to develop an intermediate approach between utilitarian and egalitarian intuitions. Secondly, in response to Tännsjö’s central objection to prioritarianism, I will argue that the theory does not apply in intrapersonal cases but is only relevant for decisions regarding the interpersonal distribution of benefits. Finally, I will suggest that a practical convergence of the four theories on specific issues such as artificial reproduction or mood enhancement is far less likely than Tännsjö seems to believe. (shrink)

This paper shows that versions of prioritarianism that focus at least partially on well-being levels at certain times conflict with conventional views of prudential value and prudential rationality. So-called timeslice prioritarianism, and pluralist views that ascribe importance to timeslices, hold that a benefit matters more, the worse off the beneficiary is at the time of receiving it. We show that views that evaluate outcomes in accordance with this idea entail that an agent who delays gratification makes an outcome (...) worse, even if it is better for the agent and worse for no one else. We take this to show that timeslice prioritarianism and some pluralist views violate Weak Pareto, and we argue that these versions of prioritarianism are implausible. (shrink)

Prioritarianism is a moral view that ranks outcomes according to the sum of a strictly increasing and strictly concave transformation of individual well-being. Prioritarianism is ‘welfarist’ (namel...

Disease prioritarianism is a principle that is often implicitly or explicitly employed in the realm of healthcare prioritization. This principle states that the healthcare system ought to prioritize the treatment of disease before any other problem. This article argues that disease prioritarianism ought to be rejected. Instead, we should adopt ‘the problem-oriented heuristic’ when making prioritizations in the healthcare system. According to this idea, we ought to focus on specific problems and whether or not it is possible and (...) efficient to address them with medical means. This has radical implications for the extension of the healthcare system. First, getting rid of the binary disease/no-disease dichotomy implicit in disease prioritarianism would improve the ability of the healthcare system to address chronic conditions and disabilities that often defy easy classification. Second, the problem-oriented heuristic could empower medical practitioners to address social problems without the need to pathologize these conditions. Third, the problem-oriented heuristic clearly states that what we choose to treat is a normative consideration. Under this assumption, we can engage in a discussion on de-medicalization without distorting preconceptions. Fourth, this pragmatic and de-compartmentalizing approach should allow us to reconsider the term ‘efficiency’. (shrink)

The Interpersonal Addition Theorem, due to John Broome, states that, given certain seemingly innocuous assumptions, the overall utility of an uncertain prospect can be represented as the sum of its individual utilities. Given ‘Bernoulli's hypothesis’ according to which individual utility coincides with individual welfare, this result appears to be incompatible with the Priority View. On that view, due to Derek Parfit, the benefits to the worse off should count for more, in the overall evaluation, than the comparable benefits to the (...) better off. Pace Broome, the paper argues that prioritarians should meet this challenge not by denying Bernoulli's hypothesis, but by rejecting one of the basic assumptions behind the addition theorem: that a prospect is better overall if it is better for everyone. This conclusion follows if one interprets the priority weights that are imposed by prioritarians as relevant only to moral, but not to prudential, evaluations of prospects. (shrink)

This paper takes its departure from the Interpersonal Addition Theorem. The theorem, by John Broome, is a re-formulation of the classical result by Harsanyi. It implies that, given some seemingly mild assumptions, the overall utility of an uncertain prospect can be seen as the sum of its individual utilities. In sections 1 and 2, I discuss the theorem’s connection with utilitarianism and in particular the extent to which this theorem still leaves room for the Priority View. According to the latter, (...) the utilitarian approach needs to be modified: Benefits to the worse off should count for more, overall, than the comparable benefits to the better off.Broome and Jensen have argued that the Priority View cannot be seen as a plausible competitor to utilitarianism: Given the addition theorem, prioritarianism should be rejected for measurement-theoretical reasons. I suggest that this difficulty is spurious: The proponents of the Priority View would be well advised, on independent grounds, to reject one of the basic assumptions on which the addition theorem is based, the so-called Principle of Personal Good for uncertain prospects.According to the Principle of Personal Good, one prospect is better than another if it is better for everyone or at least better for some and worse for none. That the Priority View, as I read it, rejects this welfarist intuition may be surprising. Isn’t welfarism a common ground for prioritarians and utilitarians? Still, as I argue, this welfarist common ground is better captured by a restricted Principle of Personal Good that is valid for *outcomes*, but not necessarily for uncertain prospects. We obtain this surprising result if we take the priority weights imposed by prioritarians to be relevant only to *moral*, but not to *prudential*, evaluations of prospects. This makes it possible for a prospect to be morally better even though it is worse for everyone concerned. The proposed interpretation of the Priority View thus drives a sharp wedge between prudence and morality. (shrink)

A well-known objection to prioritarianism, famously levelled by Mike Otsuka and Alex Voorhoeve, is that it wrongly ignores the unity of the individual in treating intra-personal cases like inter-personal cases. In this paper we accept that there should be a moral shift between these cases, but argue that this is because autonomy is a relevant consideration in intra-personal but not inter-personal cases, and one to which pluralist prioritarians ought to attend. To avoid this response, Otsuka and Voorhoeve must assume (...) we know nothing about the subjective information of the person being chosen for. But we show that this commits them to two controversial assumptions: that welfare consists in an objective list of goods, and – if one accepts an unorthodox but plausible account of the relationship between risk aversion and rationality – that there is only a narrow range of rational risk aversions. Only prioritarians who accept both these assumptions are on the hook of Otsuka and Voorhoeve’s objection; for all others, the examples have insufficient information, and so lose their sting. (shrink)

Prioritarianism is an ethical theory that gives extra weight to the well-being of the worse off. In contrast, dominant policy-evaluation methodologies, such as benefit-cost analysis, cost-effectiveness analysis, and utilitarianism, ignore or downplay issues of fair distribution. Based on a research group founded by the editors, this important book is the first to show how prioritarianism can be used to assess governmental policies and evaluate societal conditions. This book uses prioritarianism as a methodology to evaluate governmental policy across (...) a variety of policy domains: taxation, health policy, risk regulation, education, climate policy, and the COVID-19 pandemic. It is also the first to demonstrate how prioritarianism improves on GDP as an indicator of a society's progress over time. Edited by two senior figures in the field with contributions from some of the world's leading economists, this volume bridges the gap from the theory of prioritarianism to its practical application. (shrink)

For a prioritarian by contrast to a utilitarian, whether a certain quantity of utility falls within the boundary of one person's life or another's makes the following moral difference: the worse the life of a person who could receive a given benefit, the stronger moral reason we have to confer this benefit on this person. It would seem, therefore, that prioritarianism succeeds, where utilitarianism fails, to ‘take seriously the distinction between persons’. Yet I show that, contrary to these appearances, (...) prioritarianism fails, in ways strikingly parallel to those in which utilitarianism fails, to take this distinction seriously. In so doing, I draw on and develop an earlier critique of prioritarianism by disentangling and pressing two distinct separateness-of-persons objections offered there. One objection is that prioritarianism is insensitive to ‘prudential justifications’. The other is that it is insensitive to the competing claims of different individuals. (shrink)

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

Prioritarianism is a variant of utilitarianism. It differs from utilitarianism in that benefiting individuals matters more the worse off these individuals are. On this view, there are two standard ways of handling risky prospects: Ex-Post Prioritarianism adjusts for prioritizing the worse off in final outcomes and then values prospects by the expectation of the sum total of those adjusted values, whereas Ex-Ante Prioritarianism adjusts for prioritizing the worse off on each individual's expectation and then values prospects by (...) the sum total of those adjusted expectations. A standard objection to Ex-Post Prioritarianism is that it violates Ex-Ante Pareto, that is, it prescribes choices that worsen the expectations for everyone. In this article, I argue that Ex-Ante Prioritarianism suffers from much the same problem: it violates a sequential version of Ex-Ante Pareto, that is, it prescribes sequences of choices that worsen the expectations for everyone. (shrink)

According to prioritarianism, roughly, it is better to benefit a person, the worse off she is. This seems a plausible principle as long as it is applied only to fixed populations. However, once this restriction is lifted, prioritarianism seems to imply that it is better cause a person to exist at a welfare level of l than to confer l units on a person who already exists and is at a positive welfare level. Thus, prioritarianism seems to (...) assign too much weight to the welfare of possible future people. It is in this respect even more demanding than total utilitarianism. However, in this article, I argue that all told, it is not clear that prioritarian- ism is less plausible than total utilitarianism, even when it comes to Population Ethics. (shrink)

Prioritarianism can usefully be seen as a corrective to both egalitarianism and utilitarianism. It allegedly corrects for egalitarianism insofar as it tends toward equality but seems immune to the Leveling Down Objection. It allegedly corrects for utilitarianism insofar as it emphasizes improving peoples' lives but is distribution-sensitive, favoring benefiting those who are worse off over those who are better off, other things equal. The best way to understand the view and assess its prospects is to see whether on closer (...) examination it can indeed avoid the pitfalls of the two more traditional views it might replace. What emerges from such a closer examination is that prioritarianism must be very carefully specified to avoid the Leveling Down Objection. More significantly, to clearly avoid problems associated with utilitarianism, prioritarianism must be formulated in deontic rather than telic terms. It is not clear, however, that such a deontic prioritarianism has any advantages over deontic egalitarianism. (shrink)

Philosophical discussions of prioritarianism, the view that we ought to give priority to those who are worse off, have hitherto been almost exclusively focused on cases involving a fixed population. The aim of this paper is to extend the discussion of prioritarianism to encompass also variable populations. I argue that prioritarianism, in its simplest formulation, is not tenable in this area. However, I also propose several revised formulations that, so I argue, show more promise.

In his restriction of prioritarianism to cases in which the same people would exist in all the possible outcomes, Parfit stakes out an unstable position, both for himself and more generally. There is no plausible rationale for a prioritarianism that is so restricted, which is consistent with the key features of Parfit’s elaboration and defence of this view and his other commitments. The principles that might be appealed to, in an attempt to justify such a restriction, give rise (...) to a different view—one that is sensitive to the presence or absence of the competing claims of different individuals, where both the existence and the magnitude of these claims are determined by gains and losses to individuals in a manner that is not fully captured by Parfit’s prioritarian weighting. (shrink)

I begin, in section 1, with a presentation of the Interpersonal Addition Theorem. The theorem, due to John Broome (1991), is a re-formulation of the classical result by Harsanyi (1955). It implies that, given some seemingly mild assumptions, the overall utility of an uncertain prospect can be seen as the sum of its individual utilities. In sections 1 and 2, I discuss the theorem's connection with utilitarianism and in particular consider its implications for the Priority View, according to which benefits (...) to the worse off count for more, in terms of overall utility, than comparable benefits to the better off (cf. Parfit 1995 [1991]). Broome (1991) and Klint Jensen (1996) have argued that, in view of the Interpersonal Addition Theorem, the Priority View should be rejected for measurement-theoretical reasons. Therefore, it cannot be seen as a plausible competitor to utilitarianism (cf. section 1). I will suggest, however, that a proponent of the Priority View would be well-advised, on independent grounds, to reject one of the basic assumptions on which the Addition Theorem is based. I have in mind the so-called Principle of Personal Good for uncertain prospects (cf. sections 4 and 5). If the theorem is disarmed in this way, then, as a side benefit, the Priority View will avoid the afore-mentioned problems with measurement. (shrink)

I have earlier argued that, like egalitarianism, prioritarianism is exposed to the levelling down objection—which I do not find serious—but also that it faces related, more serious objections that egalitarianism avoids. In this paper I reply to Thomas Porter’s attempt to rebut this argument. I also trace the more serious objections to prioritarianism to the fact that it implies the desirability of welfare diffusion, i.e. that it is better all things considered if a quantity of welfare is distributed (...) over as many recipients as possible, so that each recipient gets a minimal benefit, and that the outcome would still be in one respect better, even if the quantity of welfare was reduced. In contrast to egalitarianism, prioritarianism therefore implies that it is in one respect better if an equality, or a solitary individual, is located at lower rather than a higher level of welfare. (shrink)

A natural formalization of the priority view is presented which results from adding expected utility theory to the main ideas of the priority view. The result is ex post prioritarianism. But ex post prioritarianism entails that in a world containing just one person, it is sometimes better for that person to do what is strictly worse for herself. This claim may appear to be implausible. But the deepest objection to ex post prioritarianism has to do with meaning: (...) ex post prioritarianism is not a genuine alternative to utilitarianism in the first place. By contrast, ex ante prioritarianism is defensible. But its motivation is very different from the usual rationales offered for the priority view. Given their hostility to egalitarianism, most supporters of the priority view have not provided reasons to reject utilitarianism. (shrink)

Utilitarianism and prioritarianism make a strong assumption about the uniqueness of measures of how good things are for people, or for short, individual goodness measures. But it is far from obvious that the presupposition is correct. The usual response to this problem assumes that individual goodness measures are determined independently of our discourse about distributive theories. This article suggests reversing this response. What determines the set of individual goodness measures just is the body of platitudes we accept about distributive (...) theories. When prioritarianism is taken to have an ex ante form, this approach vindicates the utilitarian and prioritarian presupposition, and provides an answer to an argument due to Broome that for different reasons to do with measurement, prioritarianism is meaningless. (shrink)

In this paper we argue that the use of survey data or intuitions about single person cases as a dialectically neutral data point for favouring telic egalitarianism over prioritarianism has dim prospects for success. We take as a case study Otsuka and Voorhoeve (2009)'s now well known paper and show that it either is either argumentatively irrelevant or question-begging, depending on whether the survey data about people's judgements concerning single-person cases is interpreted as being prudential or moral in character. (...) We suggest that this problem is likely to generalise to other ways of trying to use intuitions or survey data about single-person cases, where those data or intuitions are not just treated as further direct moral intuitions about prioritarianism and telic egalitarianism. (shrink)

According to prioritarianism, an influential theory of distributive justice, we have a stronger reason to benefit people the worse off these people are. Many authors have adopted a consequentialist version of prioritarianism. On this account, we have a consequentialist reason to benefit the worse off because the state of affairs where the worse off gains a given amount of utility is more valuable than the state of affairs where the better off gains roughly the same amount of utility. (...) In this paper, we argue that the consequentialist approach to prioritarianism is problematic. However, it doesn't follow that the prioritarian doctrine per se is groundless. We then suggest that we can make sense of prioritarianism by appeal to a contractualist approach. (shrink)

Derek Parfit has argued that egalitarianism is exposed to a levelling down objection because it implies, implausibly, that a change, which consists only in the better-off sinking to the level of the worse-off, is in one respect better, though it is better for nobody. He claims that, in contrast, the prioritarian view that benefits to the worse-off have greater moral weight escapes this objection. This article contends, first, that prioritarianism is equally affected by the levelling down objection as is (...) egalitarianism, but that this objection lacks force. Secondly, prioritarianism is less plausible than egalitarianism because it implies that lowering the level of equality by diffusing a quantity of welfare equally over as many recipients as possible is for the better all things considered, and that the outcome of such welfare diffusion would still be better in one respect, even if the quantity of welfare was radically reduced. (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)

abstract Derek Parfit has argued that egalitarianism is exposed to a levelling down objection because it implies, implausibly, that a change, which consists only in the better‐off sinking to the level of the worse‐off, is in one respect better, though it is better for nobody. He claims that, in contrast, the prioritarian view that benefits to the worse‐off have greater moral weight escapes this objection. This article contends, first, that prioritarianism is equally affected by the levelling down objection as (...) is egalitarianism, but that this objection lacks force. Secondly, prioritarianism is less plausible than egalitarianism because it implies that lowering the level of equality by diffusing a quantity of welfare equally over as many recipients as possible is for the better all things considered, and that the outcome of such welfare diffusion would still be better in one respect, even if the quantity of welfare was radically reduced. (shrink)

I develop the recent claim that prioritarianism, and not only its egalitarian competitors, must be committed to an impersonal outcome value (i. e. a value that makes a distribution better even if this does not affect anyone’s welfare). This value, that I label telic priority and that consists in the goodness of benefits going to the worst off recipients, implies implausible judgments that more than compete with ‘pure’ (Parfit) egalitarianism’s applause in leveling down scenarios. ‘Pure prioritarianism’, an axiological (...) theory that would consist in an unqualified commitment to telic priority only, must therefore be developed into a pluralist version of the priority view. Contra Parfit, prioritarianism and egalitarianism are on a par concerning the relationship between their pure (and implausible) formulations and their pluralist (and plausible) versions. The final section explains why telic priority always assigns preference to the worst-off (and not merely to the worse-off). (shrink)

In her recent, provocative essay “What Is the Point of Equality?”, Elizabeth Anderson argues against a common ideal of egalitarian justice that she calls “ luck egalitarianism” and in favor of an approach she calls “democratic equality.”1 According to the luck egalitarian, the aim of justice as equality is to eliminate so far as is possible the impact on people’s lives of bad luck that falls on them through no fault or choice of their own. In the ideal luck egalitarian (...) society, there are no inequalities in people’s life prospects except those that arise through processes of voluntary choice or faulty conduct, for which the agents involved can reasonably be held responsible. Anderson asserts that the adherents of luck egalitarianism, which can be elaborated in many different ways, include John Roemer, Erik Rakowski, Thomas Nagel, Ronald Dworkin, Gerald Cohen, Richard Arneson, and Philippe Van Parijs.2 In contrast, according to the democratic equality conception, justice as equality requires an end to oppressive social relationships. In the ideal society of democratic equality, the social conditions of everyone’s freedom are secured, each stands to every other in a relationship of fundamental equality, including equal respect, and all have real freedom to participate in democratic self-government. (shrink)

In the present contribution I attempt to refute a recent challenge raised by Michael Otsuka against prioritarianism, according to which the priority view is objectionable since it rejects the moral permissibility of choosing in accordance with rational self-interest – understood as maximization of expected utility – in one-person cases involving other-regarding decision-making under risk. I claim that Otsuka’s argument is bound to make an illegitimate move, which is either to assume implausibly that individuals are generally risk-neutral or to assume (...) implausibly that the decision-maker in his cases can have accurate information on the attitudes towards risk held by the individual on behalf of whom the decision is taken. I argue, pace Otsuka, that acting in accordance with rational self-interest in cases characterized by these types of epistemic constraints requires that we adopt a view on other-regarding decision-making that takes into account general empirical facts about human nature and that prioritarianism does not conflict with this latter view. (shrink)

The article develops an internalist justification of welfare ethics based on empathy. It takes up Hume’s and Schopenhauer’s internalistic (but not consistently developed) justification approach via empathy, but tries to solve three of their problems: 1. the varying strength of empathy depending on the proximity to the object of empathy, 2. the unclear metaethical foundation, 3. the absence of a quantitative model of empathy strength. 1. As a solution to the first problem, the article proposes to limit the foundation of (...) welfare ethics to certain types of empathy. 2. In response to the second problem, an internalistic metaethical conception of the justification of moral principles is outlined, the result of which is: The moral value of the well-being of persons is identical to the expected extent of (positive and negative) empathy arising from this well-being. 3. The contribution to the solution of the third problem and focus of the article is an empirical model of the (subject’s) expected extent of empathy depending on (an object’s) well-being. According to this model, the extent of empathy is not proportional to the expected empathy, but follows a concave function and is therefore prioritarian. Accordingly, the article provides a sketch of an internalist justification of prioritarianism. (shrink)

In this paper, first the term 'prioritarianism' is defined, with some mathematical precision, on the basis of intuitive conceptions of prioritarianism, especially the idea that "benefiting people matters more the worse off these people are". (The prioritarian weighting function is monotonously ascending and concave, while its first derivation is smoothly descending and convex but positive throughout.) Furthermore, (moderate welfare) egalitarianism is characterized. In particular a new symmetry condition is defended, i.e. that egalitarianism evaluates upper and lower deviations from (...) the social middle symmetrically and equally negatively (as do e.g. variance and Gini). Finally, it is shown that this feature distinguishes egalitarianism also extensionally from prioritarianism. (shrink)

Two principles form the basis for much priority setting in health. According to the greater benefit principle, resources should be directed toward the intervention with the greater health benefit. According to the worse off principle, resources should be directed toward the intervention benefiting those initially worse off. Jointly, these principles accord with so-called prioritarianism. Crucial for its operationalisation is the specification of the worse off. In this paper, we examine how the worse off can be defined as those with (...) the fewer lifetime Quality-Adjusted Life Years (QALYs). We contrast this proposal with several alternative specifications. (shrink)

The priority view has become very popular in moral philosophy, but there is a serious question about how it should be formalized. The most natural formalization leads to ex post prioritarianism, which results from adding expected utility theory to the main ideas of the priority view. But ex post prioritarianism entails a claim which is too implausible for it to be a serious competitor to utilitarianism. In fact, ex post prioritarianism was probably never a genuine alternative to (...) utilitarianism in the first place. By contrast, ex ante prioritarianism is defensible. But its motivation is very different from the usual rationales offered for the priority view. Given the untenability of ex post prioritarianism, it is more natural for most friends of the priority view to revert to utilitarianism. (shrink)

Prioritarianism is the moral view that a fixed improvement in someone's well-being matters more the worse off they are. Its supporters argue that it best captures our intuitions about unequal distributions of well-being. I show that prioritarianism sometimes recommends acts that will make things more unequal while simultaneously lowering the total well-being and making things worse for everyone ex ante. Intuitively, there is little to recommend such acts and I take this to be a serious counterexample for (...) class='Hi'>prioritarianism. (shrink)

Does individual desert matter for distributive justice? Is it relevant, for purposes of justice, that the pattern of distribution of justice’s “currency” (be it well-being, resources, preference-satisfaction, capabilities, or something else) is aligned in one or another way with the pattern of individual desert? -/- This paper examines the nexus between desert and distributive justice through the lens of individual claims. The concept of claims (specifically “claims across outcomes”) is a fruitful way to flesh out the content of distributive justice (...) so as to be grounded in the separateness of persons. A claim is a relation between a person and a pair of outcomes. If someone is better off in one outcome than a second, she has a claim in favor of the first. If she is equally well off in the two outcomes, she has a null claim between the two. In turn, whether one outcome is more just than a second depends upon the pattern of claims between them. -/- In prior work, I have elaborated the concept of claims across outcomes, and have used it to provide a unified defense of the Pareto and Pigou-Dalton axioms. Adding some further, plausible, axioms, we arrive at prioritarianism. -/- Here, I consider the possibility of desert-modulated claims—whereby the strength of an individual’s claim between two outcomes is determined not only by her well-being levels in the two outcomes, and her well-being difference between them, but also by her desert. This generalization of the notion of claims suggests a new axiom of justice: Priority for the More Deserving, requiring that, as between two individuals at the same well-being level, a given increment in well-being be allocated to the more deserving one. -/- If individual desert is intrapersonally fixed, this new axiom, together with a desert-modulated version of the Pigou-Dalton principle, and the Pareto axioms, yields a desert-modulated prioritarian account of distributive justice. Trouble arises, however, if an individual’s desert level can be different in different outcomes. In this case of intrapersonally variable desert, Priority for the More Deserving can conflict with the Pareto axioms (both Pareto indifference and strong Pareto). -/- This conflict, I believe, is sufficient reason to abandon the proposal to make claim strength a function of individual desert on top of well-being levels and differences. If distributive justice is truly sensitive to each individual’s separate perspective—if the justice ranking of outcomes is built up from the totality of individual rankings—we should embrace the Pareto axioms as axioms of justice and reject Priority for the More Deserving. In short: desert-modulated prioritarianism is a nonstarter. Rawls was right to sever distributive justice from desert. (shrink)

Lifetime quality-adjusted life-year (QALY) prioritarianism has recently been defended as a reasonable specification of the prioritarian view that benefits to the worse off should be given priority in health-related priority setting. This paper argues against this view with reference to how it relies on implausible assumptions. By referring to lifetime QALY as the basis for judgments about who is worse off lifetime QALY prioritarianism relies on assumptions of strict additivity, atomism and intertemporal separability of sublifetime attributes. These assumptions (...) entail that a health state at some period in time contributes with the same amount to how well off someone is regardless of intrapersonal and interpersonal distributions of health states. The paper argues that this is implausible and that prioritarians should take both intrapersonal and interpersonal distributions of goods into account when they establish who is worse off. They should therefore not accept that lifetime QALY is a reasonable ground for ascribing priority and reject lifetime QALY prioritarianism. (shrink)

A simple hedonistic theory allowing for interpersonal comparisons of happiness is taken for granted in this article. The hedonistic theory is used to compare utilitarianism, urging us to maximize the sum total of happiness, with prioritarianism, urging us to maximize a sum total of weighed happiness. It is argued with reference to a few thought experiments that utilitarianism is, intuitively speaking, more plausible than prioritarianism. The problem with prioritarianism surfaces when prudence and morality come apart.

According to the Welfare Diffusion Objection, we should reject Prioritarianism because it implies the ‘desirability of welfare diffusion’: the claim that it can be better for there to be less total wellbeing spread thinly between a larger total number of people, rather than for there to be more total wellbeing, spread more generously between a smaller total number of people. I argue that while Prioritarianism does not directly imply the desirability of welfare diffusion, Prioritarians are nevertheless implicitly committed (...) to certain principles for comparing different-number populations which, together with the Prioritarian same-person axiology, imply the desirability of welfare diffusion. (shrink)

In his book Well-Being and Fair Distribution, Matthew Adler advances a sustained and comprehensive argument for a certain variety of prioritarianism. This essay provides a critical overview of the book. The main criticisms made are the following. First, the ‘intersection’ approach adopted by Adler, in order to allow incommensurability in well-being, may have problematic consequences. Second, that Adler’s preferred form of prioritarianism must be restricted to non-negative utilities may be a more serious limitation than he appreciates; and there (...) may be preferable forms which avoid this restriction. Third, Adler’s case against the Ex Ante Pigou Dalton principle might be bolstered by re-evaluating the force of ex ante claims. (shrink)

Many welfarists wish to assign to each possible state of the world a numerical value that measures something like its moral goodness. How are we to determine this quantity? This paper proposes a contractualist approach: a legitimate measure of moral goodness is one that could be justified to each member of the population in question. How do we justify a measure of moral goodness to each individual? Each individual recognises the measure of moral goodness must be a compromise between the (...) different levels of well-being within the population. Some compromises are more reasonable than others; and some are better justifiable to a given member of the population than others. Each member recognises that the social chooser's measure of moral goodness is going to have to deviate from the well-being function of at least some of the members of the population. But we can nonetheless justify it to each of them if it doesn't deviate more than is necessary, and if the deviations from each member are given equal weighting in whatever process we use to determine it. This paper proposes that we begin with a measure of the distance from a proposed compromise to an individual's level of well-being, and then say that the moral goodness is the candidate compromise that minimizes the sum of distances from it to the individuals' levels of well-being. I describe a range of such measures of distance and show that some give utilitarianism, others different versions of prioritarianism. (shrink)

The seminal contribution of Sen (1976) led to a new way to conceptualize and measure absolute poverty, by arguing for the need to ‘take note of the inequality among the poor’ (Sen 1976: 227). Since then, the ‘Inequality’ of poverty has become the third ‘I’ of poverty, which together with the ‘Incidence’ and the ‘Intensity’ of it constitute the dimensions deemed relevant for poverty evaluation. In this paper, we first argue that the interest in the third ‘I’ of poverty actually (...) originates from aprioritarian(Parfit 1995) rather than an egalitarian attitude. Further, we illustrate the inability of the three ‘I's to fully comprise the criteria for the assessment of poverty which are de facto adopted by existing poverty indices. Some of them resolve distributional conflicts by following leximin, hence assigning a pivotal role to the worst off. We question the desirability of leximin, and conclude that giving absolute priority to the worst off is plausible only in cases where the latter has been identified by an exogenous threshold demarcating a significant difference in human suffering. Finally, we explore to what extent prioritarianism and the sufficiency argument of Frankfurt (1987), Crisp (2003) and Casal (2007) can help conceptualize giving absolute priority to individuals or groups indentified by exogenous (poverty and ultra-poverty) thresholds. (shrink)

In this essay I argue that even though egalitarianism and prioritarianism are different theories of social welfare, they can use the same social welfare measures. I present six different arguments for this thesis. The first argument is that conceptual connections between egalitarianism and prioritarianism ensure that any measure that works for either theory works for both. The second argument is that conditions necessary and sufficient to identify egalitarian and prioritarian measures, respectively, are equivalent. The third argument is that (...) both egalitarianism and prioritarianism can use two standard measures, typically proposed for only one theory. The fourth to sixth arguments contend that four properties that have been proposed as distinctive of either egalitarian or prioritarian measures cannot distinguish between them. I conclude that any egalitarian measure is also a prioritarian measure, and vice versa. (shrink)

The transgenerational community is based on moral similarity between contemporary and future people, referring to an ongoing moral deliberation across generations. It justifies obligations of justice towards the not yet born. Prioritarianism gives extra weight to the wellbeing of the least advantaged. I argue that both sentiments are egalitarian, and ask whether there is any tension between them. If we assume economic growth, and/or technological improvements and/or inflation, then prioritarianism prima facie implies that we should prefer to spend (...) any dollar on today’s disadvantaged than on future generations, hence is in tension with the demands of the transgenerational community. Analyzing four ways of meeting this challenge, I argue that the two principles are not in tension. (shrink)