Political egalitarians hold that there is a distinct ideal of political equality, which defines and justifies democracy. So what is political equality? The orthodox view says it is equality of opportunity for political influence, not equality of political influence. The first goal of this article is to argue against this view about the nature of political equality. From 1962 to 1983, Australia’s First Nations citizens had the right to vote, but unlike other citizens they did not have the duty to (...) vote. First Nations citizens were made politically unequal without being given any less opportunity for influence; the most plausible explanation for why they were made politically unequal is instead that they were made to exert less influence. The second goal is to use this challenge to illuminate the point of political equality. The orthodox view is typically undergirded by taking political equality to be concerned with some cosmic injustice that inheres in states of affairs, depending on the distribution of power. This is doubly mistaken. The point of political equality is deontic, not telic; and what it prescribes is not distributive, but relational. More specifically, the point of political equality is for the state to treat each citizen as an equal coauthor of the law. The overarching goal is to catalyze a more vigorous debate about political equality, akin to the long-standing debates about other dimensions of equality. (shrink)

Relational egalitarians sometimes argue that a degree of distributive equality is necessary for social equality to obtain among members of society. In this paper, we consider how such arguments fare when extended to the intergenerational case. In particular, we examine whether relational reasons for distributive equality apply between non-overlapping generations. We claim that they do not. We begin by arguing that the most common reasons relational egalitarians offer in favour of distributive equality between contemporaries do not give us reasons to (...) object to distributive inequality between non-overlapping generations. This argument by itself however will not fully suffice to show that there are no relational reasons to care about intergenerational distributive equality, given the nature of relational equality and its requirements in the intergenerational case are likely to be qualitatively different than in the contemporary case. Therefore, we also make the positive argument that for the intergenerational case to satisfy the requirements demanded by the ideal of relational equality it suffices that future persons’ interests are meaningfully incorporated and protected in the decision-making of preceding generations, and there is no basis for a concern with distributive equality. While some have argued that the one-way and asymmetrical causal influence between non-overlapping generations means concerns of social equality are inapplicable in the intergenerational case, we argue that the ongoing nature of this influence makes concerns of social equality appropriate. If successful, the upshot of the argument is that it can be coherent to maintain a commitment to relational equality between non-overlapping generations, all while remaining agnostic about distributive equality between them. (shrink)

The liberal-egalitarian concept formulated by John Rawls in his book A Theory of Justice is still vehemently debated today. Critics of this concept include, among others, Rodion Belkovich and Sergei Vinogradov, according to whom Rawlsians inevitably face a dilemma: they need to reject either the difference principle or luck egalitarianism, and each of these solutions leads to the erosion of the basic foundations of Rawls’s theory. The article presents a detailed analysis of the arguments put forward by Belkovich and Vinogradov (...) and demonstrates that the dilemma they identified is flawed for three reasons. First, it blurs the distinction between luck egalitarianism and “straight egalitarianism,” which assumes the complete equality of income and wealth in society. Luck egalitarians do not support the idea of absolute equality in distribution and consider inequality that reflects people’s responsibility for their own choices fair. Second, Rawlsian egalitarianism is essentially equated with luck egalitarianism, while they represent two clearly distinguishable approaches. Third, the kidnapper’s argument, which proves that the difference principle is incompatible with luck egalitarianism, does not provide solid reasoning against the difference principle. The argument is only applicable under limited conditions, when the difference principle is embedded as an assumption in the “argument from incentives,” which in turn is put forward by the potential beneficiaries of this incentive. According to the author’s conclusion, the above mentioned considerations clearly indicate that Rawlsians do not face any dilemma of choosing between luck egalitarianism and the difference principle, and the criticism of Rawls’s theory proposed by Belkovich and Vinogradov should be considered groundless. (shrink)

One prominent criticism of luck egalitarianism is that it requires either shameful revelations or otherwise problematic declarations by the state toward those who have had bad brute luck. Relational egalitarianism, by contrast, is portrayed as an alternative that requires no such revelations or declarations. I argue that this is false. Relational equality requires the state to draft anti-discrimination laws for both state and private action. The ideal of relational egalitarianism requires these laws to be asymmetric, that is to allow affirmative (...) action for disadvantaged groups while prohibiting affirmative action for advantaged groups. Hence, the state needs to make a public declaration on which groups are privileged and which are underprivileged; and individuals need to reveal whether they belong to groups officially declared underprivileged. These declarations are no more problematic in this case than in the case of luck egalitarianism. (shrink)

According to relational egalitarianism, justice requires equal relations. In this paper, I ask the question: can equal relations be unjust according to relational egalitarianism? I argue that while on some conceptions of relational egalitarianism, equal relations cannot be unjust, there are conceptions in which equal relations can be unjust. Surprisingly, whether equal relations can be unjust cuts across the distinction between responsibility-sensitive and non-responsibility-sensitive conceptions of relational egalitarianism. I then show what follows if one accepts a conception in which equal (...) relations can be unjust, including why it provides a reason to grant some people less political power than others. (shrink)

I argue that Harry Frankfurt’s doctrine of sufficiency, properly understood, presents a plausible alternative to egalitarianism. My position may be more general than Frankfurt’s, insofar as he limits himself to economic sufficiency; on my view, insufficiency is a generic reason for the rejection of principles governing permissible behavior. By situating sufficiency within a contractualist framework of moral permissibility, I provide an alternative to common (and, I think, mistaken) characterizations of the doctrine of sufficiency as either subordinate to equality or primarily (...) concerned with maximizing cases of sufficiency. (shrink)

Relational egalitarians claim that a situation is just only if everyone it involves relates to one another as equals. It implies that relational egalitarians believe the ideal of “living as equals” (for short) is desirable, and furthermore, necessary for justice. In this paper, I distinguish three accounts of the desirability of the ideal: the instrumental value account, the non‐instrumental value account, and the non‐consequentialist account. I argue that the former two accounts cannot provide satisfying reasons for being a relational egalitarian. (...) Instead, the ideal of “living as equals” ought to be understood as fundamentally a moral requirement in a non‐consequentialist sense. In addition, a pluralist (though fundamentally non‐consequentialist) approach is welcome. (shrink)

This article explains how social norms can help to distinguish and understand a range of different kinds of social inequality and social hierarchy. My aim is to show how the literature on social norms can provide crucial resources to relational egalitarianism, which has made social equality and inequality into a central topic of contemporary normative political theorizing. The hope is that a more discriminating and detailed picture of different kinds of social inequality will help relational egalitarians move beyond a discussion (...) of the justice or injustice of social equality as a single general category. (shrink)

The concept of service found in Christian theism and related religious perspectives offers robust support for a political defense of nonhuman animal rights, both in the eschaton and in the present state. By adapting the political theory defended by Donaldson and Kymlicka to contemporary theological models of the afterlife and of human agency, I defend a picture of heaven as a harmoniously structured society where humans are the functional leaders of a multifaceted, interspecies citizenry. Consequently, orthodox religious believers (concerned with (...) promoting God’s will “on Earth as it is in Heaven”) have a duty to promote and protect the interests of nonhuman creatures in the present, premortem state. (shrink)

Equality is typically presumed to be an end of justice; however, in this chapter, we argue that it is better understood as a condition of justice. Our argument draws on the Just World Fallacy, the phenomenon of people mistakenly believing fortuitous patterns of reward or harm to be reflective of justice. This phenomenon can undermine relationships of equality even where differences in reward or harm are ostensibly deserved. If everyone received equal pay, then the propensity for people to defer to (...) the more successful or derogate the less successful would be diminished, and thus there would be greater scope for people to enter into the sorts of relationships of equal respect and regard that just communities require. (shrink)

In the past few decades, there has been a growing literature on relational egalitarianism. Relational egalitarianism is a view on the nature and value of equality. In contrast to the dominant view in recent debates on equality—distributive egalitarianism, on which equality is about ensuring people have or fare the same in some respect—on the relational view, equality is a matter of the terms on which relationships are structured. But what exactly does it mean for people to relate as equals? And (...) why are relations of equality valuable? Relational egalitarians have offered quite different answers to each of these questions. In this article, I draw attention to some key issues that underlie these disagree- ments, and I offer a taxonomy of different viewpoints that have emerged in the recent literature on these matters. (shrink)

This article reconsiders the reciprocity objection to unconditional basic income based on the idea that reciprocity is not only a duty but a limiting condition on other duties. If the objection wer...

This dissertation fits within the literature on subordinating speech and aims to demonstrate that how language subordinates is more complex than has been described by most philosophers. I argue that the harms that subordinating speech inflicts on its targets (chapter one), the type of authority that is exercised by subordinating speakers (chapters two and three), and the expansive variety of subordinating speech acts themselves (chapter three) are all under-developed subjects in need of further refinement—and, in some cases, large paradigm shifts. (...) I also examine cases that have yet to be adequately addressed by philosophers working on this topic, like the explosion of abusive speech online (chapter four) or the distinctive speech acts of protest groups (chapter five). I argue that by considering these alongside the ‘paradigm’ cases of subordinating speech that inform most models, we are better able to capture the lived realities of this phenomena, as described by members of groups targeted by such speech. I develop a novel account of speaker authority to explain the variety of pragmatic effects subordinating speech generates. Instead of seeing this authority as reducible to either a formal position or a merely local, linguistic phenomenon, I argue for a conception of speaker authority that is a richly contextual social fact, distributed unevenly among members of different social groups. I also develop an account of collective authority that explains how a group of speakers can join together to subordinate in a way that no individual speaker is capable of doing. This account, I argue, is better able to explain the social reality of subordinating speech than individualist models. Overall, I show how a more fine-grained account of subordinating speaker authority gives us a more accurate picture of the different subordinating speech acts available to different speakers, along with how these may harm their targets. (shrink)

This paper mounts a partial defense of the basic structure objection to the egalitarian criticism of productive incentives. The defense is based on the claim that some duties of justice are subject to a reciprocity condition. The paper develops this position via an examination of the debate between Andrew Williams and G. A. Cohen on publicity and incentives. Reciprocity is an intrinsic feature of a relational conception of social justice, not simply a requirement of stability. Not all duties are conditional (...) on reciprocity because some duties are owed to third parties, as well as to their primary targets. Some forms of exploitation may be unconditionally wrong, but not the specific kind of exploitation at stake when talented individuals accept market wages. (shrink)

Given the inevitability of scarcity, should public institutions ration healthcare resources so as to prioritize those who contribute more to society? Intuitively, we may feel that this would be somehow inegalitarian. I argue that the egalitarian objection to prioritizing treatment on the basis of patients’ usefulness to others is best thought of as semiotic: i.e. as having to do with what this practice would mean, convey, or express about a person's standing. I explore the implications of this conclusion when taken (...) in conjunction with the observation that semiotic objections are generally flimsy, failing to identify anything wrong with a practice as such and having limited capacity to generalize beyond particular contexts. (shrink)

There is a deep divide amongst political philosophers of an egalitarian stripe. On the one hand, there are so-called distributive egalitarians, who hold that equality obtains within a political community when each of its members enjoys an equal share of the community’s resources. On the other hand, there are so-called social egalitarians, who instead hold that equality obtains within a political community when each of its members stands in certain relations to other members of the community, such non-domination and lack (...) of oppression, for example. In this paper, we have three aims. Our first aim is to cast doubt on the helpfulness of characterizing the debate in this way. Our second aim is to reconstruct this debate in alternative and more precise terms, so that disagreements between advocates of either side are easier to evaluate. Our third aim is to advance a hybrid account that integrates element from both views. (shrink)

This paper critically examines Richard Rorty’s “justice as larger loyalty” proposal. While Rorty is right, I argue, to reject the Kantian idea of a strict bifurcation between justice and loyalty, the former corresponding to reason the latter corresponding to sentiment, my argument is that it is nevertheless a mistake to follow Rorty in conceiving of justice as he recommends we should. This is not an endorsement of the rationalistic Kantian view Rorty rejects. Rather, I argue that there are compelling Rortyan (...) reasons for rejecting the “justice as larger loyalty” proposal, and that the argument against that proposal is paradoxically very much in the spirit of Rorty’s moral and political thought. (shrink)

In recent years, a distinction between two concepts of equality has been much discussed: 'distributive’ equality involves people having equal amounts of a good such as welfare or resources, and ‘social’ or ‘relational’ equality involves the absence of social hierarchy and the presence of equal social relations. This contrast is commonly thought to have important implications for our understanding of the relationship between equality and justice. But the nature and significance of the distinction is far from clear. I examine several (...) accounts of this issue and argue none are entirely satisfactory. In turn, I offer an alternative proposal. Relational equality, on my account, involves a concern with each person having an equal 'civic status'. I characterize this concern and show it has distinctive and normatively significant positional and temporal aspects. (shrink)

This essay provide an overview of debates about the method of political philosophy that have recently gripped the field, focusing on the relationship of theory to practice. These debates can be usefully organized using two oppositions that together carve the field into three broad families of views. Call “practicalism” the view that the theory of justice exists to guide political action. Call “utopianism” the view that reflection on the idea of a just society plays an important role in the theory (...) of justice. Call the view that combines the two positions, “utopian practicalism”. On this view, reflection on the nature of a just society has an important role to play in guiding action. There would appear to be two ways to depart from this position: by rejecting the view's utopianism or its practicalism. So we find in the literature three broad camps: utopian practicalists, anti‐utopians, and anti‐practicalists. This essay provide an opinionated overview the ongoing debates between these three broad positions. It touches on the recent cases against practicalism by G.A. Cohen and David Estlund, the comparativist methodologies advocated by anti‐utopians such as Amartya Sen and Gerry Gaus, and systems failure approaches of Elizabeth Anderson and David Wiens. It also considers the recent development of novel utopian practicalist perspectives in the work of theorists including Erik Wright, Tommie Shelby, Lea Ypi, Pablo Gilabert, and Ben Laurence. (shrink)

This paper considers the potentially wrongful discriminatory nature of certain of our dating preferences. It argues that the wrongfulness of such preferences lies primarily in the simple lookism they involve. While it is ultimately permissible for us to date people partly because of how they look, I argue that we have a duty to ‘look behind’ people’s appearance, which I take to mean that we ought not, on the basis of their appearance, to regard them as absolutely out of the (...) question for us to engage with in a romantic setting. Further, constraints similar to those suggested by a duty to look behind people’s appearance gain support from another duty we have, namely, a duty to counteract, also in our daily lives, the fact that people are undeservedly disadvantaged in various ways. (shrink)

This paper identifies a challenge for liberal relational egalitarians—namely, how to respond to the prospect of emergent inequalities of power, status, and influence arising unintentionally through the free exercise of fundamental individual liberties over time. I argue that these emergent social inequalities can be produced through patterns of nonmalicious choices, that they can in fact impede the full realization of relational equality, and that it is possible they cannot be eliminated entirely without abandoning fundamental liberal commitments to leave individuals substantial (...) discretion in their personal lives. In such cases, I argue that liberal egalitarians should accept fair relational equality—a demanding but nevertheless imperfect form of relational equality. (shrink)

This chapter explores the relational critique of distributive conceptions of justice, according to which the proper focus of egalitarian justice is the egalitarian nature of social relations rather than the equal distribution of certain goods. It maintains that the relational critique constitutes a fundamental challenge to distributive egalitarianism only if it rejects the “core distributive thesis” that holds that the distribution of some nonrelational goods has relation-independent significance for justice. It argues that several relational proposals are compatible with that thesis, (...) and therefore constitute extensions or revisions of the distributive conception rather than alternatives to it, and that those relational views that reject the core distributive thesis are the least plausible ones. Finally, the chapter shows that relational views are often ambiguous regarding the nature of the significance of egalitarian relations, i.e. whether it consists in their contribution to well-being, or in being the fitting response to equal moral status. (shrink)

The article assesses recent attempts to deflect two persistent objections to Positive Egalitarianism (PE), the view that equality adds to the goodness of a state of affairs. The first says that PE entails bringing into existence individuals who are equal to each other in leading horrible lives, such that they are worthnotliving. I assess three strategies for deflecting this objection: offering a restricted version of PE; biting the bullet; and pressing alevelling outcounter-objection. The second objection points out that for any (...) world A containing many individuals all leading very satisfying lives, and in perfect equality, PE prefers a much larger, perfectly equal population Z with much lower (yet positive) well-being. I review two main strategies for avoiding this Repellent Conclusion: a Capped Model and making egalitarianism sensitive to welfare levels. Both solutions, I show, are worse than the problems they are meant to solve. (shrink)

In this article I defend the capability approach by focusing on its built-in gender-sensitivity and on its concern with comprehensive outcomes and informationally-rich evaluation of well-being, two elements of Sen's work that are too rarely put together. I then try to show what the capability approach would have to gain by focusing on trans-positional objectivity (as Elizabeth Anderson does) and by leaving behind the narrow confines of states in favor of a more cosmopolitan stance. These preliminary discussions are followed by (...) two more precise applications. At first, I show how a gender-sensitive capability approach that respects the criteria of trans-positional objectivity and cosmopolitanism can enhance the agency of women inhabiting third-world societies. I turn next to show how mainstream feminism can insulate itself against criticisms such as bell hooks' by switching to trans-positional objectivity in public reasoning. (shrink)

Margaret Kohn argues for a reappraisal of early twentieth-century left-republican French political theory, known as ‘solidarism’. Solidarism recognises private property as legitimate, but at the same time argues that the collective nature of economic production gives rise to a claim to social property. It is social property that should underlie the case for social justice and social rights, not the standard liberal claims to individual autonomy. This paper provides an appraisal of Kohn’s recovery of solidarism, taking as its main theme (...) the relation between property and social justice. The paper first offers a typology of four theories of justice (right- and left-libertarianism, luck and relational egalitarianism) and discusses the relation of each of these to the concept of property. Then it argues that solidarism is akin to left-libertarianism in the way it formulates justice as a claim to social property. Finally, it argues that solidarists cannot escape grounding their theory in a non-property based fundamental principle, which makes the theory much less distinctive from egalitarian theories of justice than may appear at first sight. (shrink)

According to luck egalitarianism, it is not unfair when people are disadvantaged by choices they are responsible for. This implies that those who are disadvantaged by choices that prevent disadvantage to others are not eligible for compensation. This is counterintuitive. We argue that the problem such cases pose for luck egalitarianism reveals an important distinction between responsibility for creating disadvantage and responsibility for distributing disadvantage which has hitherto been overlooked. We develop and defend a version of luck egalitarianism which only (...) holds people responsible for creating disadvantage. This revision enables luck egalitarianism to offer compensation to those who are disadvantaged by preventing disadvantage to others, like dependent caretakers, without compromising the responsibility–sensitivity at the heart of luck egalitarianism. (shrink)

The feasibility constraint on the concept of justice roughly states that a necessary condition for something to qualify as a conception of justice is that it is possible to achieve and maintain given the conditions of the human world. In this paper, I propose three alternative interpretations of this constraint that could be derived from different understandings of the Kantian formula ‘ought implies can’: the ability constraint, the motivational constraint and the institutional constraint. I argue that the three constraints constitute (...) a sequence in the sense that accepting the motivational constraint presupposes that we accept the ability constraint, and to accept the institutional constraint presupposes that we accept both previous constraints. Adding the possibility of rejecting all three constraints, we get four distinct metatheoretical positions that theorists could take vis-à-vis the feasibility constraint on justice. (shrink)

Only women can bear the burdens of gestating fetuses. That fact, I suggest, bears on the morality of abortion. To illustrate and explain this point, I frame my discussion around Judith Jarvis Thomson's classic defense of abortion and Gina Schouten's recent feminist challenge to Thomson's defense. Thomson argued that, even assuming that fetuses are morally equivalent to persons, abortions are typically morally permissible. According to Schouten's feminist challenge to Thomson, however, if fetuses are morally equivalent to persons, then abortions are (...) typically morally impermissible because there is a collective moral obligation to care for the vulnerable. The consideration that is my topic, however, poses a problem for that feminist challenge to Thomson. There is reason to believe, I argue, that it is unfair that only women can bear the burdens of gestating fetuses. And, if that is unfair, it would undermine that feminist challenge to Thomson. I show, in other words, that there is a plausible and well‐motivated basis for believing that, even if fetuses are morally equivalent to persons and there is a collective obligation to care for the vulnerable, then abortions are nevertheless typically morally permissible. That is how fairness bears on the morality of abortion. (shrink)

According to relational egalitarians, equality is not primarily about the distribution of some good but about people relating to one another as equals. However, compared with other theorists in political philosophy – including other egalitarians – relational egalitarians have said relatively little on what role personal responsibility should play in their theories. For example, is equality compatible with responsibility? Should economic distributions be responsibility-sensitive? This article fills this gap. I develop a relational egalitarian framework for personal responsibility and show that (...) relational equality commits us to responsibility. I develop two sets of arguments. First, I draw on relational theories of moral responsibility – particularly Strawsonian views – to show that valuable egalitarian relationships require responsibility. Second, I show why relational equality sometimes requires that economic distributions be sensitive to responsibility and choice. I also defend a seemingly paradoxical result: being committed to responsibility, relational egalitarianism not only justifies some distributive inequalities but some relational inequalities too. Overall, relational egalitarianism gives a nuanced and coherent answer as to why and how responsibility matters from within egalitarianism. That it does should be an important argument in its favour. (shrink)

We defend a scalar theory of the relationship between material scarcity and justice. As scarcity increases beyond a specified threshold, we argue that deontological egalitarian constraints should be gradually relaxed and consequentialist considerations should increasingly determine distributions. We construct this theory by taking a bottom-up approach that is guided by principles of medical triage. Armed with this theory, we consider the range of conditions under which justice applies. We argue that there are compelling reasons for thinking that justice applies under (...) a far broader range of conditions than is standardly supposed, including those that could sensibly be labelled as conditions of extreme rather than moderate scarcity. (shrink)

In this article, we argue that apart from evaluating the causes and the social determinants of health inequalities, an evaluation of the effects of health inequalities is due. For this, we propose the ideal of relational equality as an evaluative framework, and test to what extent health inequalities threaten this ideal of a society of equals. We identify three ways in which they do and argue that these risks are especially great for those lower down the socio-economic strata. We thus (...) conclude that equality in health is instrumental to social justice, and that socio-economic inequalities in health are not only unjust due to their causes but also due to their consequences. We continue to argue that our instrumental approach opens a perspective to mitigate the identified injustices by changing society, rather than reducing inequalities in health, and argue that this is an advantage in the light of the realistic assumption that of the socio-economic health inequalities will persist. The article thus offers a complementary approach to both the evaluation and the mitigation of the injustice of socio-economic inequalities in health. (shrink)

Social egalitarians hold that one fundamental requirement of the ideal of social equality is that people should stand in relations of non-domination to one another. In the light of this, they reject luck egalitarian principles of justice as incompatible with a society of equals, because the former violate the non-domination requirement. I call this the domination objection. In this paper I examine its force against Dworkinian resource egalitarianism. There are two reasons why equality of resources might be thought to be (...) vulnerable to it. First, Dworkin has been interpreted to maintain that as long as people’s preferences are authentic, people should be consequentially responsible for the choices that flow from such preferences. However, Dworkin’s view on when people’s choices should be considered to be authentic does not rule out that the latter are sometimes influenced by norms and processes that are the outcome of domination and oppression, and so holding people fully consequentially responsible for choices that are the outcome of such preferences is itself unjust. Second, equality of resources objectionably permits bad-option-luck victims to become vulnerable to domination. I argue that Dworkinian egalitarianism is not susceptible to either of the two parts of the domination objection and defend the view that it is—contrary to the social egalitarian criticism—faithful to the social egalitarian demand for non-domination. (shrink)

The harshness objection is the most important challenge to luck egalitarianism. Very recently, Andreas Albertsen and Lasse Nielsen provided a scrupulous analysis of the harshness objection and claim that only the inconsistency objection—the objection that luck egalitarianism is incompatible with the ideal of basic moral equality—has real bite. I argue that the relevantly construed incoherence objection is not as strong as Albertsen and Nielsen believe. In doing so, first, I show that the deontological luck egalitarian conception of equal treatment does (...) not endorse harsh policies such as excessive responsibility-sensitive healthcare that would be disrespectful to the imprudent. Second, I demonstrate that deontological luck egalitarianism is not troubled by the case that involves a lack of respect for the prudent, which vexes Anderson’s relational egalitarianism that Kasper Lippert-Rasmussen’s argument highlights. I thus claim that the harshness objection is not a truly decisive objection against the luck egalitarian project. (shrink)

The strong correlation between people’s socioeconomic position and health within high income countries is a well-documented fact. A person’s occupation, income and education level tell us a lot about that person’s prospects on a long and healthy life, such that we can speak of a ‘social gradient in health’, or a ‘socioeconomic health gap’. This association is often perceived to be unjust. Therefore, it is generally thought that governments should aim to reduce socioeconomic health inequalities. However, this idea needs ethical (...) justification, for it is not evident if and why exactly these inequalities are unjust. For instance, are inequalities in health unjust per se? Or because the underlying socioeconomic inequalities are unjust? And does justice require equal health levels, or a minimum level of health? What complicates the issue, is that the width of the health gap, or the steepness of the social gradient, depends on what health measures are used. Overall, the more subjective the measure, the greater the inequalities appear to be. But are all these measures equally morally relevant? This dissertation aims to give a better understanding of these philosophical questions. It does so by investigating the question of what we should understand by health in the first part, after which it addresses the question of how to evaluate socioeconomic health inequalities in the light of justice. The introduction begins with a description of the phenomenon of socioeconomic health inequalities, and how it has been addressed by politicians, epidemiologists and philosophers in the past and today. The chapter continues by formulating the central question of the dissertation – that of which health inequalities should be focused in the light of a concern with social justice. It explicates how this dissertation contributes to answering that question, by discussing the potential relation between the conceptualisation of health and justice evaluations, and by discussing which questions are addressed in each of the following chapters. The chapter 2 addresses the question of how health is conceptualised in the philosophical and public heath literature, and how theoretical concepts of health differ. It proposes to approach health concepts as a Wittgensteinian family of thick concepts and argues that while theories on health generally argue in favour of one specific concept, a comparison of concepts shows that we may need different concepts of health given the variety of health practices. By explicating the differences between five concepts of health, this chapter argues that each captures aspects of health that all seem relevant when we talk and think about health. Classifying these concepts based on their distinctions reveals them as members of a conceptual family: each of the discussed concepts differs from the others in at least one respect and resembles the others in several respects. Moreover, the discussion of the concepts shows that ‘health’ always both describes a condition and values that condition at the same time. Having both descriptive and evaluative dimensions, we can see health concepts as ‘thick concepts’. Given this evaluative dimension, it is important to reflect on the question of what understanding of health guides specific practices. Moreover, the distinctions revealed by the classification can serve as a conceptual toolbox for reflection on the assumptions and purposes of health practices. How such reflection could work is illustrated by a brief exploration of what health aspects are focused upon in three specific health practices. Chapter 3 presents a study into the question of how health is conceptualised by ordinary citizens and to what extent conceptualisations of health differ between socioeconomic groups. By making use of the method of concept mapping, this study analyses how different socioeconomic groups formulate their own answers regarding the question ‘what does health mean to you?’. It presents concept maps of health for three different socioeconomic groups living in the city of Utrecht that reveal that all groups have a multidimensional understanding of health. An interpretation of the concept maps reveals nuanced differences between groups. The multiple aspects of health were also ranked by importance. It appears that each group assigned most importance to mental health. All in all, the study shows that people in lower socioeconomic groups are more likely to show a conceptualisation of health that refers to 1) the absence of health threats, 2) a person within his/her circumstances, 3) the value of functional notions, and 4) an accepting attitude towards life. Chapter 4 addresses the question of what the theoretical and empirical study to concepts of health could imply for health equity practices. It does so by exploring further the suggestions made in chapters 2 and 3. Regarding the question of which health aspects should guide health equity policies, this chapter discusses the question of whether we should primarily look at subjective or objective health measures, and whether a universal or relative standard of health should be central. While justice-related concerns of impartiality and equal treatment may seem to favour an objective perspective and a universal health standard, it appears that we have good reason to account for the subjective perspective as well. It is also argued that a concern for recognition and participatory parity gives room for relative health standards. Th room for relative health standards confronts us with the question of how to deal with mechanisms like adaptive preferences that the concept maps reveal. It proposes a way out, by arguing for society-relative health standards. Chapter 5 examines the question of whether inequalities in health should be evaluated ‘directly’, thus independently of a distribution of their social determinants. It proposes a sufficientarian perspective, such that the central question of evaluation is that of whether everyone is – or can be – healthy enough. By discussing two sufficientarian approaches to health and social justice – by Powers & Faden and by Nussbaum – this chapter distinguishes two ways of setting a threshold level for health. Both approaches appear to provide an unsatisfactory basis for justice evaluations and lead us away from direct evaluation if we try to settle health minima that are less arbitrary. In anticipation to chapters 6 and 7, it is argued that the perspective of sufficient health for relational equality escapes this arbitrariness: compared to that of a decent human life, it better helps to answer both the question of what socioeconomic health inequalities a society is due to avoid, and the question of when socioeconomic health inequalities are unjust considering their consequences. Chapter 6 discusses to what extent Daniels’s theory of health justice provides a satisfactory answer to the question of what health inequalities a society is due to avoid. Daniels proposes an indirect evaluative approach by arguing that we should evaluate socioeconomic health inequalities in the light of Rawls’s principles of justice as fairness. That is, if socioeconomic inequalities are in accordance with fair equality of opportunity and with the difference principle, the corresponding health inequalities would be just. It is shown that the suggestion that Rawls’s principles regulate the social determinants of health neglects that not all social determinants of health belong to society’s basic structure as conceived of by Rawls and are thereby not subjected to the principles of justice. To acknowledge the social mechanisms leading to socioeconomic health inequalities in their full complexity, it is argued that we should broaden our understanding of society’s structure in accordance with Young’s notion of social structural processes. This renders the question of what health inequalities a society is due to avoid into a question of what we can expect from the side of the various actors that uphold the social structures that produce socioeconomic health inequalities. Lastly, it is discussed how a shift to Young’s theory completes the shift to non-ideal theorising that seem already initiated by Daniels, and that with this, the distinction between direct and indirect evaluation dissolves. Chapter 7 discusses to what extent equality in health is of instrumental value for a society of free and equals. It thus takes up the idea proposed in chapter 5, that an evaluation of the consequences of health inequalities is also due. Taking relational equality as an evaluative framework reveals three ways in which inequalities in life expectancy threaten this ideal. That is, via unequal risks to stigmatisation, unequal risks to unemployment and the risk of unequal pension enjoyments. It is thereby shown that these risks are especially great for those lower down the socioeconomic strata. It thus concludes that equality in health is of instrumental value to relational equality. The chapter continues to argue that our instrumental approach opens a new perspective: to mitigate the identified injustices by changing society, rather than by reducing inequalities in health. This is argued to be an advantage in the light of the realistic assumption that of the socioeconomic health inequalities will persist. The paper thus offers a complementary approach to both the evaluation and the mitigation of the injustice of socioeconomic inequalities in health. The discussion chapter summarises the central findings of the analyses of health concepts and discusses questions regarding the philosophical and practical merits of comparing theoretical health concepts, the need for developing new health measures or concepts and the importance or nonsense of studying citizen’s views on health. Repeating this for the dissertation’s second part, the central findings of the chapters on justice evaluation are summarised and followed by a discussion of questions and issues that have remained unaddressed so far. Here, central points of discussion are my take on rules of distribution, the distinction of direct and indirect evaluation, the role of ideal and non-ideal theory, the idea of relational equality, and personal responsibility for health. The chapter concludes by noting that also in the light of justice evaluations, all commonly used health measures are relevant for justice. Therefore, my recommendations for policy and further research entail that inequalities in each of these measures deserve attention by both policymakers and researchers. Specifically, policymakers and researchers should give attention to how exactly each of these health inequalities come about, in such a way that a discussion about the question of who can be assigned responsibility to alleviate them is well-informed; and both should give attention to the effects of health inequalities on the opportunities for people to live on equal standing, in such a way that when these opportunities are diminished, actions can be considered to aim to restore relational equality. (shrink)

Drawing on empirical evidence in medicine, economics, law, and anthropology, I argue that a market is uniquely capable of meeting the demand for transplantable kidneys, and that it may be arranged so as to operate safely. The welfare gains, expected to accrue to both vendors and recipients, are sufficient to justify sales. Having spelled out the considerations recommending a kidney market, I address the most forceful objections facing the proposal. Despite its currency, the claim that incentives will crowd out altruistic (...) donors and result in a decrease in supply is empirically unsupported and predicated on an implausible view of donorsâ motives. A host of objections claim vendorsâ will not give informed consent. Many such objections identify easily remediable problems, or impose unreasonable standards â standards that would rule out morally permissible kidney donation. And all presuppose a model of morally transformative consent that, I argue, is deficient. Two further challenges point to harms inflicted on those who do not participate in the market. Some claim that those in poverty will be subject to harmful social and legal pressure to vend. This objection fails to distinguish between being pressured to perform a specific act, and being under general economic pressure and having the option to perform an act. It, moreover, presupposes vending more common than is possible. Others worry that the market will give rise to unfair pecuniary externalities. This objection also presupposes that kidney sales will occur more often than is possible. But more importantly, the normative consideration that is supposed to make such externalities especially objectionable, in fact, recommends allowing sales. I also make a political case for kidney sales. I offer an account of the stateâs proper role in the market. I begin with a conception of democratic equality according to which the state is responsible to secure for its citizens the preconditions for democratic participation. I then show that this end would be promoted were the state to end the current prohibition on sales. (shrink)

Pluralist egalitarians think that luck and relational egalitarianism each articulates a component in a pluralist account of egalitarian justice. However, this ecumenical view appears problematic in the light of Elizabeth Anderson's claim that the divide arises because two incompatible views of justification are in play, which in turn generates derivative disagreements – e.g. about the proper currency of egalitarian justice. In support of pluralist egalitarianism I argue that two of Anderson's derivative disagreements are not rooted in the disagreement over justification (...) she identifies, and that the disagreement over justification cuts across standard disagreements between luck and relational egalitarian justice. (shrink)

There is a recurrent sort of skeptical character in philosophical debates who believes that some social practice must be abolished because it involves a false presupposition about how things ‘really’ are. I examine this style of skeptical argument, using the moral responsibility skeptic as my main illustration. I excavate two unstated and un-argued for premises that it requires (which I call Undistorted Truth and Privileged Conception). This exposes the full extent of the argumentative burdens that such a skeptic must discharge. (...) I aim to make progress by offering skeptics and anti-skeptics alike a way forward: the skeptic is provided a clear agenda, while the anti-skeptic is provided a diagnostic tool to assess this style of skeptical arguments at key junctures. (shrink)

The Movement for Black Lives: Philosophical Perspectives is a welcome intervention into the ongoing discourse, both public and academic, on the issues of raised by the movement. The book will be of great interest to scholars interested in philosophical issues surrounding racial inequality and it is also suitable for adoption in advanced undergraduate and graduate courses. This volume is evidence of the fruitfulness of philosophical reflection on and engagement with social movements, as well as being an important contribution to the (...) literature on racial justice. For those looking for philosophical insights into the Movement for Black Lives, this book is essential reading. (shrink)

In recent years, a number of philosophers have argued that much theorizing about the value of equality, and about justice more generally, has focused unduly on distributive issues and neglected the importance of egalitarian social relationships. As a result, relational egalitarian views, according to which the value of egalitarian social relations provides the grounds of the commitment that we ought to have to equality, have gained prominence as alternatives to more fundamentally distributive accounts of the basis of egalitarianism, and of (...) justice-based entitlements. In this paper, I will suggest that reflecting on the kind of explanation of a certain class of our justice-based entitlements that relational egalitarian considerations can offer raises doubts about the project, endorsed by at least some relational egalitarians, of attempting to ground all entitlements of justice in the value of egalitarian social relationships. I will use the entitlement to healthcare provision as my central example. The central claim that I will defend is that even if relational egalitarian accounts can avoid implausible implications regarding the extension of justice-based entitlements to health care, it is more difficult to see how they can avoid what seem to me to be implausible explanations of why individuals have the justice-based entitlements that they do. To the extent that I am correct that relational egalitarian views are committed to offering implausible explanations of the grounds of justice-based entitlements to healthcare, this seems to me to provide at least some support for a more fundamentally distributive approach to thinking about justice in healthcare provision. (shrink)

This paper aims to offer a plausible and renewed defence of the axioms of the already well-known account of political philosophy ‘luck egalitarianism’. By finding certain support not only in the Kantian moral programme but also in widely accepted intuitions of our time, it is contended that luck egalitarianism possesses sufficient justification to become an ethical guide at the global level, revealing plausibly the existence of a compelling positive moral duty to terminate global poverty and denouncing its toleration as nothing (...) but a matter of injustice. The arguments provided to embrace such a proposal are built upon the widely accepted claim in moral philosophy that ‘all persons are equal in fundamental moral worth’. From this standpoint, I argue that the luck egalitarian doctrine can not only satisfy such a claim to its ultimate consequences, but it also reasonably overcome its most severe challenges that have diminished its merits in recent times when it aspires to become a tenable theory of justice. (shrink)

In what follows, I consider two influential views about distributive justice: democratic equality and luck egalitarianism. In examining and criticizing these views, I attempt to extract elements from each of them for what I take to be important to building a complete conception of distributive justice. I then present and defend my own view, deliberative democratic equality, a view that can be described as a hybrid account of luck egalitarianism and democratic equality.

Efforts to improve public health, both in the context of infectious diseases and non-communicable diseases, will often consist of measures that confer risk on some persons to bring about benefits to those same people or others. Still, it is unclear what exactly justifies implementing such measures that impose risk on some people and not others in the context of public health. Herein, we build on existing autonomy-based accounts of ethical risk imposition by arguing that considerations of imposing risk in public (...) health should be centered on a relational autonomy and relational justice approach. Doing so better captures what makes some risk permissible and others not by exploring the importance of power and context in such deliberations. We conclude the paper by applying a relational account of risk imposition in the cases of (a) COVID-19 measures and (b) the regulation of sugar-sweetened beverages to illustrate its explanatory power. (shrink)