ABSTRACT Individual responsibility is now very much on the political agenda. Even those who believe that its importance has been exaggerated by the political right — either because the appropriate conditions for assigning responsibility to individuals are rarely satisfied or because not enough is done to protect individuals from the more harmful consequences of their past choices and gambles — accept that individual responsibility is at least one of the values against which a society and its institutions ought to be (...) evaluated. One might be forgiven for assuming, then, that we know exactly why individual responsibility is important. The truth is otherwise. Surprisingly little philosophical work has been undertaken to analyse and separate out the different rationales that might be in play. Several possible reasons are examined here including: utility, the social bases of self‐respect, autonomy, human flourishing and fairness. However, once we adopt a pluralistic view of the value of individual responsibility we open up the possibility of value conflict, which conflict can make it harder to arrive at definitive prescriptions about which social policies best advance our concerns for individual responsibility. It is nevertheless possible to draw at least some conclusions about which policies we should favour. One important conclusion is that sometimes it is better not to hold individuals responsible for their past choices by denying them aid now, so that they might be better able to assume individual responsibility at a later date. (shrink)

It is sometimes said that a society should be judged ethically by how it treats its least-fortunate or worst-off members. In one interpretation this is not a point about justice, but instead about moral virtues such as compassion and charity. In our response to the least fortunate among us, we display, or show that we lack, fundamental moral virtues of fellow feeling and concern for others in need. In a different interpretation, however, this point is about justice and a just (...) society—the justice of a society is shown especially in how it treats its least-fortunate members. (shrink)

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

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

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

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

This paper examines the moral case for a right to religious accommodation, which requires that religious conduct be free of any serious burdens placed on it by the state. Two different types of normative argument for this right are outlined and rejected. The first appeals to religion as a ‘basic good’, and the second to religion as an ‘intense preference’. In place of these, I suggest that a third type of argument has greater prospects of success. Religious accommodation is justified (...) on the grounds that religious conduct is a ‘derivative good’— that is, it derives its value from its being necessary for something else, namely, the integrity of the religious person. (shrink)

Departing from theories of distributive justice and their relation with the distribution of health care within society, especially egalitarianism and libertarianism, this paper aims at demonstrating that the approach taken by the European Court of Justice regarding the application of the Internal Market principles (or the market freedoms) to the field of health care services has introduced new values which are more concerned with a libertarian view of health care. Moreover, the paper also addresses the question of how these new (...) values introduced by the Court may affect common principles of European health systems, such as equity and accessibility. (shrink)

A close look at the rhetoric in America's recent welfare‐reform debate has both surprising and important implications for political philosophy. Political philosophers typically presume that opponents of redistribution are motivated by considerations other than equality. Recent arguments for welfare reform, however, have been formulated in a manner consistent with most contemporary egalitarian theories. This result should make us question either the political relevance of egalitarian ideals or the adequacy of those theories of equality.

This article asks whether firms should contribute to the costs of procreation and parenthood. We explore two sets of arguments. First, we ask what the principle of fair play – central in parental justice debates – implies. We argue that if one defends a pro-sharing view, firms are required to shoulder part of the costs of procreation and parenthood. Second, we turn to the principle of fair equality of opportunity. We argue that compensating firms for costs they incur because their (...) employees decide to procreate or parent may undermine some of the incentives leading to (statistical) discrimination in the workplace. (shrink)

Relational egalitarianism says that moral equals should relate as equals. We explore how moral unequals should relate.

The article elaborates an original intertwined reading of republican theory, deliberative democracy and political equality. It argues that republicans, deliberative democrats and egalitarian scholars have not paid sufficient attention to a number of features present in these bodies of scholarships that relate them in mutually beneficial ways. It shows that republicanism and deliberative democracy are related in mutually beneficial ways, it makes those relations explicit, and it deals with potential objections against them. Additionally, it elaborates an egalitarian principle underpinning the (...) resulting model that I label Equality of Access and Deliberation. The upshot of these considerations is a novel and mutually reinforcing interrelated three-tiered theoretical and institutional proposal. (shrink)

Theories of distributive justice are often criticised for either excluding people with disabilities from the domain of justice altogether, or casting them as deficient in personal attributes. I argue that the capabilities approach to justice is largely immune to these flaws. It has the conceptual resources to locate most of the causes of disadvantage in the interaction between a person and her environment and in doing so can characterise the disadvantages of disability in a way that avoids the imputation of (...) natural deficiency. However, I also argue that the capabilities approach cannot accommodate some of the stronger claims advanced by some disability scholars. No plausible capabilities approach can guarantee that social change will always be the just or fair remedy for disadvantage, and there is a small number of severe cases of disability where capability shortfalls will be attributed to the person’s ‘deficient’ physical and mental impairments. (shrink)

The gendered division of labor is the major cause of gender inequality with respect to the broad spectrum of resources, occupations, and roles. Although many feminists aspire to an equality of outcome where there are no significant patterns of gender difference across these dimensions, many have also argued that liberal theories of social justice do not have the conceptual tools to justify a direct attack on the gendered division of labor. Indeed, many critics argue that liberalism positively condones it, presuming (...) that it arises from the free choices of individuals, which must be respected. In this paper I will accept the feminist goal of equality of outcome across roles, occupations, income, and wealth, but will argue that liberal theories of justice are consistent with strong measures aimed at promoting such equality. I will show that liberalism has the conceptual resources to justify a concrete policy measure that goes considerably beyond the measures usually championed by feminists. The example I focus on is “daddy quotas,” which refers to the tagging of a significant part of parental leave for the exclusive use of fathers. (shrink)

Recent discussions of genetic enhancement have argued that unregulated access to genetic enhancement technology will have a mainly negative impact on equality, a development that an egalitarian approach to distributive justice should be concerned with and seek to address. I argue that the extent to which egalitarians should be concerned about unequal access to genetic enhancement therapies has been overplayed. Many of the genetic differences that exist between people, including those that arise from differential access to genetic enhancement technology, are (...) simply irrelevant to egalitarian concerns. I also argue that most commentators have failed to appreciate that an egalitarian-inspired program of equal access to genetic enhancement technology may not be altogether favourable for the genetically disadvantaged in any case. The true implications of egalitarian justice in the genetic future have not been adequately explored. (shrink)

abstract This article defends luck egalitarianism as an interpretation of the egalitarian ideal against two major criticisms levelled against it by Elizabeth Anderson — that it is trapped in the distributive paradigm, and that it treats the victims of bad option luck too harshly to be considered an egalitarian theory. Against the first criticism, I argue that luck egalitarianism will condemn non‐material inequalities and injustices if an appropriate conception of well‐being is adopted. I demonstrate this by showing how the approach (...) is sensitive to the five faces of oppression developed by Iris Young. Although the second criticism is more troubling, it does not defeat luck egalitarianism, either. I will show that few of the inequalities that arise in the real world result from option luck. Further, if cases do occur, rather than abandoning the theory, the best response is to combine luck egalitarianism with another egalitarian principle that will ensure that the basic needs of all citizens are satisfied. The paper concludes by defending the appeal of the distinction between option luck and brute luck, in light of the preceding discussion. (shrink)

This paper argues that the best interpretation of Ronald Dworkin’s hypothetical insurance scheme is a holistic one that allows the parties to make choices between the policies that are available. This interpretation contrasts with the hypothecated and insurance-focused aspects that are traditionally understood as part of the procedure. The paper argues that the holistic interpretation better fits with the ideal of resource egalitarianism that people should have as much choice as possible from an equal starting point. It does so by (...) allowing people a choice over the policies that will be used to achieve their insurance preferences. (shrink)

This paper examines the relationship between the development of talented young sports people and conceptions of social justice. It is set within the context of recent policy developments in the United Kingdom that place renewed emphasis on talent development (and wider issues of ?gifted and talented education?), and justifies this with explicit reference to social justice. After providing a summary of relevant policy initiatives and their often-unstated presumptions, the paper goes on to examine the different ways in which philosophers have (...) conceptualised the role of luck in human affairs. Luck is a matter of particular interest to social justice theorists, who often frame their discussions in terms of the neutralisation of luck. This presents something of a problem for policy makers, as talent development seems destined to exaggerate the effects of luck, not neutralise them. In other words, it is suggested here that talent development cannot be justified in terms of social justice ? at least the version of social justice advocated my many of the leading theorists ? because it results in the opposite outcome than would be desired. None of this means that talent development is indefensible; it is just indefensible in the terms used in the UK talent development policy. (shrink)

Lifestyle diseases constitute an increasing proportion of health problems and this trend is likely to continue. A better understanding of the responsibility argument is important for the assessment of policies aimed at meeting this challenge. Holding individuals accountable for their choices in the context of health care is, however, controversial. There are powerful arguments both for and against such policies. In this article the main arguments for and the traditional arguments against the use of individual responsibility as a criterion for (...) the distribution of scarce health resources will be briefly outlined. It is argued that one of the most prominent contemporary normative traditions, liberal egalitarianism, presents a way of holding individuals accountable for their choices that avoids most of the problems pointed out by the critics. The aim of the article is to propose a plausible interpretation of liberal egalitarianism with respect to responsibility and health care and assess it against reasonable counter-arguments. (shrink)

The history of the documentation of health inequality is long. The way in which health inequality has customarily been documented is by comparing differences in the average health across groups, for example, by sex or gender, income, education, occupation, or geographic region. In the controversial World Health Report 2000, researchers at the World Health Organization criticized this traditional practice and proposed to measure health inequality across individuals irrespective of individuals’ group affiliation. They defended its proposal on the moral grounds without (...) clear explanation. In this paper I ask: is health inequality across individuals of moral concern, and, if so, why? Clarification of these questions is crucial for meaningful interpretation of health inequality measured across individuals. Only if there was something morally problematic in health inequality across individuals, its reduction would be good news. Specifically, in this paper I provide three arguments for the moral significance of health inequality across individuals: (a) health is special, (b) health equity plays an important and unique role in the general pursuit of justice, and (c) health inequality is an indicator of general injustice in society. I then discuss three key questions to examine the validity of these arguments: (i) how special is health?, (ii) how good is health as an indicator?, and (iii) what do we mean by injustice? I conclude that health inequality across individuals is of moral interest with the arguments (b) and (c). (shrink)

According topositive egalitarianism, not only do relations of inequality have negative value, as negative egalitarians claim, but relations of equality also have positive value. The egalitarian value of a population is a function of both pairwise relations of inequality (negative) and pairwise relations of equality (positive). Positive andnegative egalitarianismdiverge, especially in different-number cases. Hence, an investigation of positive egalitarianism might shed new light on the vexed topic of population ethics and our duties to future generations. We shall here, in light (...) of some recent criticism, further develop the idea of giving positive value to equal relations. (shrink)

In contemporary market societies, the laws do not place individuals under enforceable obligations to aid others. Perhaps the most striking exception to this broad generalization is the practice of conscription of able-bodied males into military service, particularly in time of war. Another notable exception is the legal enforcement in some contemporary societies of “Good Samaritan” obligations — obligations to provide temporary aid to victims of emergencies, such as car accident victims. The obligation applies to those who are in the immediate (...) vicinity of the emergency and who can supply aid of great value to the victim at small risk and tolerable cost to themselves. The fact that not all contemporary societies have enacted such Good Samaritan laws underscores the point that the general rule is that individuals are under no legal obligation to help others. According to some moral views, this legal situation approximately accords with the moral fact that persons who have not voluntarily incurred obligations to aid others should not be coerced into tendering such aid. Moreover, it is worth noting that these two prominent exceptions to the tendency of legal systems to eschew enforcement of positive obligations to aid others are plausibly in everyone's ex ante interest and not notably redistributive in intent. (shrink)

In recent years some moral philosophers and political theorists, who have come to be called “luck egalitarians,” have urged that the essence of social justice is the moral imperative to improve the condition of people who suffer from simple bad luck. Prominent theorists who have attracted the luck egalitarian label include Ronald Dworkin, G. A. Cohen, and John Roemer.1 Larry Temkin should also be included in this group, as should Thomas Nagel at the time that he wrote Equality and Partiality.2 (...) However, each of these theorists asserts a different position. The common ground, if any, is obscure. The idea of luck that is invoked is not transparently clear. Anyway, the term “luck egalitarianism” was coined by a critic of the doctrine, and tendentiously defined to denote an extreme version of the view that looks implausible from the start.3 With some justice Ronald Dworkin, perhaps the chief architect of the luck egalitarian position, has denied that he is a luck egalitarian. (shrink)

One way to think about capitalism-versus-socialism is to examine the extent to which capitalist economic institutions are compatible with the fulfillment of socialist ideals. The late G. A. Cohen has urged that the two are strongly incompatible. He imagines how it would make sense for friends to organize a camping trip, distills the socialist moral principles that he sees fulfilled in the camping trip model, and observes that these principles conflict with a capitalist organization of the economy. He adds that (...) these principles are ethically attractive, so if it is feasible to organize the economy on the camping trip model, we ought to do so. This essay argues to the contrary that for all that has been said, capitalist economic arrangements might be in the set of institutional arrangements that overall would best fulfill the camping trip principles, and anyway, the principles themselves ought to be rejected, so the question whether or not a capitalist set-up might satisfy these principles should not interest us. The grounds for rejecting the camping trip principles support a form of welfarist consequentialism that denies that equality of distribution of any sort is per se ethically desirable and also denies that liberal freedoms to live as one chooses are per se morally desirable. Equality and freedom should rather be regarded as in the light of possible means (or hindrances) to advancing good for people, fairly distributed. (shrink)

Some of the best philosophers do not hold academic appointments in philosophy departments. Wouldn't you rather have the ghost of Frank Ramsey (the Cambridge mathematician who died in the 1920s) as a hall mate instead of some of your current colleagues? Confining our attention to the living, we find some economists among the more philosophically inclined intellectuals. The best of these fellow traveling economistphilosophers are the Nobel Prize winner Amartya Sen and also John Roemer. In the early 1980s Roemer did (...) brilliant work on the analytical foundations of Marxist theory. He has also accomplished an imaginative retooling of the Lange-Lerner models of market socialism. For the past dozen years or so Roemer has been thinking and writing about distributive justice. This work has culminated in the two impressive books that are the subject of this review essay. Theories of Distributive Justice is explicitly a bridge-building effort. Roemer announces that his aim is to provide a philosophical perspective on recent writings by economists that are relevant to the topic of distributive justice and to provide an economist's perspective on recent writings by philosophers on distributive justice. He further announces that his primary aim is to facilitate traffic in one direction--to interpret and formulate the ideas of contemporary philosophers on distributive justice so as to introduce them to economists with a view to increasing the philosophical sophistication of work by economists on these normative issues. I endorse this aim. But since I am not a trained economist, I shall not attempt to assess the extent to which this project is successfully completed. This review explores the adequacy of Roemer's survey of contemporary theories of justice and the philosophical interest of his own contributions to debates about distributive justice. These Roemerian contributions appear interspersed among critical discussions in Theories of Distributive Justice as well as in the more recent monograph Equality of Opportunity. 1.. (shrink)

Imagine a democratic society in which all members are full citizens and citizens relate to each other as equals. Social arrangements bring it about, to the maximum possible extent, that all adults are full functioning members of society. The society is not marred by caste hierarchies, invidious status distinctions, or unequal power relations. No one is able to dominate others. Moreover, the urge to dominate over others does not loom large in social life. Each person's relations with others manifest the (...) belief, shared by all, that each person is fundamentally the equal of all others and that this equality calls for treating others with civility and mutual respect and forbearance. Each is viewed as having the right to live as she chooses, within broad constraints of morality. This individual entitlement to freedom establishes a strong presumption against paternalism, restricting a person's liberty against her will for her own good. Regarding distributive justice, the norm is that each should be enabled to have enough by way of resources and opportunities to sustain herself as a full functioning member of democratic society. (shrink)

This paper discusses what implications global luck egalitarianism (GLE) has for border control. Some authors suggest that an open‐borders policy follows from GLE. The idea is that various unchosen inequalities inevitably follow from differences in birthplace, such that GLE will always have principled reason to condemn closed borders. Others are skeptical of the assumption that GLE will have liberal implications for border control, because open borders may have other, adverse effects that outweigh the reductions in unjust inequality. Against such skeptics, (...) we argue that GLE will (typically) have quite liberal implications for border control. However, this connection is not a principled one: Whether (and to what extent) GLE favors opening or closing borders will depend upon empirical circumstances. (shrink)

The use of tanning beds has been identified as being among the most significant causes of melanoma and non-melanoma skin cancer. Accordingly, the activity is properly seen as one that involves profound harm to self. The article examines paternalistic reasons for restricting sunbed usage. We argue that both so-called soft and hard paternalistic arguments support prohibiting the use of sunbeds. We make the following three arguments: an argument from oppressive patterns of socialization suggesting that the autonomous nature of the conduct (...) in question is questionable; an argument from so-called evaluative delusions in which individuals attach incorrect weights to some of their values; a strictly hard paternalistic argument appealing to the harm in itself pertaining to the use of sunbeds. (shrink)

Recent health legislation in Norway significantly increases access to specialist care within a legally binding time frame. The paper describes the contents of the new legislation and introduces some of the challenges with proliferations of rights to health care. The paper describes some of the challenges associated with the proliferation of legal rights to health care. It explains the benefits of assessing the new law in the light of a rights framework. It then analyses the problematic aspects of establishing additional (...) priority rules as solutions to rights conflicts. It then defends adequacy criteria for acceptable priority rules when such rules are unavoidable. It finally defends our proposed method and explores concrete applications. (shrink)

With by far the lowest population density in the United States, myriad challenges attach to healthcare delivery in Alaska. In the “Size, Population, and Accessibility” section, we characterize this geographic context, including how it is exacerbated by lack of infrastructure. In the “Distributing Healthcare” section, we turn to healthcare economics and staffing, showing how these bear on delivery—and are exacerbated by geography. In the “Health Care in Rural Alaska” section, we turn to rural care, exploring in more depth what healthcare (...) delivery looks like outside of Alaska’s major cities. This discussion continues in the “Alaska’s Native Villages” section, which specifically analyzes healthcare in Alaska’s indigenous villages, some of the smallest and most isolated communities in the United States. Though many of the ways we could improve Alaskan health care for Alaskan residents are limited by its unique features, the “Justice and Healthcare Delivery” and “Technology and Telemedicine” sections consider ways in which certain policies and technology—including telemedicine—could mitigate the challenges developed in previous sections. (shrink)

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

In the luck egalitarian literature, one influential formulation of luck egalitarianism does not specify whether equalities that do not reflect people’s equivalent exercises of responsibility are bad with regard to inequality. This equivocation gives rise to two competing versions of luck egalitarianism: asymmetrical and symmetrical luck egalitarianism. According to the former, while inequalities due to luck are unjust, equalities due to luck are not necessarily so. The latter view, by contrast, affirms the undesirability of equalities as well as inequalities insofar (...) as they are due to luck. The symmetrical view, we argue, is by far the more compelling, both by internal luck egalitarian standards and in light of the external rightist emphasis on choice and responsibility to which luck egalitarianism may partly be seen as a response. Our main case for the symmetrical view is that when some people, against a background of equal opportunities, do not exercise their responsibility to the same degree as others, they cannot justifiably call for equalizing measures to be put in place. Indeed, such measures would be positively unfair. The symmetrical view, accordingly, rejects compensation in such cases, whereas the asymmetrical view, implausibly, enjoins it. We also examine two objections to this argument. First, that this view fails to qualify as genuinely egalitarian, instead collapsing the notion of equality into the notion of desert. Second, that the opposing asymmetrical view, in contrast to the symmetrical view, can draw support from its compatibility with sufficientarian concerns. Both objections are rebutted. We conclude that luck egalitarians are best served by endorsing the symmetrical, luck-neutralizing stance. (shrink)

The late G.A. Cohen is routinely considered a founding father of luck egalitarianism, a prominent responsibility-sensitive theory of distributive justice. David Miller argues that Cohen’s considered beliefs on distributive justice are not best understood as luck egalitarian. While the relationship between distributive justice and personal responsibility plays an important part in Cohen’s work, Miller maintains that it should be considered an isolated theme confined to Cohen’s exchange with Dworkin. We should not understand the view Cohen defends in this exchange as (...) Cohen’s considered view. Accepting this thesis would change both our understanding of Cohen’s political philosophy and many recent luck egalitarian contributions. Miller’s argument offers an opportunity to reassess Cohen’s writings as a whole. Ultimately, however, the textual evidence against Miller’s argument is overwhelming. Cohen clearly considers the exchange with Dworkin to be about egalitarianism as such rather than about the best responsibility-sensitive version of egalitarianism. Furthermore, Cohen often offers luck egalitarian formulations of his own view outside of the exchange with Dworkin and uses luck egalitarianism as an independent yardstick for evaluating principles and distributions. (shrink)

Rare diseases pose a particular priority setting problem. The UK gives rare diseases special priority in healthcare priority setting. Effectively, the National Health Service is willing to pay much more to gain a quality-adjusted life-year related to a very rare disease than one related to a more common condition. But should rare diseases receive priority in the allocation of scarce healthcare resources? This article develops and evaluates four arguments in favour of such a priority. These pertain to public values, luck (...) egalitarian distributive justice the epistemic difficulties of obtaining knowledge about rare diseases and the incentives created by a higher willingness to pay. The first is at odds with our knowledge regarding popular opinion. The three other arguments may provide a reason to fund rare diseases generously. However, they are either overinclusive because they would also justify funding for many non-rare diseases or underinclusive in the sense of justifying priority for only some rare diseases. The arguments thus fail to provide a justification that tracks rareness as such. There are no data in this work. (shrink)

People’s health is hugely affected by where they live, their occupational status and their socio-economic position. It has been widely argued that the presence of such social determinants in health provides good reasons to reject luck egalitarianism as a theory of distributive justice in health. The literature provides different reasons why this responsibility-sensitive theory of distributive justice should not be applied to health. The critiques submit that the social circumstances undermine or remove people’s responsibility for their health; responsibility sensitive health (...) policies would adversely affect those who are worst off and; the luck egalitarian approach to health distracts from the important task of rectifying socio-economic influences on people's health and provides individualistic solutions to collective problems. But for each of these variants of the critique luck egalitarianism provides suitable answers. The literature on social determinants is no detriment to the project of applying luck egalitarianism to health. (shrink)

Should we grant a fresh start to those who come to regret their past lifestyle choices? A negative response to this question can be located in the luck egalitarian literature. As a responsibility-sensitive theory of justice, luck egalitarianism considers it just that people’s relative positions reflect their past choices, including those they regret. In a recent article, Vansteenkiste, Devooght and Schokkaert argue against the luck egalitarian view, maintaining instead that those who regret their past choices in health are disadvantaged in (...) a relevant way and should receive compensation. Employing the ideal that people should be made equal as measured by equivalent resources, they purport to show the fairness of such an arrangement through a hypothetical scenario. Relaxing the implicit assumptions of this scenario brings forth several unattractive consequences of the fresh-start idea. The main problem is that in striving to ensure that people’s past choices do not affect their own opportunities, the authors must accept that these choices put heavy strains on the opportunities available to other people. Furthermore, the luck egalitarian position is more compelling than they admit. (shrink)

The scarcity of livers available for transplants forces tough choices upon us. Lives for those not receiving a transplant are likely to be short. One large group of potential recipients needs a new liver because of alcohol consumption, while others suffer for reasons unrelated to their own behaviour. Should the former group receive lower priority when scarce livers are allocated? This discussion connects with one of the most pertinent issues in contemporary political philosophy; the role of personal responsibility in distributive (...) justice. One prominent theory of distributive justice, luck egalitarianism, assesses distributions as just if, and only if, people's relative positions reflect their exercises of responsibility. There is a principled luck egalitarian case for giving lower priority to those who are responsible for their need. Compared to the existing literature favouring such differentiation, luck egalitarianism provides a clearer rationale of fairness, acknowledges the need for individual assessments of responsibility, and requires initiatives both inside and outside of the allocation systems aimed at mitigating the influence from social circumstances. Furthermore, the concrete policies that luck egalitarians can recommend are neither too harsh on those who make imprudent choices nor excessively intrusive towards those whose exercises of responsibility are assessed. (shrink)

The exposure of doctors, nurses and other medical professionals to risks in the context of epidemics is significant. While traditional medical ethics offers the thought that these dangers may limit the extent to which a duty to care is applicable in such situations, it has less to say about what we might owe to medical professionals who are disadvantaged in these contexts. Luck egalitarianism, a responsibility-sensitive theory of distributive justice, appears to fare particularly badly in that regard. If we want (...) to maintain that medical professionals are responsible for their decisions to help, cure and care for the vulnerable, luck egalitarianism seems to imply that their claim of justice to medical attention in case of infection is weak or non-existent. The article demonstrates how a recent interpretation of luck egalitarianism offers a solution to this problem. Redefining luck egalitarianism as concerned with responsibility for creating disadvantages, rather than for incurring disadvantage as such, makes it possible to maintain that medical professionals are responsible for their choices and that those infected because of their choice to help fight epidemics have a full claim of justice to medical attention. (shrink)

Several attempts have been made to apply the choice-sensitive theory of distributive justice, luck egalitarianism, in the context of health and healthcare. This article presents a framework for this discussion by highlighting different normative decisions to be made in such an application, some of the objections to which luck egalitarians must provide answers and some of the practical implications associated with applying such an approach in the real world. It is argued that luck egalitarians should address distributions of health rather (...) than healthcare, endorse an integrationist theory that combines health concerns with general distributive concerns and be pluralist in their approach. It further suggests that choice-sensitive policies need not be the result of applying luck egalitarianism in this context. (shrink)