Sufficientarians face a problem of arbitrariness: why place a sufficiency threshold at any particular point? One response is to seek universal goods to justify a threshold. However, this faces difficulties (despite sincere efforts) by either being too low, or failing to accommodate individuals with significant cognitive disabilities. Some sufficientarians have appealed to individuals’ subjective evaluations of their lives. I build on this idea, considering another individualized threshold: ‘tolerability’. I respond to some traditional challenges to individualistic approaches to justice: ‘expensive’ tastes, (...) and adaptive preferences. Finally, I end by offering some suggestions about how this relates to policymaking. (shrink)

Many assume that theories of distributive justice must obviously take people’s lifetimes, and only their lifetimes, as the relevant period across which we distribute. Although the question of the temporal subject has risen in prominence, it is still relatively underdeveloped, particularly in the sphere of health and healthcare. This paper defends a particular view, “momentary sufficientarianism,” as being an important element of healthcare justice. At the heart of the argument is a commitment to pluralism about justice, where theorizing about just (...) principles demands paying attention to the role particular goods play in our lives. This means that different approaches to the temporal subject—as well as other relevant issues—may be appropriate for different goods, including different goods within healthcare. In particular, the paper discusses two central goods targeted by healthcare: life-saving and pain relief. The view is offered as complementary to, rather than competitive with, lifetime approaches. As such, the paper finishes by considering how a pluralist approach, which engages both with people’s lives as a whole and with their states at particular moments, can reconcile the potentially competing claims in healthcare that emerge from these two perspectives. (shrink)

According to the sufficiency principle, distributive justice requires that everyone have some sufficient level of resources or well-being, but inequalities above this threshold have no moral significance. This paper defends a version of the sufficiency principle as the appropriate response to moral uncertainty about distributive justice. Assuming that the appropriate response to moral uncertainty is to maximize expected choiceworthiness, and given a reasonable distribution of credence in some familiar views about distributive justice, a version of the sufficiency principle strikes the (...) optimal balance between the competing moral risks posed by implementing these views. In particular, it avoids the moral risk posed by views like Nozick’s libertarianism, which forbid redistributive taxation even for the sake of helping to provide for people’s basic needs: failing to do the latter, if it turns out that justice does require it, would be very morally wrong. This “uncertainty argument” has the advantage of minimizing reliance on controversial intuitions about distributive justice, helps to specifying a non-arbitrary threshold for sufficiency, and shows that the substantive moral implications of moral uncertainty are not limited to high-stakes applied ethics issues such as abortion and vegetarianism but instead extend to an issue at the heart of political philosophy. (shrink)

The distinction between equality and sufficiency, much discussed in the distributive justice literature, is here applied to democratic theory. Overlooking this distinction can have significant normative implications, undermining some defences and criticisms of political equality, as I show by discussing the work of three prominent democratic theorists: Thomas Christiano, David Estlund, and Mark Warren. Most importantly, Christiano sometimes defends egalitarian conclusions using sufficientarian premises, or worries about inequality in situations where insufficiency is also part of the problem; inequality above the (...) level of sufficiency is not always as troubling. Estlund makes the reverse error. He attacks rather than defends political egalitarianism, but insufficiency seems to explain some of his concerns. Nonetheless, I show that political egalitarians may need to specify a sufficientarian threshold, to avoid levelling-down objections. Democratic theorists should thus take seriously the distinction between political equality and political sufficiency. More generally, political theorists and philosophers should be aware of omitted variable bias and interaction effects due to conceptual stretching arising from under-theorised distinctions in their thought experiments. (shrink)

This article brings together two debates in contemporary political philosophy: on the one hand, the dispute between the distributive and relational approaches to equality and, on the other hand, the field of intergenerational equality. I offer an original contribution to the second domain and by doing so, I inform the first. The aim of this article is thus twofold: shedding some light on an under-researched and yet crucial question – ‘which inequalities between generations matter?’ and contributing to a far-reaching debate (...) that touches upon the nature of egalitarianism. After showing that there are two key problems that fall within the scope of intergenerational equality – questions of justice between age groups and questions of equality between birth cohorts – I argue that, contrary to what the default distributive view states, some inequalities between age groups matter independently of their diachronic impact, and so partly for relational reasons. I argue that, even if we are distributive egalitarians, we must endorse the relational egalitarian conception to successfully make sense of some inequalities between age groups. I infer from this both that the putative view that the ‘relational’ conception of equality can be redescribed as distributive must be rejected and that the distributive view requires supplementation by the relational view. (shrink)

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

According to relational egalitarianism, justice requires equal relations. The theory applies to those who stand in the relevant social relations. In this paper, I distinguish four different accounts of what it means to be socially related and argue that in all of them, self-relations—how a person relates to themselves—fall within the scope of relational egalitarianism. I also point to how this constrains what a person is allowed to do to themselves.

The article argues that the possibility of an unlimited gap in income and wealth between the top and bottom segments of society is incompatible with a democratic commitment to political equality. T...

While COVID-19 vaccines provide light at the end of the tunnel in a difficult time, they also bring forth the complex ethical issue of global vaccine distribution. The current unequal global distribution of vaccines is unjust towards the vulnerable living in low-income countries. A vaccine tax should be introduced to remedy this. Under such a scheme, a small fraction of the money spent by a country on vaccines for its own population would go into a fund, such as COVAX, dedicated (...) to buying vaccines and distributing them to the world’s poorest. A vaccine tax would provide a much-needed injection of funds to remedy the unequal distribution of vaccines. The tax allows for a distribution that, to a lesser degree, reflects the ability to pay and is superior to a donation-based model because it minimises the opportunity for free-riding. (shrink)

Almost everyone believes that freedom from deprivation should have significant weight in specifying what justice between generations requires. Some theorists hold that it should always trump other distributive concerns. Other theorists hold that it should have some but not lexical priority. I argue instead that freedom from deprivation should have lexical priority in some cases, yet weighted priority in others. More specifically, I defend semi-strong sufficientarianism. This view posits a deprivation threshold at which people are free from deprivation, and an (...) affluence threshold at which people can live an affluent life, even though their lives may be even further improved beyond that point. I argue that freedom from deprivation in one generation lexically outweighs providing affluence in another generation; in all other cases, freedom from deprivation does not have lexical priority. (shrink)

In this article, I assess the prospects for the limitarian thesis that someone has too much wealth if they exceed a specific wealth threshold. Limitarianism claims that there are good political and/or ethical reasons to prevent people from having such ‘surplus wealth’, for example, because it has no moral value for the holder or because allowing people to have surplus wealth has less moral value than redistributing it. Drawing on recent literature on distributive justice, I defend two types of limitarian (...) principles of justice. First, limitarian midlevel principles draw on the limitarian thesis to specify normative commitments for guiding institutional design and individual actions. Second, the limitarian presumption draws on that thesis to specify what a just allocation of wealth requires under epistemic constraints. Such a presumption says that without substantive reasons to the contrary, we should regard a distribution as unjust if some people’s wealth exceeds the limitarian threshold. Furthermore, I will argue that we must reject a possible but implausible interpretation of limitarianism as an ideal distributive pattern. Yet both as a midlevel principle and as a presumption, limitarianism can play an important role in theorizing about justice in the real world. (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)

Limitarianism holds that there is an upper limit to how many resources, such as wealth and income, people can permissibly have. In this article, I examine the conceptual structure of limitarianism. I focus on the upper limit and the idea that resources above the limit are ‘excess resources’. I distinguish two possible limitarian views about such resources: (i) that excess resources have zero moral value for the holder; and (ii) that excess resources do have moral value for the holder but (...) that their claim to such resources is outweighed by other normative concerns. Moreover, I argue that, depending on the values limitarianism seeks to promote, limitarians should care about the number of people with excess resources or the total amount of excess resources (or both), that they can adopt redistributive measures and/or predistributive measures, and that some versions of limitarianism should take into account the distribution of risk among those above the riches line. (shrink)

This essay discusses two contributions of the principle of sufficient autonomy to educational justice. In Just Enough, Liam Shields criticizes instrumental accounts of autonomy. According to these accounts, autonomy is valuable insofar as it contributes to well-being. Shields argues that instrumental arguments fail to support mandatory autonomy education in all cases, while his non-instrumental principle of sufficient autonomy does support this. This essay develops a version of the instrumental argument and argues this version can do the work of supporting mandatory (...) autonomy education. Another contribution of the principle of sufficient autonomy is the requirement of talents discovery. According to Shields, the requirement of talents discovery renders Rawls’s principle of fair equality of opportunity more plausible, since one’s chances of accessing a given economic position depend on one’s opportunities to discover one’s innate talents. This essay argues that Rawlsian fair equality of opportunity does not have the same implications as the principle of sufficient autonomy as to which types of talents should be discovered and to what extent. (shrink)

Sufficientarian libertarianism is a theory of justice that combines libertarianism’s focus on property rights and non-interference with sufficientarianism’s concern for the poor and needy. Persons are conceived as having stringent rights to direct their lives as they see fit, provided that everyone has enough to live a self-guided life. Yet there are different ways to combine libertarianism and sufficientarianism and hence different types of sufficientarian libertarianism. In the article I present and discuss three types, and I argue that the last (...) one overcomes the problems of the other two. The first type combines libertarianism with a sufficiency principle in what is sometimes called the ‘ethics of distribution’. The second incorporates modest welfare rights into a libertarian theory of justice. The third endorses a sufficientarian Lockean proviso for practices of private property within a libertarian theory of justice. I argue that it is superior to the others. (shrink)

Despite the prominence of thresholds in theories of distributive justice, there is no general account of what sort of role is played by the idea of a threshold within such theories. This has allowed an ongoing lack of clarity and misunderstanding around views that employ thresholds. In this article, I develop an account of the concept of thresholds in distributive justice. I argue that this concept contains three elements, which threshold views deploy when ranking possible distributions. These elements are (i) (...) the level of the threshold, (ii) what constitutes the value of the threshold, and (iii) how benefits above and below the threshold must be allocated. I highlight three contributions that this particular account of thresholds makes: it clarifies the nature of the shift that occurs at the threshold; it resolves a common misunderstanding about headcount principles; and it shows how the arbitrariness objection can be met. (shrink)

In this article, I propose a novel characterization of sufficientarianism. I argue that sufficientarianism combines three claims: a priority claim that we have non-instrumental reasons to prioritize benefits in certain ranges over benefits in other ranges; a continuum claim that at least two of those ranges are on one continuum; and a deficiency claim that the lower a range on a continuum, the more priority benefits in that range have. This characterization of sufficientarianism sheds new light on two long-standing philosophical (...) debates, namely about the distinctiveness of sufficientarianism as a distributive principle and about the common objections to sufficientarianism. (shrink)

Universal basic income proposes providing instalments of constant magnitude to all. One problem with a stable basic income across life is that it seems unfair to shorter-lived persons, who are worst-off due to premature death and receive less over their whole lives. Basic capital solves this problem by providing a one-off grant to the young, but I argue that it mistreats long-lived persons, as it does not guarantee their real freedom across life. There is a dilemma between these proposals regarding (...) their respective unfairness to the short- and long-lived. The solution I propose is a net basic income of decreasing magnitude until a specific age, after which the income is constant. This solution is compatible with constant income benefits across life, and it offers a fair answer to the problem of unequal longevity, a widely neglected but essential challenge in debates about basic income. (shrink)

Principles of sufficiency are widely discussed in debates about distributive ethics. However, critics have argued that sufficiency principles are vulnerable to important objections. This paper seeks to clarify the main claims of sufficiency principles and to examine whether they have something distinctive and plausible to offer. The paper argues that sufficiency principles must claim that we have weighty reasons to secure enough and that once enough is secured the nature of our reasons to secure further benefits shifts. Having characterized sufficientarianism (...) in this way, the paper shows that the main objections to the view can be avoided; that we can examine the plausibility of sufficiency principles by appealing to certain reasons that support a shift; and that we should be optimistic about the prospects for sufficientarianism because many of our strongest reasons seem to be of this sort. This shift, I claim, is the overlooked grain of truth in sufficientarianism. (shrink)

Equality of Opportunity is widely thought of as the normative ideal most relevant to the design of educational institutions. One widely discussed interpretation of this ideal is Rawls' principle of Fair Equality of Opportunity. In this paper I argue that theories, like Rawls, that give priority to the achievement of individual autonomy, are committed to giving that same priority to a principle of sufficient opportunity. Thus, the Rawlsian's primary focus when designing educational institutions should be on sufficiency and not equality. (...) The paper then argues this commitment has at least three attractive implications. Firstly, it enables defenders of Fair Equality of Opportunity to overcome Richard Arneson's powerful objections. Secondly, it suggests a revised version of the principle of Fair Equality of Opportunity that is more plausible. Thirdly, it has attractive practical implications for educational provision. (shrink)

Utilitarians are said to be indifferent between interpersonal and intrapersonal transfers. In doing so, they fail to register the separateness of persons. This ‘separateness of persons’ objection has been traditionally used against utilitarianism, but more recently against prioritarianism. In this paper, I examine how yet another distributive view, namely sufficientarianism, fares in this respect. Sufficientarians famously believe that while inequality as such does not matter, what does matter is that all individuals meet some adequate threshold. It is often taken for (...) granted that sufficientarianism does not violate the separateness of persons. In this paper, I seek to show that that is not the case. The main challenge, however, proves to be formulating an accurate understanding of what the separateness of persons precisely means. I offer several interpretations and argue that sufficientarianism, surprisingly, violates them all. Sufficientarianism, just like utilitarianism does not respect the separateness of persons. (shrink)

What impact should sufficientarianism have on the measurement of inequality? Like other theories of justice, sufficientarianism influences how economic inequality is conceived. For the purpose of measurement, its standards of justice can be approximated by income-based thresholds of sufficiency. At which income level could a threshold of having enough be pegged in OECD countries? What would it imply for standard indicators of inequality, such as decile comparisons of cumulated income, income spreads, or the Gini coefficient? This paper suggests some answers (...) to these questions, showing that sufficientarian ideas could make a difference with respect to the measurement of inequality in a society. (shrink)

Many theories of social justice maintain that concern for the social bases of self-respect grounds demanding requirements of political and economic equality, as self-respect is supposed to be dependent on continuous just recognition by others. This paper argues that such views miss an important feature of self-respect, which accounts for much of its value: self-respect is a capacity for self-orientation that is robust under adversity. This does not mean that there are no social bases of self-respect that such theories ought (...) to incorporate. It means that they are different: they consist of the motivational and epistemic resources needed to develop and maintain such robustness. (shrink)

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

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

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

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

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

Sufficiency principles generally state that it is especially important for justice that people have enough of certain goods, but it can be hard to give a convincing answer as to what level of goods counts as enough. This paper examines a recent sufficiency view by George Sher, who argues that the threshold level of resources and opportunities that the state should provide for each citizen is whatever level gives one enough leverage to obtain further resources and opportunities without inordinate difficulty (...) or sacrifice. The argument relies on the idea that, with regard to resources and opportunities, the sufficient ability to live one’s life effectively requires only that one have enough of them as leverage. While Sher’s general account regarding “what counts as enough?” is promising in countering certain challenges typically raised against sufficiency principles, the approach to determine the threshold of resources and opportunities in terms of leverage is problematic. (shrink)

The standard version of sufficientarianism maintains that providing people with enough, or as close to enough as is possible, is lexically prior to other distributive goals. This article argues that this is excessive – more than distributive justice allows – in four distinct ways. These concern the magnitude of advantage, the number of beneficiaries, responsibility and desert, and above-threshold distribution. Sufficientarians can respond by accepting that providing enough unconditionally is more than distributive justice allows, instead balancing sufficiency against other considerations.

The indifference objection is one of the most powerful objections to sufficientarianism. Critics argue that sufficientarianism is objectionably indifferent to the distribution of benefits and burdens. This article focuses on the criticism of the latter, particularly the claim that sufficientarianism is indifferent to taxation. Contrary to this allegation, it is argued that sufficientarianism warrants progressive taxation, the reason being that even those who are sufficiently well off face the risk of being pushed below sufficiency. This risk decreases the better off (...) someone is as it is easier for those who are better off to deal with sufficiency-threatening circumstances. It is argued that the risk of insufficiency understood as a function of distance to the threshold justifies progressive taxation. The proposed line of reasoning corresponds to the sufficientarian belief that there should be no redistribution between the rich, as the differences in risk of insufficiency eventually become marginal among those who are very well off. Moreover, the proposed rationale for progressive taxation does not depend on prioritarian or egalitarian reasoning. Rather, it transpires that sufficientarianism is well-suited to justify the progressive redistributive system of the modern welfare state. (shrink)

The issue of distributive justice receives substantial amount of attention in our society. On the one hand, we are sensitive to whether and the extent to which people are responsible for being worse off. On the other hand, we are mindful of society’s worst-off members. There has been a debate over luck egalitarianism, which relates to the former concern, and relational egalitarianism, which echoes the latter. By investigating the psychological processes of these two concerns, this paper examines the reliability of (...) the argument that Elizabeth Anderson, a renowned relational egalitarian, presents against luck egalitarianism and for relational egalitarianism. It also considers whether it is possible to support luck egalitarianism and relational egalitarianism simultaneously, using an online experiment. The results of the experiment show that, first, for ordinary people, the luck consideration is as important as the basic capabilities consideration. Second, while real people consider the degree of compensation through the factors of causality and responsibility, the lack of basic capabilities directs them to determine how much victims of bad luck should be compensated. This suggests that pluralist egalitarianism is on the right track. (shrink)

In this paper I address the objection to sufficientarianism posed by Paula Casal and Richard Arneson, that it is hard to conceive of a sufficiency threshold such that distribution is highly important just below it, and not required at all just above it. In order to address this objection, I elaborate on the idea that sufficientarianism structurally can be seen to require two separate thresholds, which may or may not overlap. I then argue that a version of such a view (...) is plausible. Lastly, I distinguish this view from related proposals in the literature. (shrink)

A common objection to sufficientarianism is that it allows large inequalities above the threshold. A sharpened form of this objection highlights that this indifference also encompasses large inequalities in the distribution of burdens. Consider the burdens that follow from climate change. A theory that does not rule out placing these burdens on the worst off (of the sufficiently well off) will appear implausible to many. This paper assesses ways of addressing this objection and defends a revised conception of sufficientarianism that (...) can demand fair distribution of burdens (and benefits) above the sufficiency threshold, without giving up core sufficientarian theoretical commitments. (shrink)

Politics, Philosophy & Economics, Volume 21, Issue 1, Page 55-74, February 2022. Many find that the objectionable nature of paternalism has something to do with belief. However, since it is commonly held that beliefs are directly governed by epistemic as opposed to moral norms, how could it be objectionable to hold paternalistic beliefs about others if they are supported by the evidence? Drawing on central elements of relational egalitarianism, this paper attempts to bridge this gap. In a first step, it (...) argues that holding paternalistic beliefs about others implies a failure to regard them as equals in terms of their moral agency. In a second step, it shows that the fact that we should regard others as equals in this sense raises the threshold for sufficiency of evidence for paternalistic beliefs to be epistemically justified. That is, moral reasons of relational equality encroach on the epistemic. However, these reasons are not decisive. In cases where others are about to jeopardize critical goods such as their lives, mobility or future autonomy, relational equality sometimes calls for paternalistic action and, by extension, the formation of beliefs that render such action rational. The upshot is that in order to meet demands of relational equality we have a pro tanto reason to not hold paternalistic beliefs about others. (shrink)

Many find that the objectionable nature of paternalism has something to do with belief. However, since it is commonly held that beliefs are directly governed by epistemic as opposed to moral norms, how could it be objectionable to hold paternalistic beliefs about others if they are supported by the evidence? Drawing on central elements of relational egalitarianism, this paper attempts to bridge this gap. In a first step, it argues that holding paternalistic beliefs about others implies a failure to regard (...) them as equals in terms of their moral agency. In a second step, it shows that the fact that we should regard others as equals in this sense raises the threshold for sufficiency of evidence for paternalistic beliefs to be epistemically justified. That is, moral reasons of relational equality encroach on the epistemic. However, these reasons are not decisive. In cases where others are about to jeopardize critical goods such as their lives, mobility or future autonomy, relational equality sometimes calls for paternalistic action and, by extension, the formation of beliefs that render such action rational. The upshot is that in order to meet demands of relational equality we have a pro tanto reason to not hold paternalistic beliefs about others. (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)

In this article, I firstly discuss why a prioritarian clause can rescue the utilitarian doctrine from the risk of exacerbating inequality in the distribution of resources in those cases in which utility of income does not decline at the margin. Nonetheless, when in the presence of adaptive preferences, classic prioritarianism is more likely than utilitarianism to increase the inequality of resources under all circumstances, independently of the diminishing trend of utility. Hence, I propose to shift the informational focus of prioritarianism (...) from welfare to either social income or capabilities in order to safeguard those who are worse off. Following this, I argue that we may have reasons to limit the aggregative logic of priority-amended utilitarianism through one or more sufficiency thresholds, and that we can partially defuse the negative-thesis objection that is usually levelled against sufficientarianism, provided we interpret the threshold(s) as valid only as long as everyone is led above it. (shrink)

In this article, we deal with the evaluation of the losses suffered by persons living in urban areas as a result of energy services. In the first part, we analyse how by adopting different informational foci we obtain contrasting interpersonal evaluations regarding the same loss. In the second part, we distinguish between a diachronic and a hypothetical/moralised threshold for harm in order to assess whether individuals are benefiting from or being harmed by a given energy service. Our argument is that (...) the most accurate evaluation of an individual damage caused by an energy service can be obtained by using capabilities as informational focus, instead of realised wellbeing or means to wellbeing, and by interpreting the loss in relation to a hypothetical/moralised threshold that corresponds to a list of central capabilities. In the last part, we address monetary and non-monetary compensations for a loss that is evaluated in terms of capabilities. Accordingly, we expound how compensation policies can either restore the capabilities lost due to energy services or monetarily compensate the individual for the fact that a given capability (or set of capabilities) has been irremediably lost. (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)

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)