In the language of secular bioethics, autonomy is always accorded first place in the hierarchy of values that has come to be referred to as the “Georgetown mantra” A dictionary definition of mantra is “a verbal spell, ritualistic incantation, or mystic formula used devotionally,” and the value placed upon autonomy is largely of this nature: uncritical and uncriticised. That there should be and are limits to autonomy is obvious, but these boundaries are undefined, little discussed, and mostly unexplored. To use (...) another metaphor, our emphasis on autonomy is an index of how far the pendulum has swung in an understandable and partly justifiable reaction from, earlier paternalism; has this swing approached its proper limit, and should we be seeking a less extreme and more balanced assessment of autonomy as a bioethical value? (shrink)

Ultimately this book provides a theory of intergenerational justice that is both intellectually robust and practical with wide applicability to law and policy.

Should it be a matter of concern that youth unemployment rates are significantly higher in some countries than they have been historically? Or that parliaments.

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)

Politics, Philosophy & Economics, Volume 21, Issue 2, Page 165-189, May 2022. It is generally acknowledged that a certain amount of state intervention in health and health care is needed to address the significant market failures in these sectors; however, it is also thought that the primary rationale for state involvement in health must lie elsewhere, for example in an egalitarian commitment to equalizing access to health care for all citizens. This paper argues that a complete theory of justice in (...) health can be derived from a commitment to correcting market failure, or in other words promoting Pareto-efficiency, in the domain of health. This approach can address familiar problems around access to care, as well as problems related to resource allocation and rationing, the control of health care costs, and the foundations of public health. Egalitarian theories of justice in health cannot make sense of the depth and pervasiveness of state involvement in health and health care; only a theory rooted in the need to correct market failure can. (shrink)

In this article, I put forward an instrumental justification for the introduction of youth quotas in parliaments on grounds of justice between coexisting generations. I provide a two-fold argument drawing on the distinction between “substantive representation” and “symbolic representation”. I argue that these jointly provide a good basis for a “politics of youth presence” in parliaments. In the first section, I evaluate the impact that youth quotas can have on enhancing the chances of fair youth policies. In the second section, (...) I show that youth quotas can play an important symbolic role in the promotion of a community of political equals, with potential implications for youth political participation. (shrink)

This paper explores the debate between perfectionists and anti-perfectionists in the context of children. It suggests that the most influential and compelling arguments in favour of anti-perfectionism are adult-centric. It does this by considering four leading reasons given in favour of anti-perfectionism and shows that none apply in the case of children. In so doing, the paper defends a perfectionist account of upbringing from the attacks made against perfectionism more generally. Furthermore, because the refutation of the various anti-perfectionist arguments are (...) made exclusively dealing with children, the paper suggests that the perfectionist view of upbringing is compatible with anti-perfectionist restrictions on dealing with adults. This dual view combining perfectionism for children and anti-perfectionism for adults is referred to as restricted perfectionism. (shrink)

The issues are familiar to most in bioethics by now, through professional or personal experiences (or both). The rapidly expanding population of elderly persons who require care is raising critical...

The allocation of scarce health care resources such as flu treatment or organs for transplant presents stark problems of distributive justice. Persad, Wertheimer, and Emanuel have recently proposed a novel system for such allocation. Their “complete lives system” incorporates several principles, including ones that prescribe saving the most lives, preserving the most life-years, and giving priority to persons between 15 and 40 years old. This paper argues that the system lacks adequate moral foundations. Persad and colleagues' defense of giving priority (...) to those between 15 and 40 leaves them open to the charge that they discriminate unfairly against children. Second, the paper contends that the complete lives system fails to provide meaningful practical guidance in central cases, since it contains no method for balancing its principles when they conflict. Finally, the paper proposes a new method for balancing principles of saving the most lives and maximizing life-years. (shrink)

Citizens in wealthy liberal democracies are typically expected to see to basic needs like food, clothing, and shelter out of their own income, and those without the means to do so usually receive assistance in the form of cash transfers. Things are different with health care. Most liberal societies provide their citizens with health care or health care insurance in kind, either directly from the state or through private insurance companies that are regulated like public utilities. Except perhaps for small (...) co-pays or deductibles, citizens are not expected to see to their health needs out-of-pocket, at least for some basic level of care. Instead, when a citizen gets sick, the state or her insurance company foots the... (shrink)

In this paper, I assess Peter Dabrock's “Drawing distinctions responsibly and concretely: A European Protestant perspective on foundational theological bioethics.” I explore the ways in which Dabrock announces nontraditional Christian assumptions to guide Christian bioethics, engages the secular bioethical agenda on the very terms set by and congenial to the field of secular bioethics, and searches for insights from philosophy and science through which to recast Christian moral judgments. For example, he cites approvingly, as if they were expressive of Christian (...) moral concerns: human rights, democracy, and state-based social redistribution of resources to satisfy welfare entitlements. In this short essay, I argue that Dabrock has unduly limited the role of Traditional Christian theology to guide bioethics and, consequently, has also wrongly characterized the Christian moral life and Christian social/political obligations. (shrink)

What should maximin egalitarians think about seniority privileges? We contrast a good-specific and an all-things-considered perspective. As to the former, inertia and erasing effects of a seniority-based allocation of benefits from employment are identified, allowing us to spot the categories of workers and job-seekers made involuntarily worse off by such a practice. What matters however is to find out whether abolishing seniority privileges will bring about a society in which the all-things-considered worst off people are better off than in the (...) seniority rule's presence. An assessment of the latter's cost-reduction potential is thus needed, enabling us to bridge a practice taking place within a firm with its impact on who the least well off members of society are likely to be. Three accounts of the profitability of seniority privileges are discussed: the “(firm specific) human capital”, the “deferred compensation” and the “knowledge transfer” ones. The respective relevance of “good-specific” and “all-things-considered” analysis is discussed. It turns out that under certain circumstances, a maximin egalitarian case for seniority privileges could be made. Senior: Do you know that they are planning layoffs? Of course, it is only fair that they lay-off the newcomers first! After all, I have been loyal to the company for many years. Junior: Did I choose to be a newcomer? Footnotes1 Many thanks to two anonymous referees, to P.-M. Boulanger, B. Cockx, C. Fabre, L. Jacquet, E. Lazear, I. Robeyns, G. Vallée, Y. Vanderborght, Ph. Van Parijs, V. Vansteenberghe and J. de Wispelaere for their help and critical comments. Earlier versions of this paper were presented in Louvain-la-Neuve, Ghent, Montevideo and London. I am very grateful to these audiences. Special thanks to G. Brennan for his extensive and extremely valuable comments on earlier drafts of this paper. The usual disclaimers apply. (shrink)

Around the world, the population is ageing in ways that pose new challenges for healthcare providers. To date these have mostly been formulated in terms of challenges created by increasing costs, and the focus has been squarely on life-prolonging treatments. However, this focus ignores the ways in which many older people require life-enhancing treatments to counteract the effects of physical and mental decline. This paper argues that in doing so it misses important aspects of what justice requires when it comes (...) to older people. (shrink)

While different worries about population size are present in public debates, political philosophers often take population size as given. This paper is an attempt to formulate a Rawlsian liberal egalitarian approach to population size: does it make sense to speak of ‘too few’ or ‘too many’ people from the point of view of justice? It argues that, drawing on key features of liberal egalitarian theory, several clear constraints on demographic developments – to the extent that they are under our control (...) – can be formulated. Based on these claims, we can clarify both the grounds and content of our obligations to future generations. (shrink)

Dieser Beitrag untersucht die Frage, ob erwachsene Kinder ihren Eltern als deren Kinder etwas schulden. Ich argumentiere, dass sich entsprechende filiale Pflichten nicht begründen lassen, und zwar weder i.) mit Verweis auf Güter, die Kinder im Laufe ihrer Kindheit von ihren Eltern erhalten haben, noch ii.) vor dem Hintergrund der aktuellen Beziehung zwischen Eltern und ihren erwachsenen Kindern, noch iii.) mit Blick auf das positive Potential dieses Verhältnisses für Eltern wie Kinder. Zwar haben Kinder also keine filialen Pflichten, doch sind (...) sie iv.) dennoch in ihrer filialen Freiheit eingeschränkt. Diese Einschränkung ergibt sich aus der speziellen relationalen Vulnerabilität, welche die Eltern-Kind-Beziehung prägt und die Kindern Grund gibt, sich in ihrem Verhalten ihren eigenen Eltern gegenüber von dieser Verletzlichkeit leiten zu lassen und auf sie Rücksicht zu nehmen. (shrink)

In this paper, I offer a solution to the Capacity/Equality Puzzle. The puzzle holds that an account of the franchise may adequately capture at most two of the following: (1) a political equality-based account of the franchise, (2) a capacity-based account of disenfranchising children, and (3) universal adult enfranchisement. To resolve the puzzle, I provide a complex liberal egalitarian justification of a moral requirement to disenfranchise children. I show that disenfranchising children is permitted by both the proper political liberal and (...) the proper political egalitarian understandings of the relationship between cognitive capacity and the franchise. Further, I argue, disenfranchising children is required by a minimalistic, procedural principle of collective competence in political decision-making. At the same time, I show that political equality requires the enfranchisement of all adults, regardless of cognitive capacities, and that the collective competence principle does not ground adult disenfranchisement. This justifies the progressive legal trend that holds the capacity-based disenfranchisement of adults to be incompatible with liberal democratic principles. (shrink)

Nancy Jecker (2013) makes a compelling argument for using a capabilities approach to resolve the issue of the fair allocation of health care resources across various age groups. This question has b...

Rather than base social welfare policies on contractual bargaining, policies should focus on the duties the strong members of society have toward the weak: the poor should clearly receive more, and the rich pay more, than either group has bargained for.

Ausgehend von einem im Februar 2014 ergangenen BGH-Urteil, das die Unterhaltspflicht von erwachsenen Kindern gegenüber ihren Eltern auch im Falle des einseitigen Kontaktabbruchs bejaht, werden in diesem Beitrag Überlegungen zur Struktur und den normativen Implikationen der Eltern-Kind-Beziehung angestellt. Zum einen wird dafür plädiert, die Eltern-Kind-Beziehung als nichtsymmetrisch, d. h. als Komplex aus symmetrischen und asymmetrischen Beziehungen zu verstehen. Zum anderen wird hinsichtlich der normativen Implikationen der Eltern-Kind-Beziehung dafür argumentiert, dass Verpflichtungen innerhalb dieser Beziehung nicht vom bloßen Bestehen, sondern vom Wert (...) der Beziehung abhängig zu machen sind. Aus diesem Argument wird gefolgert, dass die im BGH-Urteil sowie im in der einschlägigen Literatur diskutierten „Past Parental Sacrifices Model“ unterstellte Symmetrie der Eltern-Kind-Beziehung zu einer inadäquaten normativen Analyse führt. Damit wird der Rechtfertigungsstrategie filialer Verpflichtungen, die auf ein Quidproquo bezüglich zurückliegender elterlicher Versorgungsleistungen gestützt ist, eine Absage erteilt. (shrink)

Societal aging raises challenging ethical questions regarding the just distribution of health care between young and old. This article considers a proposal for age-based rationing of health care, which is based on the prudential life span account of justice between age groups. While important objections have been raised against the prudential life span account, it continues to dominate scholarly debates. This article introduces a new objection, one that develops out of the well-established disability critique of social contract theories. I show (...) the implications of this critique for the prudential life span account and for the special case of age-group justice. The result is that age-based rationing based on the prudential life span approach is not supported, and that the prudential life span approach itself is not the best way to think about allocating health care between age groups. I propose an alternative approach that avoids the disability objection, and consider its implications for specific proposals for age-based rationing of health care. (shrink)

In September 1994, theNew York Timescarried a front page article declaring healthcare reform dead in Congress. The obituary on healthcare followed a Congressional decision not to pursue the issue further in 1994. Although Congress and the President will likely revisit healthcare reform during 1995, the choices may be between various incremental steps, rather than substantive changes to bring about universal coverage.

Is age discrimination ethically objectionable? One puzzle is that we sometimes assume that the target of both age discrimination and ageism must be older people, yet in poorer nations, older people are generally shown more respect. This article explores the ethical question. It looks first at ethical arguments favoring age discrimination toward younger people in low‐income, less industrialized countries of the global South, using sub‐Saharan Africa as an illustration. It contrasts these with arguments favoring age discrimination toward older people in (...) high‐income, more industrialized countries of the global North, particularly the United States and United Kingdom. Finally, it considers what role, if any, differences in life expectancy, infant and child mortality, and prospects for healthy lives should play in the moral embrace of a particular view by a community. It argues that there can be reasons to favor different types of discrimination in different parts of the world. (shrink)

In April 2019, Greta Thunberg made TIME Magazine’s 100 Most Influential People of 2019 list. The 16 year-old climate activist, who has also been nominated for a Nobel Peace Prize, started a movement that saw a multitude of student protests and school strikes around the world centred on action against climate change. TIME Magazine quoted her saying, “We can’t save the world by playing by the rules, because the rules have to be changed.” With her engagement, Thunberg inspired thousands of (...) youth activists to join her in her efforts and has thus put not only climate change on the political agenda but also the political participation and representation of the young. And this even though Thunberg and many of her fellow protesters do not yet enjoy voting rights in their respective countries. Just like the previous issue of the Intergenerational Justice Review, this one is also dedicated to the topic of the underrepresentation of younger people in political decision-making. The first two contributions in this issue pay particular attention to the existence – or lack thereof – of networks and contacts in politics that seem to be important for political representation. Daniel Stockemer and Aksel Sundström’s article titled “Youth’s underrepresentation in the European Parliament: Insights from interviews with young Members of the European Parliament ” reports results from qualitative interviews with 23 MEPs on the factors contributing to the success and failure of young people to enter the European Parliament. They find that, in general, three common themes or complaints amongst the successful young MEPs, irrespective of their party affiliation: “ a general reluctance within parties to nominate young candidates, young candidates lacking the necessary contacts in parties to get elected, and young candidates having too little experience to gain nomination for an electable seat.” Despite these heavy criticisms of established politicians and structures, the authors also summarise some more hopeful suggestions by respondents centring around the role of party youth organisations. The second contribution, by Emilien Paulis, also highlights the important role of networks and contacts, yet already at an earlier stage: when joining a political party. Drawing on social network and political participation theory and novel survey data from Belgium, Paulis explores what network patterns contribute to young people’s enrolment in a political party. He discovers strong social ties between young party members and suggests that this indicates “a certain exclusivity in recruitment patterns of political parties”. In addition, his analysis also points out that a highly homogenous network composition is a statistically significant predictor of joining a political party. Overall, Paulis, similar to Stockemer and Sundström, suggests a review of institutional processes and structures within established political organisations such as parties in order to promote a more diverse and above all younger profile of politically active citizens. The final contribution in this issue offers insights from an online survey conducted among young adults in Germany suggesting that these respondents were indeed politically interested and felt willing to assume responsibility through participation. As a consequence, Philipp Köbe concludes from his analysis that the supply-side of political organisations is the main problem in the underrepresentation and not so much young people’s lack of engagement. His four specific recommendations to political organisations follow very much from this conclusion: providing transparent and suitable information to meet young people’s interests and demands; lowering the electoral threshold for parties’ parliamentary representation to improve the representation of minority opinions; expanding youth-friendly opportunities for political participation such as video conferences and social media usages in order to reach out to the appropriate groups; improving the efficiency and impact of political decision-making to reward political engagement amongst young people. Köbe finally suggests a steering instrument for political organisations to help them achieve these goals. In the book review section, we continue the theme of political participation and representation of the young. Simon Pistor reviews the book Youthquake 2017: The Rise of Young Cosmopolitans in Britain by James Sloam and Matt Henn. The book investigates youth political participation in Britain around and after the Brexit referendum in 2016 and is built around the new notion a “youthquake” – a term initially introduced by British media to describe the surprising success of the movement behind the Labour Party but later on also becoming Oxford Dictionaries’ 2017 word of the year. Pistor writes that Sloam and Henn expand the concept of a youthquake in their book to “youthquake elections” – “ones in which dramatic changes in how many young people vote, who they vote for and how active they are in the campaign have, quite literally, shaken up the status quo”. Using this concept, the book’s central claim is that it was a youth movement based on a broader appeal to the needs of young people which spiked the higher voter turnout among young people. Pistor’s review of the book is unequivocal: using methods from comparative politics, the authors provide a “very interesting argument” and “a clear empirical case for the youthquake during the 2017 General Election in the UK”. Pistor also welcomes especially two implications of the book: many young British people are not as politically disenfranchised as general wisdom holds ; many of them are not only cosmopolitans but also British cosmopolitans interested and engaged in national politics. Overall, Simon Pistor concludes that Sloam and Henn’s book is “an empirically rich and informed study”, which might suggest that the key to future democratic successes does indeed lie with the young. Ann-Kristin Kölln Antony Mason Jörg Tremmel Markus Rutsche Maria Lenk. (shrink)

Priority setting of scarce resources in healthcare is high on the agenda of most healthcare systems implying a need to develop robust foundations for making fair allocation decisions. One central factor for such decisions in needs-based systems, following both empirical studies and theoretical analyses, is severity. However, it has been noted that severity is an under-theorized concept. One such aspect is how severity should relate to temporality. There is a rich discussion on temporality and distributive justice, however, this discussion needs (...) to be adapted to the practical and ethical requirements of healthcare priority setting principles at mid-level. In this article, we analyze how temporal aspects should be taken into account when assessing severity as a modifier for cost-effectiveness. We argue that when assessing the severity of a condition, we have reason to look at complete conditions from a time-neutral perspective, meaning that we take the full affectable stretch of the condition into account without modifying severity as patients move through the temporal stretch and without discounting the future. We do not find support for taking the ‘shape’ of a condition into account per se, e.g. whether the severity has a declining or inclining curve, or that severity is intermittent rather than continuous. In order to take severity seriously, we argue that we have reason to apply a quantified approach where every difference in severity should impact on priority setting. In conclusion, we find that this approach is practically useful in actual priority setting. (shrink)

At the beginning of the 21st century; the old 'social question' – the integration of the industrial workers – seems to have been resolved; but new cleavages appear; for example between generations. These emerge from historical or macro-structural changes but also from economic cleavages between generations. The reason why age conflicts are not more pronounced is the mediating function of political parties; unions and families. Furthermore; although it is often claimed that the welfare state is increasingly dominated by the elderly; (...) this is far from being the case. In terms of economic well-being; both the young and the old fare worse than the middle age group. In terms of political decision-making; there is no evidence for an alleged movement towards gerontocracy. (shrink)