Political egalitarians tend to defend equal distributions of voting power at specific times, as in ‘one election, one vote’. Appealing as it is, the principle seems incompatible with distributing power proportionally to the stakes voters have at different elections, as in ‘one stake, one vote’. This article argues that the tension above stems from the temporal scope ascribed to political equality, as at specific moments of democratic decision-making instead of over entire lives. More specifically, ascribing a lifetime view to political (...) equality renders equality compatible with proportionality at different elections. I first show that storable votes differ from standard votes in their distinctive commitment to lifetime political equality. I then argue that storable voting schemes are compatible with three key reasons to value political equality: equal consideration of interests, relational equality, and non-domination. Finally, storable votes are also consistent with proportionality at specific times. I conclude that the neglected idea of lifetime political equality can, through storable votes, deliver proportionality without inequality. (shrink)

This paper argues that we can see our lives as a snapshot happening now or as a moving picture extending across time. These dual ways of seeing our lives inform how we conceive of the problem of age group justice. A snapshot view sees age group justice as an interpersonal problem between distinct age groups. A moving picture view sees age group justice as a first-person problem of prudential choice. This paper explores these different ways of thinking about age group (...) justice and illustrates them using a principle of respect for human dignity, understood in terms of reasonable support for floor level central human capabilities at each stage of life. I argue that different frames are suitable for different kinds of decisions, and each provides a true, but partial, picture of aging and age group justice. (shrink)

The global COVID-19 pandemic has brought the issue of rationing finite healthcare resources to the fore. There has been much academic debate, media attention, and conversation in the homes of everyday individuals about the allocation of medical resources, diagnostic testing kits, ventilators, and personal protective equipment. Yet decisions to prioritize treatment for some individuals over others occur implicitly and explicitly in everyday practices. The pandemic has propelled the socially taboo and unavoidably prickly issue of healthcare rationing into the public spotlight—and (...) as such, healthcare rationing demands ongoing public attention and transparent discussion. This article concludes that in the aftermath of COVID-19, policymakers should work towards normalizing rationing discussions by engaging in transparent and honest debate in the wider community and public domain. Further, injecting greater openness and objectivity into rationing decisions might go some way towards dismantling the societal taboo surrounding rationing in healthcare. (shrink)

A society is said to age when its number of older members increases in relation to its number of younger members. The societies in most of the world’s industrialized nations have been aging since at least 1800. In 1800 the demographic makeup of developed countries was similar to that of many Third World countries in the early 1990s with roughly half the population under the age of 16 and very few people living beyond age of 60. Since that time, increases (...) in life expectancy, combined with declines in fertility rates, have dramatically increased the proportion of older persons in developed nations. The rapid increase in the number of older persons relative to younger ones carries important societal implications. In the domain of healthcare, societal aging will increase costs and exert greater pressure to ration services. It will, thus, bring to the fore questions, regarding a just distribution of healthcare between young and old age groups. This paper considers some of the most influential arguments to date for age-based rationing of health care. I show that these arguments fall short, and that the theoretical assumptions underlying them do not withstand careful scrutiny. (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)

Lockdowns were a morally and medically appropriate anti-contagion policy to stop the spread of Covid. However, lockdowns came with considerable costs. Specifically, lockdowns imposed harms and losses upon the young in order to benefit the elderly, who were at the highest risk of severe illness and death from Covid. This represented a shifting of the (epidemiological) burden of Covid for the elderly to a systemic burden of lockdown upon the young. This article argues that even if lockdowns were a morally (...) permissible response to Covid, the harms and losses they imposed on the young ground a claim of compensation. I defend an intergenerational compensation argument that defends a claim for an egalitarian intergenerational transfer to compensate the young for the harms of lockdown. (shrink)

Could age be a valid criterion for rationing? In Just health, Norman Daniels argues that under certain circumstances age rationing is prudent, and therefore a morally permissible strategy to tackle the problem of resource scarcity. Crucial to his argument is the distinction between two problem-settings of intergenerational equity: equity among age groups and equity among birth cohorts. While fairness between age groups can involve unequal benefit treatment in different life stages, fairness between birth cohorts implies enjoying approximate equality in benefit (...) ratios. Although both questions of fairness are distinct, the resolution of the one depends on resolution of the other. In this paper, I investigate whether Daniels’ account of age rationing could be defended as a fair way of setting limits to healthcare entitlements. I will focus on two main points. First, I will consider whether the age group problem could be resolved without appealing to a conception of the good. Second, I will demonstrate that the connection between the age group problem and the birth cohort problem runs deeper than Daniels initially thought—and that it ultimately suggests a method for prioritisation in problem solving strategies. (shrink)

It is a common view that benefits to the worse off should be given priority when health benefits are distributed. This paper addresses how to understand who is worse off in this context when individuals are differently well off at different times. The paper argues that the view that this judgment about who is worse off should be based solely on how well off individuals are when their complete lives are considered (i.e. 'the complete lives view') is implausible in this (...) context. Instead, it is argued that a pluralistic stance toward this issue should be accepted. This pluralistic stance recognizes that also the view that only focuses on how well off individuals are now and in the future (i.e. 'the forward-looking view') is relevant. The argument is based on appeals to intuitive judgments concerning who is worse off in different cases and reference to various underlying reasons why priority to benefits to the worse off is justified. (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: (1) shedding some light on an under-researched and yet crucial question – ‘which inequalities between generations matter?’ and (2) 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 (complete lives egalitarianism) 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 (but not necessarily displacement) by the relational view. (shrink)

This is a short reply to Professor Reichlin’s comment on my book Setting Health-Care Priorities. What Ethical Theories Tell Us. The version of prioritarianism I rely on in the book is defended as the most plausible one. The general claim that there is convergence between all plausible theories on distributive justice is also defended with regard to assisted reproduction, disability, and enhancement.

The fact that our attitudes change poses well-known challenges for attitude-sensitive wellbeing theories. Suppose that in the past you favoured your adventurous youthful life more than the quiet and unassuming life you expected to live as an old person; now when you look back you favour your current life more than your youthful past life. Which period of your life is better for you? More generally, how can we find a stable attitude-sensitive standard of wellbeing, if the standard is in (...) part defined in terms of unstable attitudes? In this paper, I introduce an ‘attitudinal matrix’ framework that will help us clear up the problems posed by changing attitudes across time. In particular, it will help us see what is at stake, which principles that can or cannot be combined, and what might be the best solution. I defend a very plausible candidate constraint on a solution to the challenge of changing attitudes, which I call ‘diagonalism’. It is argued that among the three main forms of substantive attitude-sensitive wellbeing theories – the attitude-version, the object-version, and the satisfaction-version – it is the satisfaction-version that can both satisfy diagonalism and provide the best account of temporal and lifetime wellbeing. (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 any normal population, health is unequally distributed across different age groups. Are such age-based health inequalities unjust? A divide has recently developed within egalitarian theories of...