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 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)

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)

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)

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)

The age-rationing debate of fifteen years ago will inevitably reemerge as health care costs escalate. All age-rationing proposals should be judged in light of the current system of rationing health care by price in the U.S., and the resulting pattern of excess and deprivation. Age-rationing should be rejected as public policy, but recognized as a personal virtue of stewardship among the elderly.

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...

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)

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

Justice Across Ages offers an attractive account of justice between the young and the old that brings together three notable principles of age-group justice: complete-lives equality, relational equality, and prudence. Yet, the book says little about the fact that many of us live longer than others, and the little it does say casts doubt on whether lifespan inequality threatens justice as construed by the three principles. This essay argues, instead, that theories of justice between the young and the old should (...) not dispense with a conception of justice between different longevity groups. It concludes that we must be sensitive to lifespan variations when designing policies to promote justice across age groups. (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)

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)

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)

ABSTRACT Norman Daniels suggests that the just distribution of resources between different age‐groups is determined by the choice a prudential agent would make in budgeting resources over the different temporal stages of a single life. He calls this view the “prudential lifespan account” of justice between age‐groups. Daniels thinks that the view recommends a rough kind of equality in resources between age‐groups. I argue that in the case of a single life prudence would choose an unequal distribution of resources. Consequently, (...) using prudence to model distribution between age‐groups might severely restrict the share of resources assigned to the elderly. If we think that extreme inequality between age‐groups would be unjust, we should continue to think of justice between age‐groups as a problem concerned with the relationship between different lives. But we should apply the requirement of equality to the temporal parts of lives, not just to complete lives. (shrink)

An aging population is often taken to require a profound reorganization of the prevailing health care system. In particular, a more cost-effective care system is warranted and ICT-based home care is often considered a promising alternative. Modern health care devices admit a transfer of patients with rather complex care needs from institutions to the home care setting. With care recipients set up with health monitoring technologies at home, spouses and children are likely to become involved in the caring process and (...) informal caregivers may have to assist kin-persons with advanced care needs by means of sophisticated technology. This paper investigates some of the ethical implications of a near-future shift from institutional care to technology-assisted home care and the subsequent impact on the care recipient and formal- and informal care providers. (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)

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)

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)

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)

Gender greatly impacts access to opportunities, potential, and success in corporate leadership roles. We begin with a general presentation of why such discussion is necessary for basic considerations of justice and fairness in gender equality and how the issues we raise must impact any ethical perspective on gender in the corporate workplace. We continue with a breakdown of the central categories affecting the success of women in corporate leadership roles. The first of these includes gender-influenced behavioral factors, such as the (...) requirements and expectations of gendered verbal and nonverbal communication styles as well as appearance. We move on to address the impact of family on corporate leadership opportunities and success, discussing the asymmetrical evaluation of an individual’s potential, authority, and competence based on gender stereotypes of familial obligations and expectations. Finally, we address how gender impacts access to networking and sponsorship opportunities and the long-term effects of systematic limitations on women’s inclusion in the upper echelons of corporate leadership. We conclude with a summary of the questions and issues raised by our discussion and direct individuals to consider how different ethical systems and moral requirements might influence their interpretations of gender and leadership in the corporate workplace. (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)

A continuing need for care for elderly, combined with looser family structures prompt the question what filial obligations are. Do adult children of elderly have a duty to care? Several theories of filial obligation are reviewed. The reciprocity argument is not sensitive to the parent–child relationship after childhood. A theory of friendship does not offer a correct parallel for the relationship between adult child and elderly parent. Arguments based on need or vulnerability run the risk of being unjust to those (...) on whom a needs-based claim is laid. To compare filial obligations with promises makes too much of parents’ expectations, however reasonable they may be. The good of being in an unchosen relationship seems the best basis for filial obligations, with an according duty to maintain the relationship when possible. We suggest this relationship should be maintained even if one of the parties is no longer capable of consciously contributing to it. We argue that this entails a duty to care about one’s parents, not for one’s parents. This implies that care for the elderly is not in the first place a task for adult children. (shrink)

The British National Health Service (BNHS) was founded, to quote Minister of Health Aneurin Bevan, to ‘universalise the best’. Over time, however, financial constraints forced the BNHS to turn to incrementalist budgeting, to rationalise care and to ask its practitioners to act as gatekeepers. Seeking a way to ration scarce tertiary care resources, BNHS gatekeepers began to use chronological age as a rationing criterion. Age-rationing became the ‘done thing’ without explicit policy directives and in a manner largely invisible to patients, (...) to Parliament, and to the public. The invisibility of the practice, however, violates the publicity principle that John Rawls and other philosophers believe essential to fairness. BNHS invisible age-rationing practices are thus a test case of the principle that fairness presupposes publicity; they raise the question: is it possible to preserve equitability in a system that uses non-public criteria to allocate scarce resources? To seek an answer, published data on access to end-stage renal disease (ESRD) treatment in Britain and the European Community (EC) are analysed. Among the findings are: that BNHS age-rationing acts as an excuse for denying care to those most likely to need ESRD treatment; and is, moreover, arbitrary and inequitable. It is further argued that no age-rationing policy can sustain visibility, and that, if the BNHS is to be fair to its patients, it must reform its present age-rationing practices, replacing them by a publicly visible, outcome-based rationing policy that rations either in terms of QALYs or triage categories. (shrink)

The COVID-19 pandemic has exacerbated many social problems and put the already vulnerable, such as racial minorities, low-income communities, and older individuals, at an even greater risk than before. In this paper we focus on older adults’ well-being during the COVID-19 pandemic and show that the risk-mitigation measures presumed to protect them, alongside the generalization of an ageist public discourse, exacerbated the pre-existing marginalization of older adults, disproportionately affecting their well-being. This paper shows that states have duties to adopt and (...) put into practice redress measures to compensate for the negative consequences of COVID-19 public health policies on older adults’ overall well-being. These duties flow from the minimal ethical requirement of respect for persons. We show that respect is a morally basic attitude that presupposes taking the others’ interests into account, with the aim of advancing their well-being. This duty is not limited to kinship, relatives, and friends but it extends to states and the rest of the civil society. In the conclusion, we draw lessons from the COVID-19 pandemic and sketch some redress measures that could compensate for the decrease in older adults’ well-being as a result of the adoption of measures to contain the spread of the virus. (shrink)

In this article I investigate the nature and extent of filial obligations. The question what (adult) children owe their parents is not only philosophically interesting, but also of increasing relevance in ageing societies. Its answer matters to elderly people and their adult children, and is relevant to social policy issues in various ways. I present the strongest arguments for and against three models of filial obligations: the ‘past parental sacrifices’ model, the ‘special relationship’ model, and the conventionalist model. There is (...) something to be said—and after consideration of objections something remains to be said—for all three models. In other words: filial obligations have more than one source, and an adequate model of filial obligations should reflect this. On its own, each of the above models is one-sided. They also fail to show the connections between the question of filial obligations and various other issues, such as issues of gender justice, the extent of institutionalization of eldercare, and social conventions regarding filial responsibility. Therefore, I integrate what I think we should keep from the aforementioned models into a contextual, pluralist model, which places filial obligations in a broader social and cultural context and relates them to issues of social justice. The model also highlights the difference between general and specific filial obligations, and the factors that determine their nature and extent, thus enabling a deeper and more comprehensive understanding of filial obligations. (shrink)

Swedish welfare has for decades served as a role model foruniversalistic welfare. When the economic recession hit Swedish economyin the beginning of the 1990s, a period of more than 50 years ofcontinuous expansion and reforms in the welfare sector came to an end.Summing up the past decade, we can see that the economic downturnenforced rationing measures in most parts of the welfare state, althoughmost of this took place in the beginning of the decade. Today, most ofthe retrenchment has stopped and (...) in some areas we can see tendencies ofrestoration – but more so in financial benefits than in the caringsectors. In the article this process is discussed as a process ofreallocation where general principles of solidarity become manifest.Various levels of decision making are discussed within the context ofsocio-political action. Current transitions in Swedish health care aredescribed with respect to coverage rates, content, marketisation anddistribution. Basic principles of distribution are highlighted in orderto analyse the meaning of social solidarity in a concrete allocativesetting. The significance of popular opinion – it's shifts anddeterminants – is also considered. The article concludes with adiscussion of how the (once salient) features of universalism inwelfare and health care provision have been affected by the developmentsin the past decade in Sweden. (shrink)

This paper reconstitutes and addresses critically the deontological and consequentialist arguments given by the French government to justify the denial of the national guaranteed minimum income support to young people under 25 years old. The deontological arguments express a concern for distributive justice and suggest that young people do not deserve income support. The consequentialist arguments; on the other hand; emphasise social efficiency: they draw on the alleged negative outcomes that the extension of income support to young people would bring (...) about. After analysing each argument; this paper concludes that the denial of RSA to young people is an illegitimate discrimination. It then proposes that we understand our duties towards young people through an account of prudence that reconciles both concerns of distributive justice with concerns for social efficiency and concerns for inter- and intragenerational justices. (shrink)

Prioritarianism pertains to the generic idea that it matters more to benefit people, the worse off they are, and while prioritarianism is not uncontroversial, it is considered a generally plausible and widely shared distributive principle often applied to healthcare prioritisation. In this paper, I identify social justice prioritarianism, severity prioritarianism and age-weighted prioritarianism as three different interpretations of the general prioritarian idea and discuss them in light of the effect of pandemic consequences on healthcare priority setting. On this analysis, the (...) paper arrives at the following three conclusions: that we have strong prioritarian reasons for special concern about the vulnerable and socially disadvantaged in reference to pandemic effects, that severity of illness is an important factor in identifying the worse off in priority setting but that this must not over-ride the special priority to the socially disadvantaged and that the maximisation rationale of the age-weighted view runs against the core prioritarian idea, and the age-weighted prioritarianism is thus unfitting as a prioritarian response to the COVID-19 case. (shrink)

As individuals grow older, they usually require assistance with the daily tasks of self-care. This type of assistance, ancillary care, is essential to maintaining the health of those who need these services. In his prudential lifespan account, Norman Daniels includes access to such services making his account an attractive proposal given the current demographic shift. In this paper, I examine the prudential lifespan account through the lens of old age and I focus on the two concepts on which the lifespan (...) account relies. I show that these two concepts, normal species functioning and opportunity cannot buttress Daniels’s lifespan account; at least it cannot do so for older persons. The tensions that I identify in the prudential lifespan account in relation to aging are instructive for the more recent proposals to include aging in a theory of health and health justice. In addition, my analysis allows me to demonstrate that Daniels’s view of opportunity is irreconcilable to capabilities, the latter being more adaptable to the realities of aging. If capabilities appear more promising, it is nonetheless imperative that the specificities of extended care, such as the need for unpaid caregiving, be taken into consideration. (shrink)