Tännsjö’s book Setting Health-Care Priorities defends the view that there are three main normative theories in the domain of distributive justice, and that these theories are both highly plausible in themselves, and practically convergent in their normative conclusions. All three theories point to a somewhat radical departure from the present distribution of medical resources: in particular, they suggest redirecting resources from marginal life extension to the care of mentally ill patients. In this paper I wish to argue, firstly, that prioritarianism (...) should not be considered as an amendment to utilitarianism, as it is in Tännsjö’s view, but as a distinctive fourth option. This can best be appreciated if we focus on a reading of the theory that emphasizes its derivation from egalitarianism and its attempt to develop an intermediate approach between utilitarian and egalitarian intuitions. Secondly, in response to Tännsjö’s central objection to prioritarianism, I will argue that the theory does not apply in intrapersonal cases but is only relevant for decisions regarding the interpersonal distribution of benefits. Finally, I will suggest that a practical convergence of the four theories on specific issues such as artificial reproduction or mood enhancement is far less likely than Tännsjö seems to believe. (shrink)

A well-known objection to prioritarianism, famously levelled by Mike Otsuka and Alex Voorhoeve, is that it wrongly ignores the unity of the individual in treating intra-personal cases like inter-personal cases. In this paper we accept that there should be a moral shift between these cases, but argue that this is because autonomy is a relevant consideration in intra-personal but not inter-personal cases, and one to which pluralist prioritarians ought to attend. To avoid this response, Otsuka and Voorhoeve must assume we (...) know nothing about the subjective information of the person being chosen for. But we show that this commits them to two controversial assumptions: that welfare consists in an objective list of goods, and – if one accepts an unorthodox but plausible account of the relationship between risk aversion and rationality – that there is only a narrow range of rational risk aversions. Only prioritarians who accept both these assumptions are on the hook of Otsuka and Voorhoeve’s objection; for all others, the examples have insufficient information, and so lose their sting. (shrink)

In a recent article, Michael Otsuka and Alex Voorhoeve argue that prioritarianism fails to account for the shift in moral significance in gains to individuals in interpersonal as compared to intrapersonal cases. In this article, I show that the priority view escapes this objection but in a way that deprives it of (some of) its anti-egalitarian stance. Despite Otsuka and Voorhoeve, prioritarianism, rightly understood, provides consistent and attractive recommendations in both single- and multi-person cases. Yet prioritarians, the article goes on (...) to show, cannot do so while availing themselves of the leveling down objection (LDO) to egalitarianism. They may not do so because similarly to egalitarianism, prioritarianism also must reject the principle of personal good. That is, egalitarians and prioritarians may sometime recommend certain actions and outcomes even when these are better for no one. Prioritarians may survive the Otsuka–Voorhoeve critique, but to do so they must abandon their anti-egalitarian stance (or at the very least, the LDO). (shrink)

Due to COVID-19’s strain on health systems across the globe, triage protocols determine how to allocate scarce medical resources with the worthy goal of maximising the number of lives saved. However, due to racial biases and long-standing health inequities, the common method of ranking patients based on impersonal numeric representations of their morbidity is associated with disproportionately pronounced racial disparities. In response, policymakers have issued statements of solidarity. However, translating support into responsive COVID-19 policy is rife with complexity. Triage does (...) not easily lend itself to race-based exceptions. Reordering triage queues based on an individual patient’s racial affiliation has been considered but may be divisive and difficult to implement. And while COVID-19 hospital policies may be presented as rigidly focused on saving the most lives, many make exceptions for those deemed worthy by policymakers such as front-line healthcare workers, older physicians, pregnant women and patients with disabilities. These exceptions demonstrate creativity and ingenuity—hallmarks of policymakers’ abilities to flexibly respond to urgent societal concerns—which should also be extended to patients of colour. This paper dismantles common arguments against the confrontation of racial inequity within COVID-19 triage protocols, highlights concerns related to existing proposals and proposes a new paradigm to increase equity when allocating scarce COVID-19 resources. (shrink)

I argue that the use of the separateness of persons in the debate between the priority view and the competing claims view is deeply flawed. In making the case, I argue for three points. First, that...

The harms of climate change are deeply uncertain. Though climate change will render most individuals more vulnerable to harm, many individuals will not actually suffer climate-related harms. In this paper, I argue that vulnerability to harms is itself a harm, because it undermines our enjoyment of the good of security. After some brief remarks on the concept of security, I give three reasons for thinking that depriving an individual of the security of basic goods harms them: it has a strong (...) contingent connection to fear and anxiety, it directly undermines their ability to make reasonable plans, and security may reasonably be valued as an end in itself. This suggests that one of our goals in determining climate policy ought to be mechanisms which ensure the security of basic goods. (shrink)

Prioritarianism is a moral view that ranks outcomes according to the sum of a strictly increasing and strictly concave transformation of individual well-being. Prioritarianism is ‘welfarist’ (namel...

Suppose that you must make choices that may influence the well-being and the identities of the people who will exist, though not the number of people who will exist. How ought you to choose? This paper answers this question. It argues that the currency of distributive ethics in such cases is a combination of an individual’s final well-being and her expected well-being conditional on her existence. It also argues that this currency should be distributed in an egalitarian, rather than a (...) prioritarian, manner. (shrink)

In this thesis, I discuss the aggregation problem for T. M. Scanlon’s “contractualism”. I argue that Scanlonian contractualists have the following two options when it comes to the aggregation problem. First, they can choose to limit aggregation directly via a specific version of the Relevance View, “Sequential Claims-Matching”. Second, Scanlonian contractualists can adopt a so-called “mixed solution” of which I propose a specific version. My mixed solution does not limit aggregation. Rather, it either avoids some of the counterintuitive results in (...) certain cases, or at least makes these same results look a lot less counterintuitive by putting them into perspective thanks to a plausible plurality of precisely specified values. The stakes between these two options are as follows. The first option justifies Scanlon’s intuition in one vs. many cases of which his “World Cup Case” is one example, but it comes at the cost of a seemingly quite limited range of application: any version of the Relevance View only works in cases in which we have no more than two groups of competing claimants. The second option has the exact opposite implications: my mixed solution cannot justify Scanlon’s intuition in one vs. many cases, but it could be applied to any case with any number of groups of competing claimants. In this choice between pre-theoretical intuition and feasibility, I would urge Scanlonian contractualists to choose feasibility. (shrink)

Luck egalitarians claim that disadvantage is worse when it emerges from an unchosen risk than when it emerges from a chosen risk. I argue that disadvantage is also worse when it emerges from an unchosen risk that the disadvantaged agent would have declined to take, had he or she been able to do so, than when it emerges from an unchosen risk that the disadvantaged agent would not have declined to take. Such a view is significant because it allows both (...) luck egalitarians and prioritarians to respond to Voorhoeve and Fleurbaey's charge that they fail to accommodate intuitions about the moral relevance of interpersonal boundaries – the so-called separateness of persons objection. I argue that the view is plausible independently of its ability to answer the separateness of persons objection, and is a natural extension of the luck egalitarian concern with the impact of unchosen circumstance. (shrink)

Several authors have argued that contractualism faces a dilemma when it comes to justifying risks generated by socially valuable activities. At the heart of the matter is the question of whether contractualists should adopt an ex post or an ex ante perspective when assessing whether an action or policy is justifiable to each person. In this paper I argue for the modest conclusion that ex post contractualism is a live option notwithstanding recent criticisms raised by proponents of the ex ante (...) perspective. I then consider how an ex post contractualist can best respond to the problem that it seems to prohibit a range of intuitively permissible and socially valuable activities. (shrink)