Many welfarists wish to assign to each possible state of the world a numerical value that measures something like its moral goodness. How are we to determine this quantity? This paper proposes a contractualist approach: a legitimate measure of moral goodness is one that could be justified to each member of the population in question. How do we justify a measure of moral goodness to each individual? Each individual recognises the measure of moral goodness must be a compromise between the (...) different levels of well-being within the population. Some compromises are more reasonable than others; and some are better justifiable to a given member of the population than others. Each member recognises that the social chooser's measure of moral goodness is going to have to deviate from the well-being function of at least some of the members of the population. But we can nonetheless justify it to each of them if it doesn't deviate more than is necessary, and if the deviations from each member are given equal weighting in whatever process we use to determine it. This paper proposes that we begin with a measure of the distance from a proposed compromise to an individual's level of well-being, and then say that the moral goodness is the candidate compromise that minimizes the sum of distances from it to the individuals' levels of well-being. I describe a range of such measures of distance and show that some give utilitarianism, others different versions of prioritarianism. (shrink)

This thesis is about the moral reasons we have to do less than best. It consists of six chapters. Part I of the thesis proposes, extends, and defends reasons to do less than best. In Chapter One (“The Conditional Obligation”) I outline and reject two recent arguments from Joe Horton and Theron Pummer for the claim that we have a conditional obligation to bring about the most good. In Chapter Two (“Agglomeration and Agent-Relative Costs”) I argue that agent-relative costs can (...) justify permissions to less than best in a far greater range of decisions contexts than we currently believe. In Chapter Three (“Risk and Aggregation”) I discuss how anti-aggregative moral theories deal with risk, whilst proposing an argument in favour of ex-post moral theories. -/- In Part II of the thesis, I discuss longtermism, presenting a series of reasons to believe we have both significant permissions and obligations to prioritise those in the short-term. In Chapter Four (“Listening to Future People”) I criticise a recent argument presented by Andreas Mogensen for the claim we cannot have obligations grounded in the wellbeing of future people. I then show that, even permitting the existence of obligations to future people, we still have significant reasons to resist longtermism on the grounds of partiality. In Chapter Five (“The Complaints of Future People”) I argue that scepticism about aggregation is inconsistent with an obligation, or indeed even a permission, to help far future people. In Chapter Six (“Leaving the Present Behind”) I explore the moral significance of “dooming”, whilst arguing that we have a pro tanto reason of fairness to prioritise aiding those currently in existence. (shrink)

Public funders of health research have been widely criticized on the grounds that their allocations of funding for disease-specific research do not reflect the relative burdens imposed by different diseases. For example, the US National Institutes of Health spends a much greater fraction of its budget on HIV/aids research and a much smaller fraction on migraine research than their relative contribution to the US burden of disease would suggest. Implicit in this criticism is a normative claim: Insofar as the scientific (...) opportunities are equal, each patient merits research into their condition proportional to the burden of disease for which that condition is responsible. This claim—the proportional view—is widely accepted but has never been fully specified or defended. In this paper, I explain what is required to specify the view, attempt to do so in the most charitable way, and then critically evaluate its normative underpinnings. I conclude that a severity-weighted proportional view is defensible. I close by drawing out five key lessons of my analysis for health research priority-setting. (shrink)

Public funders of health research have been widely criticized on the grounds that their allocations of funding for disease-specific research do not reflect the relative burdens imposed by different diseases. For example, the US National Institutes of Health spends a much greater fraction of its budget on HIV/AIDS research and a much smaller fraction on migraine research than their relative contribution to the US burden of disease would suggest. Implicit in this criticism is a normative claim: Insofar as the scientific (...) opportunities are equal, each patient merits research into their condition proportional to the burden of disease for which that condition is responsible. This claim—the proportional view—is widely accepted but has never been fully specified or defended. In this paper, I explain what is required to specify the view, attempt to do so in the most charitable way, and then critically evaluate its normative underpinnings. I conclude that a severity-weighted proportional view is defensible. I close by drawing out five key lessons of my analysis for health research priority-setting. (shrink)

The original position together with the veil of ignorance have served as one of the main methodological devices to justify principles of distributive justice. Most approaches to this topic have primarily focused on the single person decision-theoretic aspect of the original position. This paper, in contrast, will directly model the basic structure and the economic agents therein to project the economic consequences and social outcomes generated either by utilitarianism or Rawls’s two principles of justice. It will be shown that when (...) the differences in people’s productive abilities are sufficiently great, utilitarianism dominates Rawls’s two principles of justice by providing a higher level of overall well-being to every member of society. Whenever this is the case, the parties can rely on the Principle of Dominance (which is a direct implication of instrumental rationality) to choose utilitarianism over Rawls’s two principles of justice. Furthermore, when this is so, utilitarianism is free from one of its most fundamental criticisms that it ‘does not take seriously the distinction between persons’ (Rawls 1971 [1999]: 24). (shrink)

This paper presents a new kind of problem in the ethics of distribution. The problem takes the form of several “calibration dilemmas,” in which intuitively reasonable aversion to small-stakes inequalities requires leading theories of distribution to recommend intuitively unreasonable aversion to large-stakes inequalities. We first lay out a series of such dilemmas for prioritarian theories. We then consider a widely endorsed family of egalitarian views and show that they are subject to even more forceful calibration dilemmas than prioritarian theories. Finally, (...) we show that our results challenge common utilitarian accounts of the badness of inequalities in resources. (shrink)

What is the best overarching ethical principle to give a possible future superintelligent machine, given that we do not know what the best ethics are today or in the future? Eliezer Yudkowsky has suggested that a superintelligent AI should have as its goal to carry out the coherent extrapolated volition of humanity (CEV), the most coherent way of combining human goals. The article discusses some problems with this proposal and some alternatives suggested by Nick Bostrom. A slightly different proposal is (...) then suggested, which I argue solves the problems better than Yudkowsky’s proposal. (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)

This thesis consists of several independent papers in population ethics. I begin in Chapter 1 by critiquing some well-known 'impossibility theorems', which purport to show there can be no intuitively satisfactory population axiology. I identify axiological vagueness as a promising way to escape or at least mitigate the effects of these theorems. In particular, in Chapter 2, I argue that certain of the impossibility theorems have little more dialectical force than sorites arguments do. From these negative arguments I move to (...) positive ones. In Chapter 3, I justify the use of a 'veil of ignorance', starting from three more basic normative principles. This leads to positive arguments for various kinds of utilitarianism - the best such arguments I know. But in general the implications of the veil depend on how one answers what I call 'the risky existential question': what is the value to an individual of a chance of non-existence? I chart out the main options, and raise some puzzles for non-comparativism, the view that life is incomparable to non-existence. Finally, in Chapter 4, I consider the consequences for population ethics of the idea that what is normatively relevant is not personal identity, but a degreed relation of psychological connectedness. In particular, I pursue a strategy based in population ethics for understanding the controversial 'time-relative interests' account of the badness of death. (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...

In his article, “Equality as a Moral Ideal”, Harry Frankfurt argues against economic egalitarianism and presents what he calls the “doctrine of sufficiency.” According to the doctrine of sufficiency, what is morally important is not relative economic equality, but rather, whether somebody has enough, where “having enough” is a non-comparative standard of reasonable contentment that may differ from person to person given his/her aims and circumstances. The purpose of this paper is to show that Frankfurt’s original arguments in support for (...) his doctrine of sufficiency have critical problems that Frankfurt himself does not properly recognize. In the end, I will argue that in order to solve these problems the doctrine of sufficiency cannot help but to incorporate certain prioritarian commitments – commitments which many would view as implying economic egalitarianism. This is embarrassing for a doctrine whose raison d’être was mainly to defeat economic egalitarianism. (shrink)

Utilitarianism, it has been said, is not sensitive to the distribution of welfare. In making risky decisions for others there are multiple sensitivities at work. I present examples of risky decision-making involving drug allocations, charitable giving, breast-cancer screening and C-sections. In each of these examples there is a different sensitivity at work that pulls away from the utilitarian prescription. Instances of saving fewer people at a greater risk to many is more complex because there are two distributional sensitivities at work (...) that pull in opposite directions from the utilitarian calculus. I discuss objections to these sensitivities and conclude with some reflections on the value of formal modelling in thinking about societal risk. (shrink)

Harsanyi claimed that his Aggregation and Impartial Observer Theorems provide a justification for utilitarianism. This claim has been strongly resisted, notably by Sen and Weymark, who argue that while Harsanyi has perhaps shown that overall good is a linear sum of individuals’ von Neumann–Morgenstern utilities, he has done nothing to establish any connection between the notion of von Neumann–Morgenstern utility and that of well-being, and hence that utilitarianism does not follow. -/- The present article defends Harsanyi against the Sen–Weymark critique. (...) I argue that, far from being a term with precise and independent quantitative content whose relationship to von Neumann–Morgenstern utility is then a substantive question, terms such as ‘well-being’ suffer (or suffered) from indeterminacy regarding precisely which quantity they refer to. If so, then (on the issue that this article focuses on) Harsanyi has gone as far towards defending ‘utilitarianism in the original sense’ as could coherently be asked. (shrink)

In carrying out cost-benefit or cost-effective analysis, a discount rate should be applied to some kinds of future benefits and costs. It is controversial, though, whether future health is in this class. I argue that one of the standard arguments for discounting (from diminishing marginal returns) is inapplicable to the case of health, while another (favouring a pure rate of time preference) is unsound in any case. However, there are two other reasons that might support a positive discount rate for (...) future health: one relating to uncertainty, and the other relating to the instrumental benefits of improved health. While the latter considerations could be modelled via a discount rate, they could alternatively be modelled more explicitly, in other ways; I briefly discuss which modelling method is preferable. Finally, I argue against the common claims that failing to discount future health would lead to paradox, and/or to inconsistency with the way future cash flows are treated. (shrink)

Harsanyi claimed that his Aggregation and Impartial Observer Theorems provide a justification for utilitarianism. This claim has been strongly resisted, notably by Sen and Weymark, who argue that while Harsanyi has perhaps shown that overall good is a linear sum of individuals’ von Neumann-Morgenstern utilities, he has done nothing to establish any con- nection between the notion of von Neumann-Morgenstern utility and that of well-being, and hence that utilitarianism does not follow. The present article defends Harsanyi against the Sen-Weymark cri- (...) tique. I argue that, far from being a term with precise and independent quantitative content whose relationship to von Neumann-Morgenstern utility is then a substantive question, terms such as ‘well-being’ suffer (or suffered) from indeterminacy regarding precisely which quantity they refer to. If so, then (on the issue that this article focuses on) Harsanyi has gone as far towards defending ‘utilitarianism in the original sense’ as could coherently be asked. (shrink)

How should we choose between uncertain prospects in which different possible people might exist at different levels of wellbeing? Alex Voorhoeve and Marc Fleurbaey offer an egalitarian answer to this question. I give some reasons to reject their answer and then sketch an alternative, which I call person-affecting prioritarianism.

Some moral theories tell you, in some situations in which you are interacting with a group of people, to avoid acting in the way that is expectedly best for everybody. This essay argues that such theories are mistaken. Go ahead and do what is expectedly best for everybody. The argument is based on the thought that when interacting with an individual it is fine for you to act in the expected interests of the individual and that many interactions with individuals (...) may compose an interaction with a group. (shrink)

According to the priority view, or prioritarianism, it matters more to benefit people the worse off they are. But how exactly should the priority view be defined? This article argues for a highly general characterization which essentially involves risk, but makes no use of evaluative measurements or the expected utility axioms. A representation theorem is provided, and when further assumptions are added, common accounts of the priority view are recovered. A defense of the key idea behind the priority view, the (...) priority principle, is provided. But it is argued that the priority view fails on both ethical and conceptual grounds. (shrink)

The article is a plea for ethicists to regard probability as one of their most important concerns. It outlines a series of topics of central importance in ethical theory in which probability is implicated, often in a surprisingly deep way, and lists a number of open problems. Topics covered include: interpretations of probability in ethical contexts; the evaluative and normative significance of risk or uncertainty; uses and abuses of expected utility theory; veils of ignorance; Harsanyi’s aggregation theorem; population size problems; (...) equality; fairness; giving priority to the worse off; continuity; incommensurability; nonexpected utility theory; evaluative measurement; aggregation; causal and evidential decision theory; act consequentialism; rule consequentialism; and deontology. (shrink)

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 paper, I defend fairness-based retributivism against two important objections, the no-benefit objection and the social injustice objection. I argue that the theory can defeat the no-benefit objection by developing an account of how crimes can be sources of unfairness by inflicting losses on people, and that it can blunt the social injustice objection by toning down the theory’s distributive aspirations. I conclude that fairness-based retributivism, contrary to received wisdom, merits further attention from legal and political philosophers.

Risky prospects represent policies that impose different types of risks on multiple people. I present an example from food safety. A utilitarian following Harsanyi's Aggregation Theorem ranks such prospects according to their mean expected utility or the expectation of the social utility. Such a ranking is not sensitive to any of four types of distributional concerns. I develop a model that lets the policy analyst rank prospects relative to the distributional concerns that she considers fitting in the context at hand. (...) I name this model ‘the Distribution View’ posing an alternative to Parfit's Priority View for risky prospects. (shrink)

I argue that prioritarianism cannot be assessed in abstraction from an account of the measure of utility. Rather, the soundness of this view crucially depends on what counts as a greater, lesser, or equal increase in a person’s utility. In particular, prioritarianism cannot accommodate a normatively compelling measure of utility that is captured by the axioms of John von Neumann and Oskar Morgenstern’s expected utility theory. Nor can it accommodate a plausible and elegant generalization of this theory that has been (...) offered in response to challenges to von Neumann and Morgenstern. This is, I think, a theoretically interesting and unexpected source of difficulty for prioritarianism, which I explore in this article. (shrink)

Michael Otsuka, Alex Voorhoeve and Marc Fleurbaey have challenged the priority view in favour of a theory based on competing claims. The present paper shows how their argument can be used to recast the priority view. All desert claims in distributive justice are comparative. The stronger a party’s claims to a given benefit, the greater is the value of her receiving it. Ceteris paribus, the worse-off have stronger claims on welfare, and benefits to them matter more. This can account for (...) intuitions that at first appear egalitarian, as the analysis of an example of Larry Temkin’s shows. The priority view, properly understood, is desert-adjusted utilitarianism under the assumption that no other claims pertain. (shrink)

Lara Buchak argues that her version of rank-weighted utilitarianism can accommodate an implication of the separateness of persons known as “the shift,” since it requires individuals to be more willing to accept risk for themselves than to accept inequality in society. I argue that this is mistaken. Buchak’s model fails to yield the shift when the decision-maker is distinct from the affected individual, as well as in certain social decisions where the risk attitude of the group is known. These findings (...) suggest that models which derive social choice rules from individual decision rules will generally fail to uphold separateness. (shrink)

While early optimists have seen online discussions as potential spaces for deliberation, the reality of many online spaces is characterized by incivility and irrationality. Increasingly, AI tools are considered as a solution to foster deliberative discourse. Against the backdrop of previous research, we show that AI tools for online discussions heavily focus on the deliberative norms of rationality and civility. In the operationalization of those norms for AI tools, the complex deliberative dimensions are simplified, and the focus lies on the (...) detection of argumentative structures in argument mining or verbal markers of supposedly uncivil comments. If the fairness of such tools is considered, the focus lies on data bias and an input–output frame of the problem. We argue that looking beyond bias and analyzing such applications through a sociotechnical frame reveals how they interact with social hierarchies and inequalities, reproducing patterns of exclusion. The current focus on verbal markers of incivility and argument mining risks excluding minority voices and privileges those who have more access to education. Finally, we present a normative argument why examining AI tools for online discourses through a sociotechnical frame is ethically preferable, as ignoring the predicable negative effects we describe would present a form of objectionable indifference. (shrink)

The good of those who are worse off matters more to the overall good than the good of those who are better off does. But being worse off than one’s fellows is not itself bad; nor is inequality itself bad; nor do differences in well-being matter more when well-being is lower in an absolute sense. Instead, the good of the relatively worse-off weighs more heavily in the overall good than the good of the relatively better-off does, in virtue of the (...) fact that the former are relatively worse off. This paper articulates and defends the view just described. (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)

According to prioritarianism, an influential theory of distributive justice, we have a stronger reason to benefit people the worse off these people are. Many authors have adopted a consequentialist version of prioritarianism. On this account, we have a consequentialist reason to benefit the worse off because the state of affairs where the worse off gains a given amount of utility is more valuable than the state of affairs where the better off gains roughly the same amount of utility. In this (...) paper, we argue that the consequentialist approach to prioritarianism is problematic. However, it doesn't follow that the prioritarian doctrine per se is groundless. We then suggest that we can make sense of prioritarianism by appeal to a contractualist approach. (shrink)

I present a new argument for the repugnant conclusion. The core of the argument is a risky, intrapersonal analogue of the mere addition paradox. The argument is important for three reasons. First, some solutions to Parfit’s original puzzle do not obviously generalize to the intrapersonal puzzle in a plausible way. Second, it raises independently important questions about how to make decisions under uncertainty for the sake of people whose existence might depend on what we do. And, third, it suggests various (...) difficulties for leading views about the value of a person’s life compared to her nonexistence. (shrink)

The volume aims to clarify and argue in support of the distinction between ideal and nonideal theory, as it is defined and used especially by (some of) the political philosophers working on the topic of social justice. In the process of trying to achieve this aim, the volume proposes, as well, a series of analyses concerning the other major problem raised by the ideal-nonideal distinction in political theory: the problem of the soundness of ideal theory as a method of specifying (...) the concept of justice and/or as a guide for political action, institutions and policies. Except for the foreword (which sets its scene and explorative framework) and the afterword (which concludes its argumentative approach and reminds some of its key explanations and observations), the volume is organized in three chapters. The first chapter discusses John Rawls` view on the distinction between ideal and nonideal theory. Its basic intention is to clarify, assess and synthetize the main claims and theses specific to the Rawlsian outlook. This analysis is followed, in the second chapter, by an investigation of the main post-Rawlsian contributions to the project of clarifying the ideal-nonideal distinction in theorizing justice. The third chapter rejects the claim according to which the distinction between ideal and nonideal theory is unjustified or, at least, not categorical. Based on its argumentative and explanatory undertaking, the book proposes the following simple definition of the ideal-nonideal distinction in theorizing justice: ideal theory is the theory aiming to offer an (adequate) answer to the question “what is social justice?”. In other words, ideal theory is the theory of defining or specifying the concept of social justice. Nonideal theory is, instead, the area of academic research interested in answering (and bound to answer) all the other imperative questions about justice and injustice: „is social justice an achievable ideal here and now?”, „which are the best policies in correcting or mitigating the current social injustices?”, „which is the most appropriate strategy for achieving the institutional design that best realizes the principles of justice?”, „in what way are the duties of justice affected when the others fail to conform to these duties?”, „which are the requirements of retributive justice?” or „which are the principles of rectificatory justice?”. (shrink)

Abstract:The paper seeks to defend Telic Egalitarianism (TE) by distinguishing two distinct categories into which typical objections to it fall. According to one category of objections (for example, levelling down) TE isgroundless. That is, there is simply no good reason to think that inequality as such is bad. The other type of objections to TE focuses on itscounterintuitiveimplications: it is forced to condemn inequalities between ourselves and long-dead Inca peasants, or between us and worse-off aliens from other planets. The paper (...) shows that once we unpack these two types of objections to TE they become much less persuasive. (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)

Prioritarianism can usefully be seen as a corrective to both egalitarianism and utilitarianism. It allegedly corrects for egalitarianism insofar as it tends toward equality but seems immune to the Leveling Down Objection. It allegedly corrects for utilitarianism insofar as it emphasizes improving peoples' lives but is distribution-sensitive, favoring benefiting those who are worse off over those who are better off, other things equal. The best way to understand the view and assess its prospects is to see whether on closer examination (...) it can indeed avoid the pitfalls of the two more traditional views it might replace. What emerges from such a closer examination is that prioritarianism must be very carefully specified to avoid the Leveling Down Objection. More significantly, to clearly avoid problems associated with utilitarianism, prioritarianism must be formulated in deontic rather than telic terms. It is not clear, however, that such a deontic prioritarianism has any advantages over deontic egalitarianism. (shrink)

Prioritarianism is supposed to be a theory of the overall good that captures the common intuition of . But it is difficult to give precise content to the prioritarian claim. Over the past few decades, prioritarians have increasingly responded to this by formulating prioritarianism not in terms of an alleged primitive notion of quantity of well-being, but instead in terms of von NeumannPrimitivistTechnicalpriority to the worse offMorgenstern utility is a retrograde step.

The Distribution View provides a model that integrates four distributional concerns in the evaluation of risky prospects. Starting from these concerns, we can generate an ordering over a set of risky prospects, or, starting from an ordering, we can extract a characterization of the underlying distributional concerns. Separability of States and/or Persons for multiple-person risky prospects, for single-person risky prospects and for multiple-person certain prospects are discussed within the model. The Distribution View sheds light on public health policies and provides (...) a framework for the discussion of Parfit's Priority View for risky prospects. (shrink)

In this extended book review, I summarize Adler's views and critically analyze his key arguments on the measurement of well-being and the foundations of prioritarianism.

How should scarce healthcare resources be distributed? This is a contentious issue that became especially pressing during the pandemic. It is often emphasised that studies exploring public views about this question provide valuable input to the issue of healthcare priority setting. While there has been a vast number of such studies it is rarely articulated, more specifically, what the results from these studies would mean for the justification of principles for priority setting. On the one hand, it seems unreasonable that (...) public values would straightforwardly decide the ethical question of how resources should be distributed. On the other hand, in a democratic society, it seems equally unreasonable that they would be considered irrelevant for this question. In this paper we draw on the notion of reflective equilibrium and discuss the relevance and roles that empirical studies may plausibly have for justification in priority setting ethics. We develop a framework for analysing how different kinds of empirical results may have different kinds of implications for justification. (shrink)

According to the Welfare Diffusion Objection, we should reject Prioritarianism because it implies the ‘desirability of welfare diffusion’: the claim that it can be better for there to be less total wellbeing spread thinly between a larger total number of people, rather than for there to be more total wellbeing, spread more generously between a smaller total number of people. I argue that while Prioritarianism does not directly imply the desirability of welfare diffusion, Prioritarians are nevertheless implicitly committed to certain (...) principles for comparing different-number populations which, together with the Prioritarian same-person axiology, imply the desirability of welfare diffusion. (shrink)

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)

This article is about the justifiability of accepting worse cost effectiveness for orphan drugs, that is, treatments for rare diseases, in a publicly financed health care system. Recently, three arguments have been presented that may be used in favour of exceptionally advantageous economic terms for orphan drugs. These arguments share the common feature of all referring to considerations of justice or fairness: the argument of the irrelevance of group size, the argument from the principle of need, and the argument of (...) identifiability. It is argued that all of these arguments fail to support the conclusion that orphan drugs should be subsidized to a larger extent than treatments for common diseases. The argument of the irrelevance fails to distinguish between directly and indirectly relevant considerations of fairness or justice. The recent attempt to revive the moral relevance of identifiability has provided no novel reasons to think that identifiability is morally relevant in itself or due to considerations of fairness and justice. The argument from the principle of need does not fail due to any inherent flaw in the principle as such. Rather, this principle can be interpreted in different ways, and none of these interpretations support exceptionally advantageous terms economically for treating rare diseases specifically. It is concluded that we are awaiting justice based reasons for the preferential treatment of orphan drugs. (shrink)

Verweij and Dawson claim that population health has a distributive dimension; Coggon argues that this presupposes a normative commitment to equity in the very definition of population health, which should, rather, be neutral. I describe possible sources of the distributive view, several of which do not presuppose egalitarian commitments. Two relate to the nature of health as a property of individuals ; two relate to the epistemology and pragmatics of public and population health. A fifth source of the distributive view (...) is a critical stance on the concept of population health; I contrast this with Coggon’s account of the public as a shared political imaginary. None of these views is ‘neutral’: they exhibit several different kinds of normativity and quasi-normativity, but this is not problematic. I argue that the critical stance appropriately distinguishes and relates social justice and public health. (shrink)

This paper offers a novel account of how complaints of unfairness arise in risky distributive cases. According to a recently proposed view in distributive ethics, the Competing Claims View, an individual has a claim to a benefit when her well-being is at stake, and the strength of this claim is determined by the expected gain to the individual’s well-being, along with how worse off the individual is compared to others. If an individual is at a lower level of well-being than (...) another, their claim to a given benefit is stronger. On this view, the strength of individuals’ claims are a function of their comparative well-being levels. In this paper, I instead argue that competing claims obtain only when a particular relationship obtains between the fates of individuals: that one individual’s gain is at the expense of another. This is a particular complaint that obtains when the fates of individuals are tied together in such a way that inequality that is to the detriment of the person who is worse off is guaranteed to obtain. I demonstrate that this complaint arises only when individuals are exposed to a particular type of risk that allows some to gain only if others lose. As such, I propose that complaints of unfairness occur less frequently than we might think if we take the Competing Claims View to be true. A purely comparative view is unable to account for this unique complaint of unfairness. I argue that this complaint is not only independently plausible, but can serve as a foundation for a more general account of competing claims complaints. (shrink)

According to a common view, in a case involving an indivisible good and several potential beneficiaries, who are equal in every relevant respect, there is a non-instrumental reason to allocate the benefit in a way that gives each an equal chance to receive the benefit. In this paper, I argue that this view is incompatible with several plausible and widely held assumptions. I emphasize especially the assumption that the distributive role of chances is secondary to that of benefits in an (...) important sense: the value of allocating chances is related to the ways in which it is possible to allocate the relevant benefits. Specifically, chances should be allocated only when it is impossible or too costly to allocate benefits in accordance with the relative importance of the reasons in favor of allocating the relevant benefit to each potential beneficiary. Given this assumption, I argue that the fact that there is no relation between the distributive concern for chances and other distributive concerns suggests that we should reject the view that chances have a distributive role that is not merely instrumental. (shrink)

In this article we aim to reduce the force of the expensive tastes objection to equality of welfare by constructing a pluralist welfare egalitarian theory which is not defeated by it. In the first part, we argue that Cohen’s condition of responsibility-sensitiveness is not able to provide a satisfactory rebuttal of the expensive tastes objection for at least a class of theories of justice, namely those that adhere to a methodologically fact-sensitive view. In the second part, we explore the possibility (...) of constructing a welfare egalitarian theory that gives weight to both equality and efficiency. We propose two alternatives, which integrate a utilitarian constraint and a Weak Pareto constraint on equality and show that both theories consistently differentiate between compensable and non-compensable expensive tastes, but should ultimately be rejected because of other unattractive implications. Finally, we develop a fairness-constrained theory of welfare egalitarianism and suggest that it can distinguish between compensable and non-compensable expensive tastes in both a conceptually consistent and a morally plausible manner, without generating decisive additional objections. (shrink)

Telic sufficientarians hold that there is something special about a certain threshold level such that benefiting people below it, or raising them above it, makes an outcome better in at least one respect. The article investigates what fundamental value might ground that view. The aim is to demonstrate that sufficientarianism, at least on this telic version, is groundless and as such indefensible. The argument is advanced in three steps: first, it is shown that sufficientarianism cannot be grounded in a personal (...) value. Neither, secondly, is it committed to the person-affecting view, the view that says that nothing can be better if there is no one for whom it is better. This, in itself, is of interest because some sufficientarians reject egalitarianism precisely for its alleged incompatibility with the person-affecting view. Sufficientarians' disavowal of the person-affecting view implies that their view, similarly to egalitarianism, must be anchored in some impersonal value. But crucially, and this is the third step of the argument, there is no apparent value that can fit that role. We must conclude, then, that telic sufficientarianism is groundless. (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)