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)

In a famous passage in A Theory of Justice, Rawls had an interesting view on fraternity. However, he did not develop it further. The first aim of this article is to show that there are at least two possible interpretations of what Rawls wrote about fraternity: the narrow interpretation and the wide interpretation. We will focus on the narrow interpretation and attract attention to the kinds of problems it presents. In the last section we will assert that there are different (...) ways of conceptualising the ideal of fraternity and that Rawls’s general approach to the issue was just one of them and maybe not the most attractive one. (shrink)

In this article we argue that the principle of need, on some interpretations, could be used to justify the spending of publically funded health care resources on cognitive enhancement and that this also holds true for individuals whose cognitive capacities are considered normal.The increased, and to an extent, novel demands that the modern technology and information society places on the cognitive capacities of agents, e.g., regarding good and responsible decision-making, have blurred the line between treatment and enhancement. More specifically, it (...) has shifted upwards. As a consequence, principles of need on their most reasonable interpretations can be used to support publically funded cognitive enhancement. At least this is so, if broader aims than curing and ameliorating diseases are included in the goals of health care. We suggest that it would be plausible to see health care as accepting such broader goals already today. (shrink)

La présente contribution vise à offrir au lecteur une présentation de la doctrine suffisantiste de la justice, de ses justifications générales et spécifiques et de son articulation possible avec d’autres théories de la justice. Elle explore certains aspects plus particuliers tels que la place de la responsabilité en son sein, son applicabilité au domaine intergénérationnel ou son positionnement par rapport à la question des « vies-complètes ». Elle montre aussi en quoi, quelles que soient les faiblesses possibles de cette doctrine, (...) elle présente des caractéristiques la rendant non redondante, en particulier par rapport à l’égalitarisme du leximin.This paper aims at presenting sufficientarianism, its justifications, specificities and the ways in which it can be combined with other theories of justice. We also explore more specific dimensions such as the place of responsibility-sensitivity, the doctrine’s application to the intergenerational realm or its interest for « complete-life » questions. We show to what extent, despite some weaknesses, it is not redundant when compared to or combined with leximin egalitarianism. (shrink)

I propose a modal logic that enables to reason about self-regarding and otherregarding motivations in strategic games. This logic integrates the concepts of joint action, belief, individual and group payoff. The first part of the article is focused on self-regarding agents. A self-regarding agent decides to perform a certain action only if he believes that this action maximizes his own personal benefit. The second part of the article explores different kinds of other-regarding motivations such as fairness and reciprocity. Differently from (...) self-regarding agents, other-regarding agents also consider the benefits of their choices for the group. Moreover, their decisions can be affected by their beliefs about other agents' willingness to act for the well-being of the group. The analysis also considers team-directed reasoning, i.e. the mode of reasoning that people use when they take themselves to be acting as members of a group or a team. (shrink)

Conceptions of desert and responsibility have had a powerful influence in justifying economic inequality. Currently, they are being reaffirmed in policies advocated by the centre left in Britain. In contrast, luck egalitarianism, one of the dominant theoretical positions in contemporary political philosophy, puts equality at the top of the agenda and notoriously undermines traditional notions of desert and rejects the conception of personal responsibility on which traditional ideas rely. Although luck egalitarians are sceptical about desert and redefine responsibility to reduce (...) its role in arguments for just distribution, they nevertheless retain a commitment to holding people responsible for the distributive consequences of what they freely choose to do. They attempt to demonstrate that equality can be reconciled with responsibility. I will argue that luck egalitarians have not gone far enough in eliminating desert and responsibility from the armoury of social justice, and that their own arguments should have led them to do so. My aim in this article is to push the ideas implicit in luck egalitarian's arguments to their logical conclusion. I argue that for practical and conceptual reasons, they should have formulated their theories as though hard determinism is true, or nearly true, even if it is not. Denying the pertinence of judgements of desert and responsibility to questions of distributive justice removes an obstacle to egalitarian aims by suggesting a more egalitarian distribution than one that is hostage to voluntary choice. It could be accepted that luck egalitarianism cannot accommodate the concept of personal responsibility without accepting the conclusion that considerations of responsibility should be abandoned. However, any plausible account of responsibility would demonstrate that existing inequalities are undeserved, and that these inequalities make a mockery of politicans current emphasis on personal responsibility. (shrink)

This paper examines and rejects two normative justifications for low-fee private schools, whose expansion throughout the Global South in recent years has been significant. The first justification – what I shall call the ideal thesis – contends that LFPS are the best mechanism to expand access to quality education, particularly at the primary level, and that the premise of their success is that they reject educational equality and state intervention in educational affairs, traditionally associated with public schools, embracing instead educational (...) adequacy and unregulated markets for education. Against this thesis, the paper argues that an ideal educational arrangement must not do away with educational equality and some degree of state interference. The other justification for LFPS – the secondbest thesis – contends that although LFPS do not represent the ideal state of affairs, they nonetheless bring us a step closer to the ideal of universal primary education; they are a ‘realistic’ approximation to that goal. Against the second-best thesis, the paper argues that this justification commits the approximation fallacy: by deviating from the ideal educational arrangement LFPS may obstruct rather than facilitate its achievement. (shrink)

Volume 19, Issue 7, July 2019, Page 1-5.

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)

According to the Maximin principle of distributive justice, one outcome is more just than another if the worst off individual in the first outcome is better off than the worst off individual in the second. This is often interpreted as a highly egalitarian principle, and, more specifically, as a highly egalitarian way of balancing a concern with equality against a concern with efficiency. But this interpretation faces a challenge: why should a concern with efficiency and equality lead us to a (...) concern only for the very worst off? Egalitarian proponents of Maximin tend to meet this challenge by showing that it possible to formally derive Maximin from surprisingly weak conditions relating efficiency and equality to justice. But in this paper, I argue that this reply fails. The issue is not that the proofs are invalid, but instead that every existing proof of Maximin transforms into an impossibility result as soon as we realize that any reasonable conception of equality must satisfy a certain formal property. The upshot is that even if it is possible to defend Maximin on other grounds, there is no known way to defend it on the grounds that it balances a concern with equality against a concern for efficiency. Further, more general implications of this result for egalitarian theories of distributive justice are also explored. (shrink)

Lifetime quality-adjusted life-year (QALY) prioritarianism has recently been defended as a reasonable specification of the prioritarian view that benefits to the worse off should be given priority in health-related priority setting. This paper argues against this view with reference to how it relies on implausible assumptions. By referring to lifetime QALY as the basis for judgments about who is worse off lifetime QALY prioritarianism relies on assumptions of strict additivity, atomism and intertemporal separability of sublifetime attributes. These assumptions entail that (...) a health state at some period in time contributes with the same amount to how well off someone is regardless of intrapersonal and interpersonal distributions of health states. The paper argues that this is implausible and that prioritarians should take both intrapersonal and interpersonal distributions of goods into account when they establish who is worse off. They should therefore not accept that lifetime QALY is a reasonable ground for ascribing priority and reject lifetime QALY prioritarianism. (shrink)

There are several powerful motivations for neutral value‐based deontic theories such as Act Consequentialism. Traditionally, such theories have had great difficulty accounting for partiality towards one's personal relationships and projects. This paper presents a neutral value‐based theory that preserves the motivations for Act Consequentialism while vindicating some crucial intuitions about reasons to be partial. There are two central ideas. The first is that when it comes to working out what you ought to do, your friends’ interests, the needs of your (...) family, the significance of your own projects and ideals, etc. have more weight than the interests and needs of strangers. Your friends’ interests are not (thereby) more neutrally valuable than the interests of others. So there is a difference between the value of an outcome and its deontic significance. The second familiar idea is that reasons are modifiable. Reasons of partiality are reasons the weights of which are a function of the value of the relevant outcome modified by facts about the value of caring about the outcome in question. The resulting principle has various further explanatory advantages; in particular, it accounts for project‐ and relationship‐specific permissions and requirements, both at a time and across time. (shrink)

Pour les tenants de l’égalitarisme du maximin, le contexte intergénérationnel constitue un triple défi. Primo, ce que requiert le maximin intergénérationnel ne se confond-il pas avec l’interdiction de la désépargne posée par une conception commutative de la justice comme réciprocité indirecte? Secundo, ne sommes-nous contraints de prendre au sérieux, plus qu’ailleurs, les préoccupations aggrégatives des utilitaristes afin d’éviter une « stagnation éternelle dans la misère » et ainsi de renoncer au maximin? Tertio, n’est-ce pas un contexte où égalitarisme et maximin (...) ne diffèrent pas dans leurs conséquences pratiques? L’A. répond par la négative aux trois questions. Il montre en particulier en quoi l’égalitarisme du maximin s’écarte d’une règle de non-désépargne. Il indique la manière dont il importe de penser la justice entre générations de manière proprement distributive et il examine la manière dont le défi « aggrégatif » peut être relevé. (shrink)

It is widely believed that consequentialists are committed to the claim that persons are mere containers for well-being. In this article I challenge this view by proposing a new version of consequentialism, according to which the identities of persons matter. The new theory, two-dimensional prioritarianism, is a natural extension of traditional prioritarianism. Two-dimensional prioritarianism holds that wellbeing matters more for persons who are at a low absolute level than for persons who are at a higher level and that it is (...) worse to be deprived of a given number of units than it is good to gain the same number of units, even if the new distribution is a permutation of the original one. If a fixed amount of well-being is transferred from one person to another and then transferred back again, two-dimensional prioritarianism implies that it would have been better to preserve the status quo. (shrink)

Accelerated COVID-19 vaccine development represents an important accomplishment and a milestone in the history of vaccine evolution. However, the vaccine’s scarcity made its equitable global allocation and distribution ambiguous. Despite the initial pledges from wealthy countries for fairness and inclusivity towards the poorer ones, the policies followed diverged significantly. Wealthy countries have vastly superior access to vaccines in a reality likened to an ethical disaster. This paper calls for the need for fair global vaccine allocation and distribution and examines the (...) barriers that were met along the way, originating from different points, such as the nationalistic approach on the matter that most wealthy countries have adopted or the inability of poor countries to purchase or manufacture vaccines. Further, a suggestion regarding the ethical principles and values that ought to guide global vaccine allocation and distribution is provided with a higher priority given to helping the worst-off, saving the most lives, protecting people in high risk, such as frontline healthcare professionals, and minimising social gaps, along with an ethical theoretical background for each prioritisation. It is not too late for wealthy countries to realise that vaccine inequity prolongs pandemics, so that they change their policies in favour of the global common good that will not only provide immediate universal benefits but will also serve as a guide for future pandemic crises. (shrink)

European Journal of Philosophy, Volume 30, Issue 2, Page 503-514, June 2022.

Negative duties are duties not to perform an action, while positive duties are duties to perform an action. This article focuses on the question of who holds the positive duties correlative to human rights. I start by outlining the Universal Scope Thesis, which holds that these duties fall on everyone. In its support, I present an argument by analogy: positive and negative duties correlative to human rights perform the same function; correlative negative duties are generally thought to be universal; by (...) analogy, we have reason to think that positive duties are held by everyone. I then consider three disanalogies that challenge the above argument. To address these worries, I introduce the notion of ‘aggregative duties’ – duties that can only be adequately grasped when we focus on the aggregate effect of the actions and omissions of different agents. This framework allows me to refine the initial thesis and address the objections. (shrink)

The three most common responses to Taurek’s ‘numbers problem’ are saving the greater number, equal chance lotteries and weighted lotteries. Weighted lotteries have perhaps received the least support, having been criticized by Scanlon What We Owe to Each Other ( 1998 ) and Hirose ‘Fairness in Life and Death Cases’ ( 2007 ). This article considers these objections in turn, and argues that they do not succeed in refuting the fairness of a weighted lottery, which remains a potential solution to (...) cases of conflict. Moreover, it shows how these responses actually lead to a new argument for weighted lotteries, appealing to fairness and Pareto-optimality. (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)

When considering the introduction of a new intervention in a budget constrained healthcare system, priority setting based on fair principles is fundamental. In many jurisdictions, a multi-criteria approach with several different considerations is employed, including severity and cost-effectiveness. Such multi-criteria approaches raise questions about how to balance different considerations against each other, and how to understand the logical or normative relations between them. For example, some jurisdictions make explicit reference to a large patient benefit as such a consideration. However, since (...) patient benefit is part of a cost-effectiveness assessment it is not clear how to balance considerations of greater patient benefit against considerations of severity and cost-effectiveness. The aim of this paper is to explore the role of a large patient benefit as an independent criterion for priority setting in a healthcare system also considering severity and cost-effectiveness. By taking the opportunity cost of new interventions (i.e., the health forgone in patients already receiving treatment) into account, we argue that patient benefit has a complex relationship to priority setting. More specifically, it cannot be reasonably concluded that large patient benefits should be given priority if severity, cost-effectiveness, and opportunity costs are held constant. Since we cannot find general support for taking patient benefit into account as an independent criterion from any of the most discussed theories about distributive justice: utilitarianism, prioritarianism, telic egalitarianism and sufficientarianism, it is reasonable to avoid doing so. Hence, given the complexity of the role of patient benefit, we conclude that in priority practice, a large patient benefit should not be considered as an independent criterion, on top of considerations of severity and cost-effectiveness. (shrink)

This thesis is based on the assumption that the intersection of moral philosophy and practical risk management is a rewarding area to study. In particular, the thesis assumes that concepts, ideas, and methods that are used in moral philosophy can be of great benefit for risk analysis, but also that practices in risk regulation provide a useful testing ground for moral philosophical theories. The thesis consists of an introduction and five articles. Article I is a review article on social and (...) ethical aspects of radiation protection related to nuclear power generation. The paper concludes that four areas of social and ethical issues stand out as central: The first is uncertainty and the influence of value judgments in scientific risk assessments. The second is the distributions of risks and benefits between different individuals, in both space and time. The third is the problem of setting limits when there is no known level of exposure associated with a zero risk. The fourth is related to stakeholder influence and risk communication. Article II discusses ethical issues related to the proposal that doses below a certain level should be excluded from the system of radiation protection, without any regard for the number of people exposed. Different arguments for excluding small radiation doses from regulation are examined and a possible solution to the problem of regulating small risks is proposed in the article: Any exclusion of small doses from radiation protection ought to be based on a case-by-case basis, with the condition that the expected value of harm remains small. Article III examines what makes one distribution of individual doses better than another distribution. The article introduces a mathematical framework based on preference logic, in which such assessments can be made precisely in terms of comparisons between alternative distributions of individual doses. Principles of radiation protection and from parallel discussions in moral philosophy and welfare economics are defined using this framework and their formal properties analyzed. Article IV argues that the ethical theory of “responsibility-catering prioritarianism” is well positioned to deal with the reasonable requirements in an ethical theory of risk. The article shows how responsibility-catering prioritarianism can be operationalized using a prioritarian social welfare function based on hypothetical utilities. For this purpose, a hypothetical utility measure called ‘responsibility-adjusted utility’ is proposed, which is based on the utility that would normally be expected given circumstances outside of the control of the individual. Article V was written as a response to the Fukushima disaster. Several authors have called the Fukushima disaster a ‘black swan.’ However, the article argues that the hazards of large earthquakes and tsunamis were known before the accident, and introduces and defines the concept of a ‘black elephant,’ as a high-impact event that lies beyond the realm of regular expectations, but is ignored despite existing evidence. (shrink)

In the event of a pandemic, demand for vaccines may exceed supply. One proposal for allocating vaccines is to use a lottery, to give all citizens an equal chance, either of getting the vaccine or of surviving. However, insistence on strict equality can result in seriously suboptimal outcomes. I argue that the requirement to treat all citizens impartially need not be interpreted to require equal chances, particularly where citizens are differently situated. Assuming that we want to save lives, we should (...) also seek to use vaccine efficiently, so far as this is compatible with equality. Thus, in allocating vaccine, we may want to be sensitive to different levels of need and/or effects on vaccine production. While such policies may result in unequal chances, they may even improve everyone’s chances. In such cases, the resultant inequality is not a violation of impartiality, but a consequence of considering each person’s claim seriously. (shrink)

The design of global development goals has been beset by deep flaws, inconsistencies, and manifest unfairness to some developing countries. Momentum has now peaked for the creation of Sustainable Development Goals to replace the Millennium Development Goals. This comment addresses three challenges that arise in setting development goals, and recommends feasible development goals that can meaningfully guide development cooperation, and focus the attention of policy makers on the worst-off.

The background of this paper is the ongoing dismantling of the social insurance systems in favour of commercialisation and privatisation of insurances needed for illness, old age and premature death. This combined with the increased possibility of using genetic testing for differentiating personal insurance premiums has the potentiality of creating a ‘genetic proletariat’ — an uninsurable high-risk population. The common way of handling this problem in Sweden, and many other developed countries around the North Atlantic, has been to regulate insurance (...) companies’ right to ask for and use genetic information in various ways. There is a distinction between partial regulation (that allows insurance companies access to genetic information from genetic tests already made, sometimes only above a specified amount, but not to demand new tests) and total regulation (that forbids insurance companies to ask for or use any genetic information). I will argue that these forms of regulation probably will have adverse consequences given the dismantling of collective social insurance systems. If this is convincing, a better way to solve the problem of an uninsurable high-risk population (and other problems) is to resurrect the collective, obligatory insurance systems in which the individual risk profile does not constitute a basis for premium determination. Both arguments cast in terms of consequences and justice render support for this conclusion. (shrink)

The article examines the relationship between a wrongdoer and his victim. Based on this examination, a justification for criminal punishment is proposed. It is argued that crime violates thea prioriequality of constituent boundaries and of infinite human value between the wrongdoer and the victim. Criminal punishment re-equalizes respective boundaries and infinite human value. To develop this argument, the article observes how subject-subject boundaries are essential for the formation of separateness between subjects - separateness which is recognized and acknowledged by them (...) in a cooperative process. The article further discusses the value of boundaries and the significance of theira prioriequality in every human relationship. It then shows how crime, which is intrusion of the victim’s boundaries, works to demolish the victim’s self-recognizing separateness and hence to create inequality in the parties’ value. Last, the article demonstrates that only punishment can reset the relationship between the parties and re-equate their (still infinite) human value in the relationship. (shrink)

This paper examines different mechanisms for adjudicating disagreement about distributive justice. It begins with a case where individuals have deeply conflicting convictions about distributive justice and must make a social choice regarding the distribution of goods. Four mechanisms of social choice are considered: social contract formation, Borda count vote, simple plurality vote, and minimax bargaining. I develop an agent-based model which examines which mechanisms lead to the greatest degree of satisfying justice-based preferences over the course iterated social choices. Agents are (...) ascribed two kinds of motivations: they wish to realize justice and to receive a greater package of goods. Each agent seeks to realize her ideal distribution, and the failure to do so leaves agents “disappointed,” resulting in their trading off the pursuit of gains in justice in favor of gains in self-interest. Mechanisms are assessed using the metric of how many agents remain interested in justice over the course of iterated adjudication. The mechanisms are also examined under some non-ideal conditions, such as the presence of power asymmetries or strategic behavior. Several significant results are addressed: social contract formation and simple plurality voting are robust under the conditions considered, bargaining is a highly ineffective means of adjudicating distributive disagreement, and lastly allowing for concessions in justice for gains in self-interest proves to be a crucial mechanism for ensuring the stability of resolutions. (shrink)

I consider two difficulties which have been presented to egalitarianism: Parfit’s “Levelling Down Objection” and my “Paradox of the Baseline”. I show that making things worse for some people even with no gain to anyone is actually an ordinary and indeed necessary feature of our moral practice, yet nevertheless the LDO maintains its power in the egalitarian context. I claim that what makes the LDO particularly forceful in the case against egalitarianism is not the very idea of making some people (...) worse off with no gain to others, but the disrespect for value inherent in egalitarianism; and similarly that the POB is a reductio of choice -egalitarianism because of its inversion of the intuitively correct attitude to the generation of value. I conclude that in the light of the absurdity and paradox so frequently lurking in moral and social life, and particularly with the complexity of modern life and obliquity of change, we need to be much more modest than egalitarians have been in putting forth ambitious moral and social models. (shrink)

Ever since the publication of Harry Frankfurt’s “Equality as a Moral Ideal” :21–43, 1987), the doctrine of sufficiency has attracted great attention among both ethical theorists and political philosophers. The doctrine of sufficiency consists of two main theses: the positive thesis states that it is morally important for people to have enough; and the negative thesis states that once everybody has enough, relative inequality has absolutely no moral importance. Many political philosophers have presented different versions of sufficientarianism that retain the (...) general spirit of what Frankfurt had proposed in his seminal work. However, all of these different versions of sufficientarianism suffer from two critical problems: they fail to give right answers to lifeboat situations, and they fail to provide continuous ethical judgments. In this paper, I show a version of utilitarianism that solves these problems while retaining the major attractions of sufficientarianism. I call it “prospect utilitarianism.” In addition, I show that prospect utilitarianism can avoid standard objections to utilitarianism and has aspects that can appeal to both prioritarians and egalitarians as well. (shrink)

Prioritarianism is the moral view that a fixed improvement in someone's well-being matters more the worse off they are. Its supporters argue that it best captures our intuitions about unequal distributions of well-being. I show that prioritarianism sometimes recommends acts that will make things more unequal while simultaneously lowering the total well-being and making things worse for everyone ex ante. Intuitively, there is little to recommend such acts and I take this to be a serious counterexample for prioritarianism.

In this paper, I explore the ethics of subject selection in the context of biomedical research. I reject a key principle of what I shall refer to as the standard view. According to this principle, investigators should select participants so as to minimise aggregate risk to participants and maximise aggregate benefits to participants and society. On this view, investigators should exclude prospective participants who are more susceptible to risk than other prospective participants. I argue instead that investigators should select subjects (...) in accordance with an alternative principle: formal equality of opportunity. According to this principle, investigators must treat all prospective participants the same unless differential treatment is warranted by the scientific goals of the study or the need to promote participants' medically related interests. All prospective participants (1) who meet the scientifically defined eligibility criteria and (2) for whom participation is consistent with their medically related interests should have an equal, formal opportunity to participate in the study. Prospective participants should not be excluded simply because they are more susceptible to risk than others. (shrink)

In a little noted passage in A Theory of Justice, John Rawls argued that genetic intervention in the traits of offspring may be morally required as a matter of distributive justice. Given that the “greater natural assets” of each “enables him to pursue a preferred plan of life[,]” Rawls wrote, the parties to the original position “want to insure for their descendents the best genetic endowment.…Thus over time a society is to take steps at least to preserve the general level (...) of natural abilities and to prevent the diffusion of serious defects.…The pursuit of reasonable policies in this regard is something that earlier generations owe to later ones.” Whether biological enhancement actually is a moral obligation we owe to future generations is a question that I have taken up elsewhere, but which lies beyond my scope here. If we agree with Rawls that some measure of safe and effective genetic intervention may be required as a matter of justice, it stands to ask how the distribution of genetic goods – that is, the hereditary basis of human traits – should be carried out. (shrink)

We clarify options for conceptualizing equity, or what we refer to as justice, in resource allocation. We do this by systematically differentiating, expounding, and then illustrating eight different substantive principles of justice. In doing this, we compare different meanings that can be attributed to “need” and “the capacity to benefit”. Our comparison is sharpened by two analytical tools. First, quantification helps to clarify the divergent consequences of allocations commended by competing principles. Second, a diagrammatic approach developed by economists Culyer and (...) Wagstaff offers a visual and conceptual aid. Of the eight principles we illustrate, only two treat as relevant both a person’s initial health state and a person’s CTB per resource unit expended: allocate resources so as to most closely equalize final health states and allocate resources so as to equally restore health states to population norms. These allocative principles ought to be preferred to the alternatives if one deems relevant both a person’s initial health state and a person’s CTB per resource unit expended. Finally, we examine some possibilities for conceptualizing benefits as relative to how badly off someone is, extending Parfit’s thought on Prioritarianism. Questions arise as to how much intervention effects accruing to the worse off count for more and how this changes with improving health. We explicate some recent efforts to answer these questions, including in Dutch and British government circles. These efforts can be viewed as efforts to operationalize need as an allocative principle. Each effort seeks to maximize in the aggregate quanta of effect that are differentially valued in favor of the worst off. In this respect, each effort constitutes one type of Prioritarianism, which Parfit failed to differentiate from other types. (shrink)

Journal of Political Philosophy, EarlyView.

An important argument against prohibiting organ sales is that it removes the best option available to individuals in dire circumstances. However, this line of reasoning fails to recognise that selling a kidney on a regulated market is only the best option in a very narrow comparison, where a regulated organ market is compared with banning organ sales. Once we acknowledge this narrowness, selling a kidney is not the best option. This paves the way for a distributive justice-based critique of the (...) ‘best option’ argument for organ markets, which illuminates that organ markets should be compared with a broader set of alternatives. If providing the option of selling a kidney is not the best option, but rather the best option we are willing to provide, and one which means that many people will remain in poverty and unjust circumstances, then this reflects poorly on those societies willing to offer only this option and not a better one. (shrink)