Policy analyses begin with a systematic overview of the policy problem they address. This includes a comprehensive discussion of the nature and context of the problem, and the institutional and behavioral factors responsible for its emergence. Problem statements must also explain why the status quo is bad or undesirable, why it is something that governments, rather than private actors, should address, and establish that the relevant government institutions have the legitimacy to intervene. In this chapter, I provide an overview of (...) the principal types of policy problems that it is morally appropriate for governments to address. Each type denotes a class of states of affairs that (1) are bad, undesirable, or unjust, (2) the government is particularly well-suited to address, and (3) arise from spheres of action over which the relevant government institutions have the right to intervene. I begin with a discussion of collective action problems, that is, states of affairs in which action by rational and self-interested private actors is collectively self-defeating. I then argue for two additional types of policy problems. First, since the goal of government action is the construction of a just legal order, not merely an efficient one, states of affairs which are unjust constitute an additional type of policy problem. Relatedly, second, whereas analyses of collective action problems typically presuppose the existence of effective government institutions which can address them, such institutions may be deficient and/or unjust. A third type of policy problem is therefore deficient government institutions. -/- . (shrink)

Machine learning algorithms are increasingly used to support decision-making in the exercise of public authority. Here, we argue that an important consideration has been overlooked in previous discussions: whether the use of ML undermines the democratic legitimacy of public institutions. From the perspective of democratic legitimacy, it is not enough that ML contributes to efficiency and accuracy in the exercise of public authority, which has so far been the focus in the scholarly literature engaging with these developments. According to one (...) influential theory, exercises of administrative and judicial authority are democratically legitimate if and only if administrative and judicial decisions serve the ends of the democratic law maker, are based on reasons that align with these ends and are accessible to the public. These requirements are not satisfied by decisions determined through ML since such decisions are determined by statistical operations that are opaque in several respects. However, not all ML-based decision support systems pose the same risk, and we argue that a considered judgment on the democratic legitimacy of ML in exercises of public authority need take the complexity of the issue into account. This paper outlines considerations that help guide the assessment of whether a ML undermines democratic legitimacy when used to support public decisions. We argue that two main considerations are pertinent to such normative assessment. The first is the extent to which ML is practiced as intended and the extent to which it replaces decisions that were previously accessible and based on reasons. The second is that uses of ML in exercises of public authority should be embedded in an institutional infrastructure that secures reason giving and accessibility. (shrink)

Is authoritarian power ever legitimate? The contemporary political theory literature—which largely conceptualizes legitimacy in terms of democracy or basic rights—would seem to suggest not. I argue, however, that there exists another, overlooked aspect of legitimacy concerning a government’s ability to ensure safety and security. While, under normal conditions, maintaining democracy and rights is typically compatible with guaranteeing safety, in emergency situations, conflicts between these two aspects of legitimacy can and often do arise. A salient example of this is the COVID-19 (...) pandemic, during which severe limitations on free movement and association have become legitimate techniques of government. Climate change poses an even graver threat to public safety. Consequently, I argue, legitimacy may require a similarly authoritarian approach. While unsettling, this suggests the political importance of climate action. For if we wish to avoid legitimating authoritarian power, we must act to prevent crises from arising that can only be resolved by such means. (shrink)

Thick concepts, namely those concepts that describe and evaluate simultaneously, present a challenge to science. Since science does not have a monopoly on value judgments, what is responsible research involving such concepts? Using measurement of wellbeing as an example, we first present the options open to researchers wishing to study phenomena denoted by such concepts. We argue that while it is possible to treat these concepts as technical terms, or to make the relevant value judgment in-house, the responsible thing to (...) do, especially in the context of public policy, is to make this value judgment through a legitimate political process that includes all the stakeholders of this research. We then develop a participatory model of measurement based on the ideal of co-production. To show that this model is feasible and realistic, we illustrate it with a case study of co-production of a concept of thriving conducted by the authors in collaboration with a UK anti-poverty charity Turn2us. (shrink)

The main goal of this thesis is to provide a clear basis for the analysis of alternative currencies, such as Bitcoin, LETS, Local currencies, the WIR or Carbon currencies. It attempts to determine whether alternative currencies might constitute just and workable alternatives, either in the form of small-scale experiments or in the form of more radical reforms. The first chapter proposes a new way to classify currencies. The second examines the case in favour of monetary plurality. The third analyses the (...) claims in favour of restricting the use of money locally, within a community, or to certain goods. The fourth studies the link between money and the market. Finally, a post-scriptum focuses on Bitcoin and cryptocurrencies. This thesis highlights that these currencies are drivers of several potential conflicts. Their widespread use might conflict with the adequate management of monetary policy, with social justice, and with liberal values. These conflicts are potential, for they would come into existence only if alternative currencies increased in scope. However, there is no reason to disregard potential conflicts when the case in their favour relies mostly on their potential benefits. (shrink)

Dit werkstuk betrekt zich op de vraag of de de facto legitimiteit van Knoet de Grote als koning van Angelsaksisch Engeland, te verklaren is aan de hand van de theorieën over legitimiteit zoals gepostuleerd door Maximilian Carl Emil Weber (1864—1920). Bestaande literatuur over Knoet de Grote zijn troonsbestijging, zoals dat van vooraanstaand 19e-eeuws historicus Edward Augustus Freeman, zou een ‘geromantiseerd’ beeld hebben geschetst van de kwestie. Dit werkstuk zal kijken of dit beeld, aan de hand van Webers theorie over waar (...) legitimiteit in gegrond kan zijn, ten eerste terecht te noemen is en, ten tweede, of het Knoets status als legitiem vorst van het ‘Angelsaksische’ volk goed kan verklaren. (shrink)

ABSTRACT:Demands have been growing upon firms to take actions in the interests of workers, the environment, local communities, and others. Firms sometimes have felt they could best discharge such responsibilities by cooperating with other firms. This, however, is suspect from the point of view of a purely economic interpretation of competition law, since interfirm agreements may raise prices and thus lower welfare for consumers. Should competition law remain focused on competition enhancing economic welfare, or be reformed to allow for acts (...) of cooperation that are socially beneficial? To answer this question, the article provides a philosophical reevaluation of the deep-seated view that firms are merely private actors. It argues that demands of political legitimacy should also be addressed at firms cooperating together, and that standard views of democratic accountability should be broadened, introducing a model of delegated, sequential decision making which allows regulatory agencies and parliaments to control interfirm agreements. (shrink)

The article offers a reconstruction of John Rawls views on political legitimacy, from A Theory of Justice to his late writings on political liberalism. It argues that Rawls had three conceptions of legitimacy, not two as one might expect based on the distinction between his two major works. Its argument is that the most radical change in Rawls’ thinking about legitimacy occurs in ‘Introduction to the Paperback Edition’ and ‘The Idea of Public Reason Revisited’. Here Rawls assumes that there can (...) be a reasonable pluralism not only of comprehensive doctrines, but also of political liberal conceptions of justice. As a consequence, the standard of political legitimacy is no longer specified as sufficient justice relative to justice as fairness, but instead as sufficient justice relative to a family of political conceptions of justice – a family which in turn is animated by an ideal of public reasoning about constitutional matters and matters of basic justice. The article also shows how Rawls’ late ideal of public reason is grounded in the need for legitimate constitutional government. (shrink)

Technology could be used to improve morality but it could do so in different ways. Some technologies could augment and enhance moral behaviour externally by using external cues and signals to push and pull us towards morally appropriate behaviours. Other technologies could enhance moral behaviour internally by directly altering the way in which the brain captures and processes morally salient information or initiates moral action. The question is whether there is any reason to prefer one method over the other? In (...) this article, I argue that there is. Specifically, I argue that internal moral enhancement is likely to be preferable to external moral enhancement, when it comes to the legitimacy of political decision-making processes. In fact, I go further than this and argue that the increasingly dominant forms of external moral enhancement may already be posing a significant threat to political legitimacy, one that we should try to address. Consequently, research and development of internal moral enhancements should be prioritised as a political project. (shrink)

One of the most noticeable trends in recent years has been the increasing reliance of public decision-making processes on algorithms, i.e. computer-programmed step-by-step instructions for taking a given set of inputs and producing an output. The question raised by this article is whether the rise of such algorithmic governance creates problems for the moral or political legitimacy of our public decision-making processes. Ignoring common concerns with data protection and privacy, it is argued that algorithmic governance does pose a significant threat (...) to the legitimacy of such processes. Modelling my argument on Estlund’s threat of epistocracy, I call this the ‘threat of algocracy’. The article clarifies the nature of this threat and addresses two possible solutions. It is argued that neither solution is likely to be successful, at least not without risking many other things we value about social decision-making. The result is a somewhat pessimistic conclusion in which we confront the possibility that we are creating decision-making processes that constrain and limit opportunities for human participation. (shrink)

Which standards should we employ to evaluate the global order? Should they be standards of justice or standards of legitimacy? In this article, I argue that liberal political theorists need not face this dilemma, because liberal justice and legitimacy are not distinct values. Rather, they indicate what the same value, i.e. equal respect for persons, demands of institutions under different sets of circumstances. I suggest that under real-world circumstances – characterized by conflicts and disagreements – equal respect demands basic-rights protection (...) and democratic participation, which I here call ‘political justice’. I conclude the article by considering three possible configurations of the global order – the ‘democratic world-state’, ‘independent democratic states’, and ‘mixed’ models – and argue that a commitment to political justice speaks in favour of the latter. (shrink)

What justifies political power? Most philosophers argue that consent or democracy are important, in other words, it matters how power is exercised. But this book argues that outcomes primarily matter to justifying power.

In this chapter, we turn our attention to the effects of the attention economy on our ability to act autonomously as a group. We begin by clarifying which sorts of groups we are concerned with, which are structured groups (groups sufficiently organized that it makes sense to attribute agency to the group itself). Drawing on recent work by Purves and Davis (2022), we describe the essential roles of trust (i.e., depending on groups to fulfill their commitments) and trustworthiness (i.e., the (...) property of a group that makes trusting them fitting) in autonomous group action, with particular emphasis on democratic institutions (which we view as group agents) and democratic legitimacy (which depends on trust and trustworthiness). We then explain how engagement maximization promotes polarization, which is detrimental to trust and trustworthiness and, in turn, democratic legitimacy and democratic institutions. We close by considering what groups might do to protect themselves from the threat posed to them by the attention economy. (shrink)

Machine learning algorithms are expected to improve referral decisions. In this article I discuss the legitimacy of deferring referral decisions in primary care to recommendations from such algorithms. The standard justification for introducing algorithmic decision procedures to make referral decisions is that they are more accurate than the available practitioners. The improvement in accuracy will ensure more efficient use of scarce health resources and improve patient care. In this article I introduce a proceduralist framework for discussing the legitimacy of algorithmic (...) referral decisions and I argue that in the context of referral decisions the legitimacy of an algorithmic decision procedure can be fully accounted for in terms of the instrumental values of accuracy and fairness. I end by considering how my discussion of procedural algorithmic legitimacy relates to the debate on algorithmic fairness. (shrink)

Social scientists and research ethicists have begun, somewhat belatedly, to confront and address the ethical challenges raised by public policy experiments. In doing so however, they have not fully availed themselves of the large and sophisticated literature on the ethics of clinical research which has developed over the past 40 years. While clinical and public policy research are different, I argue that the clinical research ethics literature yields valuable insights for discussions of the ethics of policy experiments. Focusing on seven (...) ethical issues which have received a good deal of attention in public and scholarly discussions of the ethics of policy experiments, I make use of the history of reflection on the ethics of clinical research to provide guidance to researchers planning and conducting policy experiments. (shrink)

Hypocrisy seems to be a distinctive moral wrong. This thesis offers an account of that wrong. The distinctive wrong of hypocrisy is not a rational failing, or a deception of others. It is a problem in how we critique, and blame, others, when we ourselves are guilty of similar faults. Not only does it seem wrong to blame others hypocritically; it is also widely remarked that hypocrites ‘lack standing’ to blame. I defend both judgments. When we engage others in response (...) to wrongdoing, there is both instrumental and non-instrumental value in ensuring that those who face similar moral predicaments reason about these predicaments, and the appropriate responses to them, together. Hypocrisy is wrong because it hampers our ability to realise that value. And hypocrites lose standing to blame for a similar reason. Standing depends on the value of particular people engaging in an accountability procedure together, a value which the hypocrite forestalls, by failing to acknowledge wrongdoing in the course of blaming. This account of a duty to blame non-hypocritically helps unpack the relationship between hypocrisy and a range of other defects in a person’s standing. It also responds to a central sceptical challenge to the wrongness of hypocritical blaming. The challenge is that accurate hypocritical blaming can’t be wrong because it is morally good, and indeed is morally better than not blaming others at all. My response: hypocritical blaming is wrong, not because it is morally worse than not blaming at all, but because it is second-best, i.e. worse than non-hypocritical blaming, which enables mutual deliberation about wrongdoing. (shrink)

The Committee on Economic, Social and Cultural Rights (CESCR) has a new mechanism to receive individual complaints and issue views, which makes the question of how the Committee should interpret the broad articles of the International Covenant on Economic, Social and Cultural Rights more pressing than ever. Most commentators on the legitimacy of the CESCR’s interpretation have argued that interpreters should make better use of Articles 31–33 of the Vienna Convention on the Law of Treaties (VCLT) in order to improve (...) the legitimacy of their findings. In this article, we argue conversely that the individual communication mechanism should be evaluated and reformed in terms of legitimate authority. In the context of the Committee’s process of interpretation, we contend that proportionality is better suited than the various interpretive options of the VCLT to offer a consistent procedure that is able to generate legitimacy by attenuating the tension between personal and collective autonomy. (shrink)

We are living in an algorithmic age where mathematics and computer science are coming together in powerful new ways to influence, shape and guide our behaviour and the governance of our societies. As these algorithmic governance structures proliferate, it is vital that we ensure their effectiveness and legitimacy. That is, we need to ensure that they are an effective means for achieving a legitimate policy goal that are also procedurally fair, open and unbiased. But how can we ensure that algorithmic (...) governance structures are both? This article shares the results of a collective intelligence workshop that addressed exactly this question. The workshop brought together a multidisciplinary group of scholars to consider barriers to legitimate and effective algorithmic governance and the research methods needed to address the nature and impact of specific barriers. An interactive management workshop technique was used to harness the collective intelligence of this multidisciplinary group. This method enabled participants to produce a framework and research agenda for those who are concerned about algorithmic governance. We outline this research agenda below, providing a detailed map of key research themes, questions and methods that our workshop felt ought to be pursued. This builds upon existing work on research agendas for critical algorithm studies in a unique way through the method of collective intelligence. (shrink)

The characteristic features of ensemble dance improvisation (EDI) make it an interesting case for theories of intentional collective action. These features include the high degree of freedom enjoyed by each individual, and the lack of fixed hierarchical roles, rigid decision procedures, or detailed plans. In this article, we present a “reductive” approach to collective action, apply it to EDI, and show how the theory enriches our perspective on this practice. We show, with the help of our theory of collective action, (...) that EDI (as typically practiced) constitutes a significant collective achievement, one that manifests an impressive, spontaneous, jointly cooperative and individually highly autonomous activity that meets demanding aesthetic standards. Its being good in this way is not a mere extrinsic feature of the artwork, but part of its aesthetic value. We end by discussing how this value is easily missed by classic aesthetics, but is revealed by more contemporary frameworks like social aesthetics. (shrink)

Seeing how the idea of the ‘ruler cult’ and the necessary ‘myth-making’ to establish it exists to this day, as seen with the regime of a 21st century dictator like Kim Jong-il, it would be most interesting to see what parallels exist between cases of divine leadership and what we might learn about our contemporary cult rulers when looking at the dynamics of the two-millennia-old cult of the deified Emperor Augustus. As such, I have formulated a central question that focuses (...) on the reign of Divus Augustus, and in doing so provides opportunity to extrapolate from it new insights in similar but contemporary figures of leadership. A clear case of 'to understand motives in the present, one must look at actions in the past.'. (shrink)

This book investigates law's interaction with practical reasons. What difference can legal requirements—e.g. traffic rules, tax laws, or work safety regulations—make to normative reasons relevant to our action? Do they give reasons for action that should be weighed among all other reasons? Or can they, instead, exclude and take the place of some other reasons? The book critically examines some of the existing answers and puts forward an alternative understanding of law's interaction with practical reasons. -/- At the outset, two (...) competing positions are pitted against each other: Joseph Raz's view that (legitimate) legal authorities have pre-emptive force, namely that they give reasons for action that exclude some other reasons; and an antithesis, according to which law-making institutions (even those that meet prerequisites of legitimacy) can at most provide us with reasons that compete in weight with opposing reasons for action. These two positions are examined from several perspectives, such as justified disobedience cases, law's conduct-guiding function in contexts of bounded rationality, and the phenomenology associated with authority. -/- It is found that, although each of the above positions offers insight into the conundrum at hand, both suffer from significant flaws. These observations form the basis on which an alternative position is put forward and defended. According to this position, the existence of a reasonably just and well-functioning legal system constitutes a reason that fits neither into a model of ordinary reasons for action nor into a pre-emptive paradigm—it constitutes a reason to adopt an (overridable) disposition that inclines its possessor towards compliance with the system's requirements. (shrink)

It is widely believed that a conservative moral outlook is opposed to biomedical forms of human enhancement. In this paper, I argue that this widespread belief is incorrect. Using Cohen’s evaluative conservatism as my starting point, I argue that there are strong conservative reasons to prioritise the development of biomedical enhancements. In particular, I suggest that biomedical enhancement may be essential if we are to maintain our current evaluative equilibrium (i.e. the set of values that undergird and permeate our current (...) political, economic, and personal lives) against the threats to that equilibrium posed by external, non-biomedical forms of enhancement. I defend this view against modest conservatives who insist that biomedical enhancements pose a greater risk to our current evaluative equilibrium, and against those who see no principled distinction between the forms of human enhancement. (shrink)

One of the core issues in contemporary political philosophy is concerned with `political obligation.' Stated in an overly simplified way, the question being asked when one investigates political obligation is, "What, if anything, do citizens owe to their government and how are these obligations generated if they do exist?" The majority of political philosophers investigating this issue agree that a political obligation is a moral requirement to act in certain ways concerning political matters. Despite this agreement about the general nature (...) of what is being searched for, a broad division has arisen between political obligation theorists - there are some who take political obligations to actually exist and there are some who take there to be no general political obligation. While there is debate within the camp defending political obligation about what it is that generates the obligations, the common core of all "defender theories" is the fundamental idea that one has a moral requirement to support and obey the political institutions of one's country. Despite utilitarianism's status as one of the major ethical theories, historically, it has largely been dismissed by theorists concerned with political obligation. Within the contemporary debate it is generally accepted that utilitarianism cannot adequately accommodate a robust theory of political obligation. The overarching objective of this dissertation is to challenge this general dismissal of a utilitarian account and to build upon the two accounts which have been developed in offering a robust utilitarian theory of political obligation which can be considered a competitor to the other contemporary theories. However, as this utilitarian account of political obligation develops, the possibility will also emerge for a non-antagonistic relationship between the utilitarian theory on offer and the contemporary political obligation debate. The moral reasons posited by the traditional theories of political obligation can be included in and accommodated by my utilitarian account. The utilitarian account of political obligation can accept that there are many types of reasons explaining why broad expectations concerning individual and group behavior are created, and each type of reason can be understood as supporting the utilitarian claim that there are moral reasons for following the laws and supporting legitimate political authorities. Taken all together, my arguments will take the form of a three tiered response to the prevailing opinion that any utilitarian attempt to account for political obligations is doomed. The first tier contends that the utilitarian can consistently claim that there are moral reasons to follow the law. This is not a particularly strong claim, but it is one which has been denied by the vast majority of political theorists. The second tier of my argument addresses this apparent issue by contending that even the traditional deontological accounts of political obligation are not offering more than this. Lastly, it is contended that, given the contingent features of humans, the strength of the utilitarian political obligations is comparable to other accounts' analyses of the obligations. (shrink)

According to some philosophers and social scientists, mainstream economic theories currently play an unprecedented role in shaping human societies. This phenomenon can be linked to the dissemination of methodological individualism, where common goods are interpreted as reducible to aggregates of individuals' well-being. Nonetheless, some emergent difficulties of economics in coping with global institutional issues have encouraged some authors to revise that paradigm. In the last three decades, there has been a parallel growing philosophical interest in investigating social sciences' epistemological and (...) ontological foundations. Unfortunately, these two research trends have often not communicated systematically enough to understand the specific ontology of collective aims. It is still unclear whether some irreducible social goods exist and how the answer to this question can set up a consistent understanding of cooperative actions. This dissertation addresses this issue, drawing on philosophical investigations about collective intentionality. It claims that a coherent ontological taxonomy of irreducible and reducible social goods is theoretically viable and can reframe prevailing approaches to collective action dilemmas influenced by the traditional economic categorisation of goods. The research begins by analysing how the influential theory of public goods has paved the way for some social and moral impasses. Furthermore, some theoretical proposals suggesting the existence of relational goods and common-pool resources are scrutinised. Hence, a refutation of the ontological reduction of all social goods to individual ones is developed, arguing that a specific form of cooperation, grounded in we-intentions and we-reasoning, shows the plausibility of the existence of some kinds of irreducible collective goods. Expanding on that view, a refinement of this categorisation of social goods is put forward by underlying the function of some relational entities, such as trust and shared sensemaking processes, in making cooperation robust in uncertain environments. Finally, by applying the taxonomy to collective action gridlocks regarding climate change, digital information, and public education, the consistency of this hypothesis is tested, showing that a pluralistic ontological account of social goods might improve the moral understanding of current social dilemmas. (shrink)

In recent years there have been several calls in professional and academic journals for healthcare personnel in Canada to raise the profile of postcolonial theory as a theoretical and explanatory framework for their practice with Indigenous people. In this paper I explore some of the challenges that are likely to confront those healthcare personnel in engaging with postcolonial theory in a training context. I consider these challenges in relation to three areas of conflict. First I consider conflicts around paradigms of (...) knowledge, wherein postcolonial theory operates from a different base from most professional knowledge in health care. Second I consider conflicts of ideology, wherein postcolonial theory is largely at odds with Canada’s political and popular cultures. And finally I consider issues around the question of Canada’s legitimacy, which postcolonial theory puts in doubt. I suggest ways in which these conflicts might be addressed and managed in the training context, and also identify potential positive outcomes that would be enabling for healthcare personnel, and might also contribute to an improvement in Canada’s relationship with its indigenous peoples. (shrink)

Moral and legal philosophy are too entangled: moral philosophy is prone to model interpersonal moral relationships on a juridical image, and legal philosophy often proceeds as if the criminal law is an institutional reflection of juridically imagined interpersonal moral relationships. This article challenges this alignment and in so doing argues that the function of the criminal law lies not fundamentally in moral blame, but in regulation of harmful conduct. The upshot is that, in contrast to interpersonal relationships, the criminal law (...) cannot lose its standing to blame through institutional analogues of hypocrisy, complicity, and meddling. Rather, certain forms of structural and severe historical and contemporary injustice point to the question of the overall legitimacy of state authority. (shrink)

I discuss ethical aspects of behavioural policies in domestic energy usage, recycling, food waste and transportation.

Contrary to the popular belief, I argue that a more inclusive polity does not necessarily conflict with the goal of improving the epistemic capacities of deliberation. My argument examines one property of democracy that is usually thought of in non-epistemic terms, inclusion. Inclusion is not only valuable for moral reasons, but it also has epistemic virtues. I consider two epistemic benefits of inclusive deliberation: inclusive deliberation helps to create a more complete picture of the world that everyone dwells together; and (...) inclusive deliberation can be helpful in reducing biases and errors endemic to a society. Having advanced two epistemic arguments for inclusive deliberation, I argue that the Deweyan model best captures the knowledge-pooling function of deliberation. (shrink)

Natural disasters are social disruptions triggered by physical events. Every year, hundreds of natural disasters occur and tens of thousands of people are killed as a result. I maintain that everyone would want to be provided with assistance in the aftermath a natural disaster. If a national government is not providing post disaster assistance, then we expect that some other institution has the responsibility to provide it. Unfortunately, that is not the case currently. Therefore, in this thesis I argue that (...) in some situations the international community is required to intervene on behalf of those affected by the disaster caused by a natural hazard. Natural disaster intervention is a moral requirement: because the international community has a duty to provide the goods we are entitled to as per the human right to welfare, even in natural disaster scenarios. After making my argument as to why a natural disaster intervention policy should be developed I explain the basic principles of such a policy by applying the Just War criteria to natural disaster scenarios in which a national government is unable or unwilling to provide assistance to its people. (shrink)

A central problem of political philosophy is that of explaining how a state could have the moral authority to enforce laws, promulgate laws which citizens are thereby obliged to obey, give new duties to citizens and levy taxes. Many rival solutions to this problem of political authority have been offered by contemporary and recent philosophers but none has obtained wide acceptance. The current debate takes no cognisance of George Berkeley’s ‘Passive Obedience’, in which he defends the exceptionless duty of not (...) using force to resist the state and offers a rule-consequentialist account of morality which indicates an explanation of political authority as grounded in the social connectedness of human beings. I expound, criticise and develop Berkeley’s explanation to provide a promising solution to the problem of political authority. The solution impugns the political authority of all existing states as well as the duty of passive obedience. (shrink)

The strong correlation between people’s socioeconomic position and health within high income countries is a well-documented fact. A person’s occupation, income and education level tell us a lot about that person’s prospects on a long and healthy life, such that we can speak of a ‘social gradient in health’, or a ‘socioeconomic health gap’. This association is often perceived to be unjust. Therefore, it is generally thought that governments should aim to reduce socioeconomic health inequalities. However, this idea needs ethical (...) justification, for it is not evident if and why exactly these inequalities are unjust. For instance, are inequalities in health unjust per se? Or because the underlying socioeconomic inequalities are unjust? And does justice require equal health levels, or a minimum level of health? What complicates the issue, is that the width of the health gap, or the steepness of the social gradient, depends on what health measures are used. Overall, the more subjective the measure, the greater the inequalities appear to be. But are all these measures equally morally relevant? This dissertation aims to give a better understanding of these philosophical questions. It does so by investigating the question of what we should understand by health in the first part, after which it addresses the question of how to evaluate socioeconomic health inequalities in the light of justice. The introduction begins with a description of the phenomenon of socioeconomic health inequalities, and how it has been addressed by politicians, epidemiologists and philosophers in the past and today. The chapter continues by formulating the central question of the dissertation – that of which health inequalities should be focused in the light of a concern with social justice. It explicates how this dissertation contributes to answering that question, by discussing the potential relation between the conceptualisation of health and justice evaluations, and by discussing which questions are addressed in each of the following chapters. The chapter 2 addresses the question of how health is conceptualised in the philosophical and public heath literature, and how theoretical concepts of health differ. It proposes to approach health concepts as a Wittgensteinian family of thick concepts and argues that while theories on health generally argue in favour of one specific concept, a comparison of concepts shows that we may need different concepts of health given the variety of health practices. By explicating the differences between five concepts of health, this chapter argues that each captures aspects of health that all seem relevant when we talk and think about health. Classifying these concepts based on their distinctions reveals them as members of a conceptual family: each of the discussed concepts differs from the others in at least one respect and resembles the others in several respects. Moreover, the discussion of the concepts shows that ‘health’ always both describes a condition and values that condition at the same time. Having both descriptive and evaluative dimensions, we can see health concepts as ‘thick concepts’. Given this evaluative dimension, it is important to reflect on the question of what understanding of health guides specific practices. Moreover, the distinctions revealed by the classification can serve as a conceptual toolbox for reflection on the assumptions and purposes of health practices. How such reflection could work is illustrated by a brief exploration of what health aspects are focused upon in three specific health practices. Chapter 3 presents a study into the question of how health is conceptualised by ordinary citizens and to what extent conceptualisations of health differ between socioeconomic groups. By making use of the method of concept mapping, this study analyses how different socioeconomic groups formulate their own answers regarding the question ‘what does health mean to you?’. It presents concept maps of health for three different socioeconomic groups living in the city of Utrecht that reveal that all groups have a multidimensional understanding of health. An interpretation of the concept maps reveals nuanced differences between groups. The multiple aspects of health were also ranked by importance. It appears that each group assigned most importance to mental health. All in all, the study shows that people in lower socioeconomic groups are more likely to show a conceptualisation of health that refers to 1) the absence of health threats, 2) a person within his/her circumstances, 3) the value of functional notions, and 4) an accepting attitude towards life. Chapter 4 addresses the question of what the theoretical and empirical study to concepts of health could imply for health equity practices. It does so by exploring further the suggestions made in chapters 2 and 3. Regarding the question of which health aspects should guide health equity policies, this chapter discusses the question of whether we should primarily look at subjective or objective health measures, and whether a universal or relative standard of health should be central. While justice-related concerns of impartiality and equal treatment may seem to favour an objective perspective and a universal health standard, it appears that we have good reason to account for the subjective perspective as well. It is also argued that a concern for recognition and participatory parity gives room for relative health standards. Th room for relative health standards confronts us with the question of how to deal with mechanisms like adaptive preferences that the concept maps reveal. It proposes a way out, by arguing for society-relative health standards. Chapter 5 examines the question of whether inequalities in health should be evaluated ‘directly’, thus independently of a distribution of their social determinants. It proposes a sufficientarian perspective, such that the central question of evaluation is that of whether everyone is – or can be – healthy enough. By discussing two sufficientarian approaches to health and social justice – by Powers & Faden and by Nussbaum – this chapter distinguishes two ways of setting a threshold level for health. Both approaches appear to provide an unsatisfactory basis for justice evaluations and lead us away from direct evaluation if we try to settle health minima that are less arbitrary. In anticipation to chapters 6 and 7, it is argued that the perspective of sufficient health for relational equality escapes this arbitrariness: compared to that of a decent human life, it better helps to answer both the question of what socioeconomic health inequalities a society is due to avoid, and the question of when socioeconomic health inequalities are unjust considering their consequences. Chapter 6 discusses to what extent Daniels’s theory of health justice provides a satisfactory answer to the question of what health inequalities a society is due to avoid. Daniels proposes an indirect evaluative approach by arguing that we should evaluate socioeconomic health inequalities in the light of Rawls’s principles of justice as fairness. That is, if socioeconomic inequalities are in accordance with fair equality of opportunity and with the difference principle, the corresponding health inequalities would be just. It is shown that the suggestion that Rawls’s principles regulate the social determinants of health neglects that not all social determinants of health belong to society’s basic structure as conceived of by Rawls and are thereby not subjected to the principles of justice. To acknowledge the social mechanisms leading to socioeconomic health inequalities in their full complexity, it is argued that we should broaden our understanding of society’s structure in accordance with Young’s notion of social structural processes. This renders the question of what health inequalities a society is due to avoid into a question of what we can expect from the side of the various actors that uphold the social structures that produce socioeconomic health inequalities. Lastly, it is discussed how a shift to Young’s theory completes the shift to non-ideal theorising that seem already initiated by Daniels, and that with this, the distinction between direct and indirect evaluation dissolves. Chapter 7 discusses to what extent equality in health is of instrumental value for a society of free and equals. It thus takes up the idea proposed in chapter 5, that an evaluation of the consequences of health inequalities is also due. Taking relational equality as an evaluative framework reveals three ways in which inequalities in life expectancy threaten this ideal. That is, via unequal risks to stigmatisation, unequal risks to unemployment and the risk of unequal pension enjoyments. It is thereby shown that these risks are especially great for those lower down the socioeconomic strata. It thus concludes that equality in health is of instrumental value to relational equality. The chapter continues to argue that our instrumental approach opens a new perspective: to mitigate the identified injustices by changing society, rather than by reducing inequalities in health. This is argued to be an advantage in the light of the realistic assumption that of the socioeconomic health inequalities will persist. The paper thus offers a complementary approach to both the evaluation and the mitigation of the injustice of socioeconomic inequalities in health. The discussion chapter summarises the central findings of the analyses of health concepts and discusses questions regarding the philosophical and practical merits of comparing theoretical health concepts, the need for developing new health measures or concepts and the importance or nonsense of studying citizen’s views on health. Repeating this for the dissertation’s second part, the central findings of the chapters on justice evaluation are summarised and followed by a discussion of questions and issues that have remained unaddressed so far. Here, central points of discussion are my take on rules of distribution, the distinction of direct and indirect evaluation, the role of ideal and non-ideal theory, the idea of relational equality, and personal responsibility for health. The chapter concludes by noting that also in the light of justice evaluations, all commonly used health measures are relevant for justice. Therefore, my recommendations for policy and further research entail that inequalities in each of these measures deserve attention by both policymakers and researchers. Specifically, policymakers and researchers should give attention to how exactly each of these health inequalities come about, in such a way that a discussion about the question of who can be assigned responsibility to alleviate them is well-informed; and both should give attention to the effects of health inequalities on the opportunities for people to live on equal standing, in such a way that when these opportunities are diminished, actions can be considered to aim to restore relational equality. (shrink)