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 paper develops a general approach to how society should compensate for losses that individuals incur due to public health interventions aimed at controlling the spread of infectious diseases. The paper falls in three parts. The first part provides an initial introduction to the issues and briefly outlines five different kinds of public health interventions that will be used as test cases. They are all directed at individuals and aimed at controlling the spread of infectious diseases (1) isolation, (2) quarantine, (...) (3) recommended voluntary social distancing, (4) changes in health care provision for asymptomatic carriers of multi-resistant microorganisms, and (5) vaccination. The interventions will be briefly described including the various risks, burdens and harms individuals who are subject to these interventions may incur. The second part briefly surveys current compensation mechanisms as far as any exist and argue that even where they exist they are clearly insufficient and do not provide adequate compensation. The third part will then develop a general framework for compensation for losses incurred due to public health interventions in the infectious disease context. This is the major analytical and constructive part of the paper. It first analyses pragmatic and ethical arguments supporting the existence of an obligation on the part of the state to compensate for such losses, and then considers whether this obligation can be defeated by (1) resource considerations, or (2) issues relating to personal responsibility. (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 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)

One of the ways in which public health officials control outbreaks of epidemic disease is by attempting to control the situations in which the infectious agent can spread. This may include isolation of infected persons, quarantine of persons who may be infected and detention of persons who are present in or have entered premises where infected persons are being treated. Most who have analysed such measures think that the restrictions in liberty they entail and the detriments in welfare they impose (...) can be justified and this paper proceeds from the assumption that detention measures are justifiable in some circumstances. Such measures are often implemented without any compensation being given to the persons who are detained. This raises the question: What do we owe to those whose liberty is justifiably restricted (e.g. through isolation, quarantine or detention) as a public health measure during a public health emergency? More specifically, do we owe them compensation for any losses they experience? The paper falls in four main sections. The first section provides examples of the current regulatory state of affairs from the US, Canada and WHO. The second section lays out the liberal, welfarist and pragmatic arguments for providing compensation. The third section discusses the arguments against compensation and the fourth and final section provides the conclusion. It is argued that the arguments for providing compensation clearly outweigh the counterarguments and that the default public policy therefore should be that compensation is provided. (shrink)

:This paper questions the distinction between egalitarianism and prioritarianism, arguing that it is important to separate the reasons for particular social preferences from the contents of these preferences, that it is possible to like equality and separability simultaneously, and that some egalitarians and prioritarians may therefore share the same social preferences. The case of risky prospects, for which Broome has proposed an interesting example meant to show that egalitarians and prioritarians cannot share the same preferences, is scrutinized. The levelling down (...) objection is also examined. (shrink)

Parfit advertised the priority view as a new and fundamental theory in the ethics of distribution. He never discusses risk, and many writers follow suit when discussing the priority view. This article formalizes two popular arguments for a commonly accepted risk-free definition of the priority view. One is based on a direct attempt to define the priority view, the other is based on a contrast with utilitarianism and egalitarianism. But neither argument succeeds, and more generally, it is not possible to (...) make sense of the priority view in a risk-free framework. The article pays particular attention to the proper role of evaluative measurements in theorizing about the ethics of distribution. Despite appearances, approaching the priority view in terms of risk from the outset is argued to be quite natural. (shrink)

The priority view has become very popular in moral philosophy, but there is a serious question about how it should be formalized. The most natural formalization leads to ex post prioritarianism, which results from adding expected utility theory to the main ideas of the priority view. But ex post prioritarianism entails a claim which is too implausible for it to be a serious competitor to utilitarianism. In fact, ex post prioritarianism was probably never a genuine alternative to utilitarianism in the (...) first place. By contrast, ex ante prioritarianism is defensible. But its motivation is very different from the usual rationales offered for the priority view. Given the untenability of ex post prioritarianism, it is more natural for most friends of the priority view to revert to utilitarianism. (shrink)