Wealth and income are highly predictive of health and longevity. Egalitarians who maintain that this “socioeconomic-status gradient” in health is unjust are challenged by the fact that a significant component of it is owed to the higher prevalence of certain kinds of voluntary risk-taking among members of lower socioeconomic groups. Some egalitarians have argued that these apparently free personal choices are not genuinely free, and that those who make them should not be held morally responsible for the resulting harms to (...) their health. I argue to the contrary that such choices usually are fully free, and that those who make them are responsible for their consequences. This does not imply, however, that society cannot also be responsible for those consequences. It is responsible for them if they are statistically foreseeable and avoidable outcomes of unjust public institutions and policies. I show that many of the harms to health that contribute to the voluntary behavioral component of the SES health gradient satisfy that description. Society can therefore be morally responsible for those harms, even though the individuals who suffer them are also fully responsible for them. (shrink)

When is it fair that some people are less healthy than others due to their own individual choices and preferences? In this paper, I explore two alternative answers. The first is a luck-egalitarian account that holds people responsible for choices that society could have reasonably expected them to avoid. I argue that this account is indeterminate and go on to sketch an alternative proposal based on Rawls’s idea of a “social division of responsibility.” This latter approach connects the notion of (...) responsibility for health to the social conditions under which health-related behaviour is developed. (shrink)

This chapter discusses how justice applies to public health. It begins by outlining three different metrics employed in discussions of justice: resources, capabilities, and welfare. It then discusses different accounts of justice in distribution, reviewing utilitarianism, egalitarianism, prioritarianism, and sufficientarianism, as well as desert-based theories, and applies these distributive approaches to public health examples. Next, it examines the interplay between distributive justice and individual rights, such as religious rights, property rights, and rights against discrimination, by discussing examples such as mandatory (...) treatment and screening. The chapter also examines the nexus between public health and debates concerning whose interests matter to justice (the “scope of justice”), including global justice, intergenerational justice, and environmental justice, as well as debates concerning whether justice applies to individual choices or only to institutional structures (the “site of justice”). The chapter closes with a discussion of strategies, including deliberative and aggregative democracy, for adjudicating disagreements about justice. (shrink)

If we want to make people more equal, what should we make them more equal in? For example, should it be resources, such as income, or should it be subjective well-being, such as preference satisfaction? The aim of this article is to critically examine the two main answers to this question within a luck egalitarian moral framework, which is a framework that aims to eliminate inequalities caused by non-responsibility factors, while preserving inequalities due to responsibility factors. I argue that the (...) arguments typically presented in favor of equalizing incomes rather than subjective well-being are weak and that within a luck egalitarian moral framework the claim that resources and not welfare should be considered the appropriate basis for interpersonal comparisons is in need of justification.The question of what society should equalize is applied to the issue of what should be the fair level of unemployment insurance compensation: Should we only compensate the involuntary unemployed for the income loss associated with unemployment, or also for the non-pecuniary costs associated with unemployment? The answer to this question, I argue, depends on where the cut between responsibility factors and non-responsibility factors is drawn. (shrink)

My aim in this chapter is to place John Stuart Mill’s distinctive utilitarian political philosophy in the context of the debate about luck, responsibility, and equality. I hope it will reveal the extent to which his utilitarianism provides a helpful framework for synthesizing the competing claims of luck and relational egalitarianism. I attempt to show that when Mill’s distributive justice commitments are not decided by direct appeal to overall happiness, they are guided by three main public principles: an impartiality principle, (...) a sufficiency principle, and a merit principle. The question then becomes how luck and relational considerations figure into his articulation of these public principles. I argue that relational egalitarianism is more fundamental than considerations of luck and responsibility in Mill’s thought, but I also hope to show that any fleshed out picture of Mill’s reform proposals must recognize his condemnation of the role luck plays in determining the distribution of opportunities and outcomes. (shrink)

A leading classical utilitarian, John Stuart Mill is an unlikely contributor to the public reason tradition in political philosophy. To hold that social rules or political institutions are justified by their contribution to overall happiness is to deny that they are justified by their being the object of consensus or convergence among all those holding qualified moral or political viewpoints. In this chapter, I explore the surprising ways in which Mill nevertheless works to accommodate the problems and insights of the (...) public reason tradition, and the extent to which he makes arguments that can help those working within that tradition. Mill’s utilitarian theory incorporates the claim that the demands of social life require a publicly accepted set of normative expectations to govern judgments about when one has met one’s obligations and, relatedly, about the appropriateness of blame or punishment. (shrink)

The late G.A. Cohen is routinely considered a founding father of luck egalitarianism, a prominent responsibility-sensitive theory of distributive justice. David Miller argues that Cohen’s considered beliefs on distributive justice are not best understood as luck egalitarian. While the relationship between distributive justice and personal responsibility plays an important part in Cohen’s work, Miller maintains that it should be considered an isolated theme confined to Cohen’s exchange with Dworkin. We should not understand the view Cohen defends in this exchange as (...) Cohen’s considered view. Accepting this thesis would change both our understanding of Cohen’s political philosophy and many recent luck egalitarian contributions. Miller’s argument offers an opportunity to reassess Cohen’s writings as a whole. Ultimately, however, the textual evidence against Miller’s argument is overwhelming. Cohen clearly considers the exchange with Dworkin to be about egalitarianism as such rather than about the best responsibility-sensitive version of egalitarianism. Furthermore, Cohen often offers luck egalitarian formulations of his own view outside of the exchange with Dworkin and uses luck egalitarianism as an independent yardstick for evaluating principles and distributions. (shrink)

While libertarians affirm personal responsibility as a central moral and political value, libertarian theorists write relatively little about the theory and practice of this value. Focusing on the work of F. A. Hayek and David Schmidtz, this article identifies the core of a libertarian approach to personal responsibility and demonstrates the ways in which this approach entails a radical revision of the ethics and American politics of personal responsibility. Then, I highlight several central implications of this analysis in the American (...) political and economic status quo. First, this analysis makes a mockery of so-called libertarian/conservative ‘fusionism’, such that libertarian personal responsibility cannot partner with meritocratic conservative thought to provide a plural grounding for rejecting progressive or redistributive economic policy. Next, preferred libertarian policies threaten the status, esteem and social bases of self-respect of citizens who are worse-off through little or no fault of their own. Finally, these policies undermine the ethics of personal responsibility that Americans from across the ideological spectrum value and many conservatives and libertarians celebrate. In the American status quo, those who value personal responsibility must reserve a central place for policies that mitigate opportunity and distributive inequalities. (shrink)

Nu cu foarte mult timp în urmă, grupul de teorie socială şi politică din cadrul proiectului POSDRU 89/1.5/S/56815 „Societatea bazată pe cunoaştere-cercetări, dezbateri, perspective”, a publicat, tot la editura Institutul European, lucrarea Concepte şi teorii social-politice. Volumul de faţă reprezintă un nou pas al grupului nostru de lucru în realizarea proiectului inaugurat prin publicarea acelei lucrări. Este vorba, reamintesc, despre proiectul elaborării unor volume care să-i ajute pe cei interesaţi în iniţierea (lor sau a altora) în teoria (şi în special (...) filosofia) politică, mai ales în dezvoltările sale conceptuale, argumentative şi problematologice recente. Desigur, nu am intenţionat în mod expres ca aceste volume să fie utile doar în această direcţie. Speranţa noastră a fost, dimpotrivă, ca ele să fie interesante şi pentru cercetătorii cu experienţă în investigarea şi dezbaterea temelor abordate în cadrul lor, mai ales pentru că unele capitole prezintă idei, argumente sau perspective originale, care, credem noi, merită atenţia critică a comunităţii cercetătorilor români. Menirea lor fundamentală rămâne totuşi, în intenţia noastră, cea introductivă. Aşa cum recunoşteam în cuvântul său înainte, Concepte şi teorii socialpolitice nu este deloc un volum exhaustiv. Teorii şi ideologii politice reprezintă, în bună măsură, şi o încercare de a compensa cumva acest „defect” al volumului în cauză. Desigur, nici publicarea lui nu ne permite să susţinem că am atins obiectivul oferirii unei introduceri cât mai complete în teoria/filosofia politică actuală. Deşi Teorii şi ideologii politice prezintă câteva dintre cele mai importante teorii sau ideologii politice contemporane, există multe altele care nu sunt prezentate (sau cel puţin nu sunt prezentate atât de detaliat pe cât ar fi meritat) între paginile sale. Mă refer aici, spre exemplu, la libertarianism, comunitarianism, cosmopolitism sau capabilism (ca teorie a dezvoltării umane). Ne consolăm însă în baza a trei argumente. Unul este acela că, aşa cum se poate observa cu uşurinţă din cuprinsul său, cartea de faţă prezintă totuşi un număr important dintre principalele teorii şi ideologii politice recente (unele dintre ele pentru prima dată în literatura românească de specialitate). Al doilea este acela că unele dintre teoriile sau ideologiile politice care nu sunt abordate aici au beneficiat deja de prezentări competente şi atente la noi (unele dintre ele chiar în Concepte şi teorii social-politice). În sfârşit, al treilea argument este acela că sperăm cu toţii că prezentul volum nu reprezintă ultimul nostru pas în realizarea obiectivului menţionat în debutul acestei intervenţii. Sperăm, altfel spus, să putem prezenta acele teorii sau ideologii politice care nu şi-au găsit locul între paginile lui sau ale celui precedent cu o altă ocazie. Ţin să precizez însă că volumul pe care îl introduc prin această intervenţie nu este întrutotul o continuare a celui precedent, deşi între ele există, desigur, destule afinităţi, relaţii şi continuităţi tematice. Mai exact, el nu ar putea fi descris totalmente neproblematic ca reprezentând „al doilea tom” al volumului Concepte şi teorii social-politice. Titlul său este menit să indice acest lucru. Dacă lucrarea anterioară era centrată pe prezentarea unora dintre principalele concepte ale teoriei/filosofiei social-politice contemporane, cartea de faţă prezintă câteva dintre principalele teorii sau ideologii dezvoltate şi apărate de politologii, filosofii, economiştii sau „ideologii” politici contemporani. Nici de această dată nu voi încerca să rezum principalele idei expuse sau metodologii utilizate de către autori în prezentarea teoriilor sau ideologiilor politice care se regăsesc între paginile ce urmează. Temeiul meu este acelaşi: acolo unde au considerat că este cazul, autorii capitolelor şi-au rezumat ei înşişi ideile prezentate sau/şi metodologiile utilizate. În plus, cititorul interesat să-şi facă o idee prealabilă despre conţinutul ideatic şi problematologic al cărţii dispune de un rezumat al ei (în limbile engleză şi franceză) în finalul său. În consecinţă, mă voi mulţumi să închei doar prin a exprima încă o dată speranţa noastră că această carte se va dovedi utilă celor cărora li se adresează cu preponderenţă. Sperăm, în alte cuvinte, ca ea să le fie de ajutor în înţelegerea şi evaluarea adecvată a teoriilor şi ideologiilor pe care le prezintă. Şi mai important, sperăm că ea îi va stimula să caute să aprofundeze cercetarea acestor teorii şi ideologii şi – mai ales – să iniţieze propriile investigaţii sistematice şi riguroase în această privinţă. Dezvoltarea politologiei şi a filosofiei politice în spaţiul românesc, ca să nu mai vorbim despre clarificarea şi fundamentarea cât mai completă şi adecvată a opţiunilor ideologice ale partidelor politice din România, au nevoie de acest lucru. (shrink)

This paper develops a full account of Rawls's notion of a well-ordered society and uses it to address two luck egalitarian objections to his principles of justice. The first is an internal criticism which claims that Rawls's account of justice is better captured by a responsibility-sensitive egalitarian account. The second is an external objection according to which, regardless of the alleged inconsistency between Rawls's principles and his account of justice, we should reject those principles in favour of a responsibility-sensitive criterion (...) because it better captures our moral intuitions about distributive justice. The argument presented answers both objections by defending the value of well-orderedness and showing the difficulties of responsibility-sensitive egalitarian conceptions in realizing this ideal. (shrink)

The scarcity of livers available for transplants forces tough choices upon us. Lives for those not receiving a transplant are likely to be short. One large group of potential recipients needs a new liver because of alcohol consumption, while others suffer for reasons unrelated to their own behaviour. Should the former group receive lower priority when scarce livers are allocated? This discussion connects with one of the most pertinent issues in contemporary political philosophy; the role of personal responsibility in distributive (...) justice. One prominent theory of distributive justice, luck egalitarianism, assesses distributions as just if, and only if, people's relative positions reflect their exercises of responsibility. There is a principled luck egalitarian case for giving lower priority to those who are responsible for their need. Compared to the existing literature favouring such differentiation, luck egalitarianism provides a clearer rationale of fairness, acknowledges the need for individual assessments of responsibility, and requires initiatives both inside and outside of the allocation systems aimed at mitigating the influence from social circumstances. Furthermore, the concrete policies that luck egalitarians can recommend are neither too harsh on those who make imprudent choices nor excessively intrusive towards those whose exercises of responsibility are assessed. (shrink)

Luck egalitarianism is often taken to task for its alleged harsh implications. For example, it may seem to imply a policy of nonassistance toward uninsured reckless drivers who suffer injuries. Luck egalitarians respond to such objections partly by pointing to a number of factors pertaining to the cases being debated, which suggests that their stance is less inattentive to the plight of the victims than it might seem at first. However, the strategy leaves some cases in which the attribution of (...) individual responsibility is appropriate . One such case is oral health or significant aspects of this. It is appropriate, the paper argues, to hold people responsible for a number of factors that affect their oral health. A luck egalitarian approach inspired by John Roemer can assess whether people have acted responsibly by comparing their choices to those of their peers. A luck egalitarian approach to oral health would recommend prioritizing scarce resources in a responsibility-weighted queuing system and include copayment and general taxation among its measures of financing. (shrink)

Helen Frowe has recently offered what she calls a “practical” account of self-defense. Her account is supposed to be practical by being subjectivist about permissibility and objectivist about liability. I shall argue here that Frowe first makes up a problem that does not exist and then fails to solve it. To wit, her claim that objectivist accounts of permissibility cannot be action-guiding is wrong; and her own account of permissibility actually retains an objectivist (in the relevant sense) element. In addition, (...) her attempt to restrict subjectivism primarily to “urgent” situations like self-defense contradicts her own point of departure and is either incoherent or futile. Finally, the only actual whole-heartedly objectivist account she criticizes is an easy target; while those objectivist accounts one finds in certain Western European jurisdictions are immune to her criticisms. Those accounts are also clearly superior to hers in terms of action-guidingness. (shrink)

Traditional outcome-orientated egalitarian principles require access to information about the size of individual holdings. Recent egalitarian political theory has sought to accommodate considerations of responsibility. Such a move may seem problematic, in that a new informational burden is thereby introduced, with no apparent decrease in the existing burden. This article uses a simple model with simulated data to examine the extent to which outcome egalitarianism and responsibility-sensitive egalitarianism (‘luck egalitarianism’) can be accurately applied where information is incomplete or erroneous. It (...) is found that, while outcome egalitarianism tends to be more accurately applied, its advantage is not overwhelming, and in many prima facie plausible circumstances luck egalitarianism would be more accurately applied. This suggests that luck egalitarianism cannot be rejected as utopian. Furthermore, while some argue that, in practice, luck egalitarianism is best realized indirectly, by securing equality of outcome, our evidence suggests that a luck egalitarian rule of regulation offers a far more accurate implementation of the luck egalitarian ideal than does an outcome egalitarian rule of regulation. (shrink)

This rejoinder to Roemer examines Roemer's amendment to his EOp criterion, explains the similarities and differences between Roemer's approach to equality of opportunity and the economic literature inspired by the fair allocation theory, and proposes some clarifications on the compensation principle and the role of the reward principle in the definition of a responsibility-sensitive social criterion. It highlights the power of the ideal of respect for individual preferences with respect to the reward issue and the concern for potential harshness of (...) the social criterion toward the individuals who fail to make good use of their opportunities. It discusses Roemer's objection against holding individuals responsible for their preferences. (shrink)

In recent years some moral philosophers and political theorists, who have come to be called “luck egalitarians,” have urged that the essence of social justice is the moral imperative to improve the condition of people who suffer from simple bad luck. Prominent theorists who have attracted the luck egalitarian label include Ronald Dworkin, G. A. Cohen, and John Roemer.1 Larry Temkin should also be included in this group, as should Thomas Nagel at the time that he wrote Equality and Partiality.2 (...) However, each of these theorists asserts a different position. The common ground, if any, is obscure. The idea of luck that is invoked is not transparently clear. Anyway, the term “luck egalitarianism” was coined by a critic of the doctrine, and tendentiously defined to denote an extreme version of the view that looks implausible from the start.3 With some justice Ronald Dworkin, perhaps the chief architect of the luck egalitarian position, has denied that he is a luck egalitarian. (shrink)

What level of government subsidy of higher education is justified, in what form, and for what reasons? We answer these questions by applying the hypothetical insurance approach, originally developed by Ronald Dworkin in his work on distributive justice. On this approach, when asking how to fund and deliver public services in a particular domain, we should seek to model what would be the outcome of a hypothetical insurance market: we stipulate that participants lack knowledge about their specific resources and risks, (...) and ask what insurance contracts they would take out to secure different types of benefit and protection in the domain in question. The great benefit of the hypothetical insurance approach is that it allows us to take apparently intractable questions about interpersonal distribution and transform them into questions about intrapersonal distributions: that is, questions about how an individual would choose to distribute risks and resources across the various lives that they might end up living, in light of their individual ambitions and preferences. Applying this approach to higher education, we argue that the UK model of higher education funding in which the costs of an individual's higher education are shared between general taxation and the individual herself, with the latter element to be paid retrospectively through an income-contingent state-backed loan, is vindicated as just. In particular, we argue that it is more just than alternatives such as a graduate tax, full funding through general taxation, and full privatisation. (shrink)

This thesis in an invistigation into the concept of "harm" and its moral relevance. A common view is that an analysis of harm should include a counterfactual condition: an act harms a person iff it makes that person worse off. A common objection to the moral relevance of harm, thus understood, is the non-identity problem. -/- This thesis criticises the counterfactual condition, argues for an alternative analysis and that harm plays two important normative roles. -/- The main ground for rejecting (...) the counterfactual condition is that it has unacceptable consequences in cases of overdetermination and pre-emption. Several modifications to the condition are considered but all fail to solve this problem. -/- According to the alternative analysis to do harm is to perform an act which is responsible for the obtaining of a state of affairs which makes a person’s life go worse. It is argued that should be understood in terms of counterfactual dependence. This claim is defended against counterexamples based on redundant causation. An analysis of is also provided using the notion of a well-being function. It is argued that by introducing this notion it is possible to analyse contributive value without making use of counterfactual comparisons and to solve the non-identity problem. -/- Regarding the normative importance of harm, a popular intuition is that there is an asymmetry in our obligations to future people: that a person would have a life worth living were she to exist is not a reason in favour of creating that person while that a person would have a life not worth living is a reason against creating that person. It is argued that the asymmetry can be classified as a moral option grounded in autonomy. Central to this defence is the suggestion that harm is relevant to understanding autonomy. Autonomy involves partly the freedom to pursue one’s own aims as long as one does no harm. (shrink)

While there need be no conflict in theory between addressing global inequality (inequalities between people worldwide) and addressing domestic inequality (inequalities between people within a political community), there may be instances in which the feasible mechanism for reducing global inequality risks aggravating domestic inequality. The burgeoning literature on global justice has tended to overlook this type of scenario, and theorists espousing global egalitarianism have consequently not engaged with cases that are important for evaluating and clarifying the content of their theories. (...) This chapter explores potential tensions between promoting global and domestic inequality. We introduce a class of second-best scenarios that global justice theorists have neglected to demonstrate the importance of such scenarios as an aid to constructing and evaluating ideals of global justice. (shrink)

Pluralist egalitarians think that luck and relational egalitarianism each articulates a component in a pluralist account of egalitarian justice. However, this ecumenical view appears problematic in the light of Elizabeth Anderson's claim that the divide arises because two incompatible views of justification are in play, which in turn generates derivative disagreements – e.g. about the proper currency of egalitarian justice. In support of pluralist egalitarianism I argue that two of Anderson's derivative disagreements are not rooted in the disagreement over justification (...) she identifies, and that the disagreement over justification cuts across standard disagreements between luck and relational egalitarian justice. (shrink)

This paper scrutinizes the tension between individuals’ rights and paternalism. I will argue that no normative account that includes rights of individuals can justify hard paternalism since the infringement of a right can only be justified with the right or interest of another person, which is never the case in hard paternalism. Justifications of hard paternalistic actions generally include a deviation from the very idea of having rights. The paper first introduces Tom Beauchamp as the most famous contemporary hard paternalist (...) by outlining his moral theory (principlism) and showing why it, as it stands, has to allow for hard paternalism. Secondly, the paper focuses on the notion of rights within principlism. I will employ traditional theories of rights to make sense of rights in principlism. Unfortunately, this attempt fails. In the third part, then, I claim that rights can only be limited with reference to the rights or interests of others. This structure is the very point of rights, it is their bite. I will argue for this claim and show its implications. The most important implication is that not only principlism, but every normative theory that includes rights of individuals, has to abolish hard paternalism. (shrink)

People’s health is hugely affected by where they live, their occupational status and their socio-economic position. It has been widely argued that the presence of such social determinants in health provides good reasons to reject luck egalitarianism as a theory of distributive justice in health. The literature provides different reasons why this responsibility-sensitive theory of distributive justice should not be applied to health. The critiques submit that the social circumstances undermine or remove people’s responsibility for their health; responsibility sensitive health (...) policies would adversely affect those who are worst off and; the luck egalitarian approach to health distracts from the important task of rectifying socio-economic influences on people's health and provides individualistic solutions to collective problems. But for each of these variants of the critique luck egalitarianism provides suitable answers. The literature on social determinants is no detriment to the project of applying luck egalitarianism to health. (shrink)

Several attempts have been made to apply the choice-sensitive theory of distributive justice, luck egalitarianism, in the context of health and healthcare. This article presents a framework for this discussion by highlighting different normative decisions to be made in such an application, some of the objections to which luck egalitarians must provide answers and some of the practical implications associated with applying such an approach in the real world. It is argued that luck egalitarians should address distributions of health rather (...) than healthcare, endorse an integrationist theory that combines health concerns with general distributive concerns and be pluralist in their approach. It further suggests that choice-sensitive policies need not be the result of applying luck egalitarianism in this context. (shrink)

Luck egalitarianism is a family of egalitarian theories of distributive justice that aim to counteract the distributive effects of luck. This article explains luck egalitarianism's main ideas, and the debates that have accompanied its rise to prominence. There are two main parts to the discussion. The first part sets out three key moves in the influential early statements of Dworkin, Arneson, and Cohen: the brute luck/option luck distinction, the specification of brute luck in everyday or theoretical terms and the specification (...) of advantage as resources, welfare, or some combination of these. The second part covers three later developments: the democratic egalitarian critique of luck egalitarianism, the luck egalitarian acceptance of pluralism, and luck egalitarian doubts about the significance of the brute luck/option luck distinction. (shrink)

This article explores the Rawlsian goal of ensuring that distributions are not influenced by the morally arbitrary. It does so by bringing discussions of distributive justice into contact with the debate over moral luck initiated by Williams and Nagel. Rawls’ own justice as fairness appears to be incompatible with the arbitrariness commitment, as it creates some equalities arbitrarily. A major rival, Dworkin’s version of brute luck egalitarianism, aims to be continuous with ordinary ethics, and so is (a) sensitive to non-philosophical (...) beliefs about free will and responsibility, and (b) allows inequalities to arise on the basis of option luck. But Dworkin does not present convincing reasons in support of continuity, and there are compelling moral reasons for justice to be sensitive to the best philosophical account of free will and responsibility, as is proposed by the revised brute luck egalitarianism of Arneson and Cohen. While Dworkinian brute luck egalitarianism admits three sorts of morally arbitrary disadvantaging which correspond to three forms of moral luck (constitutive, circumstantial, and option luck), revised brute luck egalitarianism does not disadvantage on the basis of constitutive or circumstantial luck. But it is not as sensitive to responsibility as it needs to be to fully extinguish the influence of the morally arbitrary, for persons under it may exercise their responsibility equivalently yet end up with different outcomes on account of option luck. It is concluded that egalitarians should deny the existence of distributive luck, which is luck in the levels of advantage that individuals are due. (shrink)

Individuals who become ill as a result of personal lifestyle choices often shift the monetary costs of their healthcare needs to the taxpaying public or to fellow members of a private insurance pool. Some argue that policies permitting such cost shifting are unfair. Arguments for this view may seem to draw support from luck egalitarian accounts of distributive justice. This essay argues that the luck egalitarian framework provides no such support. To allocate healthcare costs on the basis of personal responsibility (...) would arbitrarily and publicly burden socially detectable risk-takers while undetectable risk-takers continue to get a free ride. That problem is unavoidable even on the assumption that distributive institutions outside the healthcare sector are fully just. In actual, farfrom-just societies, imposing personal liability for the costs of voluntary risk taking would be wrong for an additional reason. Doing so would tend to magnify existing distributive injustices. These conclusions draw attention to two common ‘moral fallacies of the second best’ that can arise when applying ideal normative theory to matters of institutional design and in real-world policy contexts. (shrink)

This review article of Shlomi Segall's Health, Luck, and Justice (Princeton University Press, 2010) addresses three issues: first, Segall’s claim that luck egalitarianism, properly construed, does not object to brute luck equality; second, Segall’s claim that brute luck is properly construed as the outcome of actions that it would have been unreasonable to expect the agent to avoid; and third, Segall’s account of healthcare and criticism of rival views. On the first two issues, a more conventional form of luck egalitarianism (...) – that is, one which objects to brute luck even if it creates equality, and which construes brute luck as the inverse of agent responsibility – is defended. On the third issue, strengths and weaknesses in Segall’s criticism of Rawlsian, democratic egalitarian, and all-luck egalitarian approaches to healthcare, and in his own luck egalitarian approach, are identified. (shrink)

Even where an act appears to be responsible, and satisfies all the conditions for responsibility laid down by society, the response to it may be unjust where that appearance is false, and where those conditions are insufficient. This paper argues that those who want to place considerations of responsibility at the centre of distributive and criminal justice ought to take this concern seriously. The common strategy of relying on what Susan Hurley describes as a 'black box of responsibility' has the (...) advantage of not taking responsibility considerations to be irrelevant merely because some specific account of responsibility is mistaken. It can, furthermore, cope perfectly well with an absence of responsibility, even of the global sort implied by hard determinism and other strongly sceptical accounts. Problems for the black box view come in where responsibility is present, but in a form that is curtailed in one significant regard or another. The trick, then, is to open the box of responsibility just enough that its contents can be the basis for judgements of justice. I identify three 'moderately sceptical' forms of compatibilism that cannot ground judgements of justice, and are therefore expunged by the strongest 'grey box' view. (shrink)

Lifestyle diseases constitute an increasing proportion of health problems and this trend is likely to continue. A better understanding of the responsibility argument is important for the assessment of policies aimed at meeting this challenge. Holding individuals accountable for their choices in the context of health care is, however, controversial. There are powerful arguments both for and against such policies. In this article the main arguments for and the traditional arguments against the use of individual responsibility as a criterion for (...) the distribution of scarce health resources will be briefly outlined. It is argued that one of the most prominent contemporary normative traditions, liberal egalitarianism, presents a way of holding individuals accountable for their choices that avoids most of the problems pointed out by the critics. The aim of the article is to propose a plausible interpretation of liberal egalitarianism with respect to responsibility and health care and assess it against reasonable counter-arguments. (shrink)

This thesis argues that a particular version of equal opportunity for welfare is the best way of meeting the joint demands of three liberal egalitarian ideals: distributional equality, responsibility, and respect for individuals’ differing reasonable judgements of their own good. It also examines which social choice rules best represent these demands. Finally, it defends the view that achieving equal opportunity for welfare should not only be a goal of formal public institutions, but that just citizens should also sometimes be guided (...) by it in their everyday life. The version of equal opportunity for welfare it defends differs from some well-known contemporary versions in the following ways. First, it rejects a definition of welfare as the degree of satisfaction of a person’s preferences, because, it argues, this conception of welfare cannot adequately deal with preference change. Instead, it suggests that we should adopt a conception of welfare based on a list of goods and conditions that are recognised as valuable from the perspective of a variety of different conceptions of the good. Second, it argues that individuals’ prima facie claim to an equally valuable share of the world’s resources—a claim which is based on their equal moral worth—is limited to situations in which giving one person a more valuable share means that someone else ends up with a less valuable share. It also argues that in situations where we can improve at least one person’s situation without worsening anyone else’s, we generally do not fail to respect each person’s equal moral worth by doing so, even if this leads to inequalities. Third, it defends a distinct view of responsibility, which justifies social arrangements that give people certain options with reference to the value that individuals can achieve (but don’t necessarily achieve) through their choices from these options. (shrink)

All conceptions of equal opportunity draw on some distinction between morally justified and unjustified inequalities. We discuss how this distinction varies across a range of philosophical positions. We find that these positions often advance equality of opportunity in tandem with distributive principles based on merit, desert, consequentialist criteria or individuals' responsibility for outcomes. The result of this amalgam of principles is a festering controversy that unnecessarily diminishes the widespread acceptability of opportunity concerns. We therefore propose to restore the conceptual separation (...) of opportunity principles concerning unjustified inequalities from distributive principles concerning justifiable inequalities. On this view, equal opportunity implies that that morally irrelevant factors should engender no differences in individuals' attainment, while remaining silent on inequalities due to morally relevant factors. We examine this idea by introducing the principle of ‘opportunity dominance' and explore in a simple application to what extent this principle may help us arbitrate between opposing distributive principles. We also compare this principle to the selection rules developed by John Roemer and Dirk Van de Gaer. (shrink)

A liberal egalitarian theory of justice seeks to combine the values of equality, personal freedom, and personal responsibility. It is considered a much more promising position than strict egalitarianism, because it supposedly provides a fairness argument for inequalities reflecting differences in choice. However, we show that it is inherently difficult to fulfill this ambition. We present a liberal egalitarian paradox which shows that there does not exist any robust reward system that satisfies a minimal egalitarian and a minimal liberal requirement. (...) Moreover, we demonstrate how libertarianism may be justified in this framework if we drop the egalitarian condition. (shrink)

Many believe that it is morally wrong to give lower priority for a liver transplant to alcoholics with end-stage liver disease than to patients whose disease is not alcohol-related. Presumably, alcoholism is a disease that results from factors beyond one's control and therefore one cannot be causally or morally responsible for alcoholism or the liver failure that results from it. Moreover, giving lower priority to alcoholics unfairly singles them out for the moral vice of heavy drinking. I argue that the (...) etiology of alcoholism may involve enough control for the alcoholic to be responsible for his condition and accordingly have a weaker claim to receive a new liver than someone who acquires the disease through no fault of his own. In addition, I show why it is more plausible to reframe the question of priority in terms of control and responsibility rather than virtue and vice. Given that medical resources like livers are scarce, some people may justifiably be given lower priority than others in receiving these resources. (shrink)

There is a large and growing body of empirical work on people’s intuitions about distributive justice. In this paper, we investigate how well luck egalitarianism and desertism—the two normative approaches that appear to cohere well with people’s intuitions—are supported by more fine-grained findings in the empirical literature. The time is ripe for a study of this sort, as the positive literature on justice has blossomed over the last three decades. The results of our investigation are surprising. In three different contexts (...) (good option luck, good brute luck, and bad brute luck) in which the demands of luck egalitarianism and those of a mainstream desert-based view come apart, the latter carries the day. One ramification of these findings is that people’s intuitions about justice are moralized; that is, they appeal to particular conceptions of the good. Luck egalitarians must decide whether to embrace these moralized intuitions by adopting desertism—or to resist them. (shrink)

This article presents a fairness principle for evaluating decision-making based on predictions: a decision rule is unfair when the individuals directly impacted by the decisions who are equal with respect to the features that justify inequalities in outcomes do not have the same statistical prospects of being benefited or harmed by them, irrespective of their socially salient morally arbitrary traits. The principle can be used to evaluate prediction-based decision-making from the point of view of a wide range of antecedently specified (...) substantive views about justice in outcome distributions. (shrink)

Should priority in the allocation of organs be given to those who have previously donated or declared their willingness to do so? This article examines the Israeli priority rule in light of two prominent critiques of priority rules, pertaining to failure to reciprocate and unfairness. The scope and content of these critiques are interpreted from the perspective of equality of opportunity. Because the Israeli priority rule may be reasonably criticized for unfairness and failing to reward certain behaviors, the article develops (...) an adjusted priority rule, which removes and adjust the elements in the Israeli priority rule deemed problematic. However, such a priority rule is complex to the extent that it may fail to increase donation rates and furthermore introduce new concerns of fairness, as the better off may be better able to navigate the complex adjusted priority rule. (shrink)

Based on the Chinese General Social Survey database, this article explores the relationship between income inequality and residents’ subjective well-being from the perspective of inequality of opportunity and inequality of effort. We find that inequality of opportunity has a negative impact on subjective well-being in China, where inequality of effort has a positive impact. Our empirical results are robust for changing the inequality indicators. In the sub-sample studies, consistent conclusions are obtained in rural areas, whereas in urban areas only inequality (...) of effort has a significant impact. The results of mechanism study show that inequality of opportunity decreases residents’ sense of fairness, and inequality of effort increases residents’ sense of fairness, thus affecting their subjective well-being. The results of this study provide a good response to the inconclusive research findings on the impact of income inequality on subjective well-being. (shrink)

The objective of this article is to explore people’s attitudes toward responsibility in the allocation of public health care resources. Special attention is paid to conceptualizations of responsibility involving blame and sanctions. A representative sample of the Norwegian population was asked about various responsibility mechanisms that have been proposed in the theoretical literature on health care and personal responsibility, from denial of treatment to a tax on unhealthy consumer goods. Survey experiments were employed to study treatment effects, such as whether (...) fairness considerations affect attitudes about responsibility. We find that, overall, a substantial minority of the respondents find it fair to let the health care system sanction people—in one way or another—for voluntary behaviors that increase the risk of becoming ill. Quite surprisingly, we find that people are more prone to report that they should themselves be held responsible for unhealthy lifestyles than others. (shrink)

This article carves out a new path between the two dominant wings of contemporary egalitarianism. The luck egalitarian emphasis on choice and personal responsibility is misplaced because individuals differ so deeply, and arbitrarily, in their choice-making capacities. Allowing inequalities to result from ‘choice’ is akin to allowing inequalities to stem from the possession of any other morally arbitrary factor – such as skin colour or gender. The move towards relational egalitarianism has been a case of two-steps forward, one-step back. While (...) the shift away from the focus on choice is salutary, the concurrent rejection of luck is problematic, given the prevalence and importance of luck-based discrepancies in opportunities to lead a good life. A new conceptual framework is presented: good life egalitarianism. The guiding idea is that given the unavoidable arbitrariness of human capacities, the foundation for a good life should be assured for people regardless of the actual choices that they make. The essential goods necessary for leading a good life – such as the opportunities to self-determine and to enjoy non-dominating social relationships – should be guaranteed to all. (shrink)

Some rights are so important for human autonomy and well-being that many scholars insist they should not be waived, traded, or abandoned. Privacy is a recent addition to this list. At the other end of the spectrum is the belief that privacy is a mere unimportant interest or preference. This paper defends a middle path between viewing privacy as an inalienable, non-waivable, non-transferrable right and the view of privacy as a mere subjective interest. First, an account of privacy is offered (...) that clarifies the concept and demonstrates how privacy is directly related to human health and well-being. Second, along with considering and rejecting several accounts for why privacy might be considered an inalienable right, an argument is offered for why it is morally permissible to waive, transfer, abandon, or alienate privacy. (shrink)

Eli Feiring has developed a concept of forward-looking responsibility in healthcare. On this account, what matters morally in the allocation of scarce healthcare resources is not people's past behaviours but rather their commitment to take on lifestyles that will increase the benefit acquired from received treatment. According to Feiring, this is to be preferred over the backward-looking concept of responsibility often associated with luck egalitarianism. The article critically scrutinises Feiring's position. It begins by spelling out the wider implications of Feiring's (...) view. Against this background, it shows that (i) Feiring's distinction between backward-looking and forward-looking responsibility is incompatible with the Scanlonian notion of responsibility she apparently endorses; (ii) her favoured forward-looking notion of responsibility is subject to the objections levelled against the luck egalitarian view (whatever the strength of such objections). (shrink)

If it is true, as suggested by Sir Michael Marmot and other researchers, that status impacts health and therefore accounts for some of the social gradient in health, then it seems to be the case that it would be possible to bring about more equality in health by equalizing status. The purpose of this article is to analyze this suggestion. First, we suggest a working definition of what status precisely is. Second, following a luck egalitarian approach to distributive justice, we (...) consider whether and to which extent individuals are responsible themselves for their position in a status hierarchy. Third, we consider the contours of a difficult question, namely which political measures are feasible in order to reduce health-affective inequalities in status and fourth, whether or to what extent such measures are legitimate. We argue that on the basis of these considerations, we have at least some prima facie reasons to counter (at least some) status inequalities in order to equalize health. (shrink)

According to what we could call the "liberal" theory of distributive justice, people do not deserve the money they are able to make in the market for contributing to the economy. Yet the standard arguments for that view, which center on the fact that persons have very limited control over the size of their contributions, would also seem to imply that persons cannot deserve admiration, appreciation, esteem, praise and so on for these and other contributions. The control asymmetry is this: (...) the first conclusion of these arguments is acceptable but the second not. This paper is an effort to defend that claim, but without appeal to the notion of control. (shrink)

Amartya Sen and Martha Nussbaum have argued that justice is concerned, at least in part, with the distribution of capabilities (opportunities to function). Richard Arneson, G.A. Cohen, and John Roemer have argued that justice is concerned with something like the distribution of opportunities for well-being. I argue that, although some versions of the capability view are incompatible with some versions of the opportunity for well-being view, the most plausible version of the capability view is identical to a slight generalization of (...) the opportunity for well-being view. (shrink)

Artificial intelligence (AI) is becoming increasingly influential in most people’s lives. This raises many philosophical questions. One is what responsibility we have as individuals to guide the development of AI in a desirable direction. More specifically, how should this responsibility be distributed among individuals and between individuals and other actors? We investigate this question from the perspectives of five principles of distribution that dominate the discussion about responsibility in connection with climate change: effectiveness, equality, desert, need, and ability. Since much (...) is already written about these distributions in that context, we believe much can be gained if we can make use of this discussion also in connection with AI. Our most important findings are: (1) Different principles give different answers depending on how they are interpreted but, in many cases, different interpretations and different principles agree and even strengthen each other. If for instance ‘equality-based distribution’ is interpreted in a consequentialist sense, effectiveness, and through it, ability, will play important roles in the actual distributions, but so will an equal distribution as such, since we foresee that an increased responsibility of underrepresented groups will make the risks and benefits of AI more equally distributed. The corresponding reasoning is true for need-based distribution. (2) If we acknowledge that someone has a certain responsibility, we also have to acknowledge a corresponding degree of influence for that someone over the matter in question. (3) Independently of which distribution principle we prefer, ability cannot be dismissed. Ability is not fixed, however and if one of the other distributions is morally required, we are also morally required to increase the ability of those less able to take on the required responsibility. (shrink)

There is an ongoing increase in the use of mobile health technologies that patients can use to monitor health-related outcomes and behaviours. While the dominant narrative around mHealth focuses on patient empowerment, there is potential for mHealth to fit into a growing push for patients to take personal responsibility for their health. I call the first of these uses ‘medical monitoring’, and the second ‘personal health surveillance’. After outlining two problems which the use of mHealth might seem to enable us (...) to overcome—fairness of burdens and reliance on self-reporting—I note that these problems would only really be solved by unacceptably comprehensive forms of personal health surveillance which applies to all of us at all times. A more plausible model is to use personal health surveillance as a last resort for patients who would otherwise independently qualify for responsibility-based penalties. However, I note that there are still a number of ethical and practical problems that such a policy would need to overcome. The prospects of mHealth enabling a fair, genuinely cost-saving policy of patient responsibility are slim. (shrink)

In this paper I aim to examine some problematic implications of the fact that individuals are prone to making systematic reasoning errors, for resource egalitarianism. I begin by disentangling the concepts of preferences, choices and ambitions, which are sometimes used interchangeably by egalitarians. Subsequently, I claim that the most plausible interpretation of resource egalitarianism takes preferences, not choices, as the site of responsibility. This distinction is salient, since preference-sensitive resource egalitarianism is faced with an important objection when applied to situations (...) in which the empirically reasonable assumption that individuals have different degrees of computational abilities is introduced. I first show that this objection can be raised in cases involving individuals who have incomplete information, but that it ultimately fails for such cases since we can appeal to higher order insurance markets in order to mitigate any initial concerns. I further claim, however, that the objection is much more powerful in cases involving individuals who have different reasoning skills, since the appeal to higher order insurance markets is no longer tenable. Consequently, the ideal principle of justice proposed by Dworkin is met with a new feasibility challenge. Finally, I claim that the problem of reasoning errors and various forms of cognitive biases also affect Dworkin’s non-ideal principle of justice, skewing the outputs of the hypothetical insurance mechanism in an unjustifiable manner. (shrink)