One of the foremost egalitarian theories in recent years, luck egalitarianism, has recently been subjected to the charge that it is in fact incoherent. This charge is brought by David Miller who highlights two dimensions of luck egalitarianism: on the one hand a commitment to the justice of certain inequalities arising from responsible choices; on the other a commitment to injustice of brute inequalities. The putative incoherence emerges in cases where the inequalities that justice requires on the basis of individuals' (...) responsible choices also entail brute luck inequalities for which there are the very same grounds of justice to condemn. Here I argue that the charge of incoherence against luck egalitarianism fails. In service of this I clarify the quite specific sense in which luck egalitarianism requires inequalities and demonstrate the coherence of this with its condemnation of other inequalities. (shrink)

Imagine a two-person distributive case in which Ernest's choices yield X and Bertie's choices yield X + Y, producing an income gap between them of Y. Neither Ernest nor Bertie is responsible for this gap of Y, since neither of them has any control over what the other agent chooses. This is what Susan Hurley calls the “Boring Problem” for luck egalitarianism. Contrary to Hurley's relatively dismissive treatment of it, it is contended that the Boring Problem poses a deep problem (...) for standard luck egalitarianism. To counter it, luck egalitarianism needs to be recast as a baseline-relative theory. This new version of luck egalitarianism is then put to work against some significant problems that have been encountered by luck egalitarianism: Saul Smilansky's “Paradox of the Baseline,” the “Partiality Worry,” and the “Pluralism Worry.” But baseline-relative luck egalitarianism is not without problems of its own. (shrink)

According to Luck egalitarians, fairness requires us to bring it about that nobody is worse off than others where this results from brute bad luck, but not where they choose or deserve to be so. In this paper, I consider one type of brute bad luck that appears paradigmatic of what a Luck Egalitarian ought to be most concerned about, namely that suffered by people who are born to badly off parents and are less well off as a result. However, (...) when we consider what is supposedly unfair about this kind of unequal brute luck, luck egalitarians face a dilemma. According to the standard account of luck egalitarianism, differential brute luck is unfair because of its effects on the distribution of goods. Yet, where some parents are worse off because they have chosen to be imprudent, it may be impossible to neutralize these effects without creating a distribution that seems at least as unfair. This, I argue, is problematic for luck egalitarianism. I, therefore, explore two alternative views that can avoid this problem. On the first of these, proposed by Shlomi Segall, the distributional effects of unequal brute luck are unfair only when they make a situation more unequal, but not when they make it more equal. On the second, it is the unequal brute luck itself, rather than its distributional effects, that is unfair. I conclude with some considerations in favour of this second view, while accepting that both are valid responses to the problem I describe. (shrink)

In healthcare priority settings, early access to treatment before reimbursement decisions gives rise to problems of whether negative decisions for cost‐effectiveness reasons should result in withdrawing treatment, already accessed by patients. Among professionals there seems to be a strong attitude to distinguish between withdrawing and withholding treatment, viewing the former as ethically worse. In this article the distinction between withdrawing and withholding treatment for reasons of cost effectiveness is explored by analysing the doing/allowing distinction, different theories of justice, consequentialist and (...) virtue perspectives. The authors do not find any strong reasons for an intrinsic difference, but do find some reasons for a consequentialist difference, given present attitudes. However, overall, such a difference does not, all things considered, provide a convincing reason against withdrawal, given the greater consequentialist gain of using cost‐effective treatment. As a result, patients should be properly informed when given early access to treatment, that such treatment can be later withdrawn following a negative reimbursement decision. (shrink)

BackgroundThe idea that individuals are responsible for their health has been the focus of debate in the theoretical literature and in its concrete application to healthcare policy in many countries. Controversies persist regarding the form, substance and fairness of allocating health responsibility to the individual, particularly in universal, need-based healthcare systems.ObjectiveTo examine how personal health responsibility has been framed and rationalised in Norwegian key policy documents on priority setting.MethodsDocuments issued or published by the Ministry of Health and Care Services between (...) 1987 and 2018 were thematically analysed. We developed a predefined conceptual framework that guided the analysis. The framework included: the subject and object of responsibility, the level of conceptual abstraction, temporality, normative justificatory arguments and objections to the application of personal health responsibility.ResultsAs an additional criterion, personal health responsibility has been interpreted as relevant if: the patient’s harmful behaviour is repeated after receiving treatment, and if the success of the treatment is conditional on the patient’s behavioural change. When discussed as a retrospective criterion, considerations of reciprocal fairness have been dominant. When discussed as a prospective criterion, the expected benefit of treatment justified its relevance.ConclusionPersonal health responsibility appears to challenge core values of equality, inclusion and solidarity in the Norwegian context and has been repeatedly rejected as a necessary criterion for priority setting. However, the responsibility criterion seems to have some relevance in particular priority setting decisions. (shrink)

Recent literature on responsibility-sensitive egalitarianism has suggested that an opposition to unchosen inequality on the grounds of unfairness is compatible with a range of accounts as to which inequalities are fair. I argue that forms of responsibility-sensitive egalitarianism face a challenge in the construction of such accounts; namely to explain the fairness of such inequalities specifically, as opposed to their being merely justified in a broader sense. I illustrate the nature of this challenge through an interesting parallel with an issue (...) in value theory in the form of the so-called ‘wrong kind of reason’ problem. (shrink)