Principles of sufficiency are widely discussed in debates about distributive ethics. However, critics have argued that sufficiency principles are vulnerable to important objections. This paper seeks to clarify the main claims of sufficiency principles and to examine whether they have something distinctive and plausible to offer. The paper argues that sufficiency principles must claim that we have weighty reasons to secure enough and that once enough is secured the nature of our reasons to secure further benefits shifts. Having characterized sufficientarianism (...) in this way, the paper shows that the main objections to the view can be avoided; that we can examine the plausibility of sufficiency principles by appealing to certain reasons that support a shift; and that we should be optimistic about the prospects for sufficientarianism because many of our strongest reasons seem to be of this sort. This shift, I claim, is the overlooked grain of truth in sufficientarianism. (shrink)

This paper presents a new kind of problem in the ethics of distribution. The problem takes the form of several “calibration dilemmas,” in which intuitively reasonable aversion to small-stakes inequalities requires leading theories of distribution to recommend intuitively unreasonable aversion to large-stakes inequalities. We first lay out a series of such dilemmas for prioritarian theories. We then consider a widely endorsed family of egalitarian views and show that they are subject to even more forceful calibration dilemmas than prioritarian theories. Finally, (...) we show that our results challenge common utilitarian accounts of the badness of inequalities in resources. (shrink)

What kind of equality should we value and why? Current debate centres around whether distributive equality is valuable. However, it is not the only (potentially) morally significant form of equality. David Miller and T. M. Scanlon have emphasised the importance of social equality—a strongly egalitarian notion distinct from distributive equality, and which cannot be reduced to a concern for overall welfare or the welfare of the worst-off. However, as debate tends to focus on distribution, social equality has been neglected and (...) we do not have a clear understanding of what it is and why it might be valuable. This paper aims to address this gap. (shrink)

In this paper, I argue that sufficientarian principles are indispensable in the set of principles that have bearing on issues in distributive ethics. I provide two arguments in favor of this claim. First, I argue that sufficientarianism is the only framework that allows us to appropriately analyze what sort of obligations we have toward individuals who are badly off due to their own faults and choices. Second, I argue that sufficientarianism is the only theory that provides an adequate framework for (...) thinking about the desperately badly off. (shrink)

The standard version of sufficientarianism maintains that providing people with enough, or as close to enough as is possible, is lexically prior to other distributive goals. This article argues that this is excessive – more than distributive justice allows – in four distinct ways. These concern the magnitude of advantage, the number of beneficiaries, responsibility and desert, and above-threshold distribution. Sufficientarians can respond by accepting that providing enough unconditionally is more than distributive justice allows, instead balancing sufficiency against other considerations.

In this article, I propose a novel characterization of sufficientarianism. I argue that sufficientarianism combines three claims: a priority claim that we have non-instrumental reasons to prioritize benefits in certain ranges over benefits in other ranges; a continuum claim that at least two of those ranges are on one continuum; and a deficiency claim that the lower a range on a continuum, the more priority benefits in that range have. This characterization of sufficientarianism sheds new light on two long-standing philosophical (...) debates, namely about the distinctiveness of sufficientarianism as a distributive principle and about the common objections to sufficientarianism. (shrink)

Journal of Political Philosophy, Volume 30, Issue 2, Page 230-248, June 2022.

Prioritarianism is a moral view that ranks outcomes according to the sum of a strictly increasing and strictly concave transformation of individual well-being. Prioritarianism is ‘welfarist’ (namel...

The main body of this paper assesses a leading recent theory of fairness, a theory put forward by John Broome. I discuss Broome's theory partly because of its prominence and partly because I think it points us in the right direction, even if it takes some missteps. In the course of discussing Broome's theory, I aim to cast light on the relation of fairness to consistency, equality, impartiality, desert, rights, and agreements. Indeed, before I start assessing Broome's theory, I discuss (...) two very popular conceptions of fairness that contrast with his. One of these very popular conceptions identifies fairness with the equal and impartial application of rules. The other identifies fairness with all-things-considered moral rightness. (shrink)

Morality seems important, in the sense that there are practical reasons — at least for most of us, most of the time — to be moral. A central theoretical motivation for consequentialism is that it appears clear that there are practical reasons to promote good outcomes, but mysterious why we should care about non-consequentialist moral considerations or how they could be genuine reasons to act. In this paper we argue that this theoretical motivation is mistaken, and that because many arguments (...) for consequentialism rely upon it, the mistake substantially weakens the overall case for consequentialism. We argue that there is indeed a theoretical connection between good states and reasons to act, because good states are those it is fitting to desire and there is a conceptual connection between the fittingness of a motive and reasons to perform the acts it motivates. But while some of our motives are directed at states, others are directed at acts themselves. We contend that just as the fittingness of desires for states generates reasons to promote the good, the fittingness of these act-directed motives generates reasons to do other things. Moreover, we argue that an act’s moral status consists in the fittingness of act-directed feelings of obligation to perform or avoid performing it, so the connection between fitting motives and reasons to act explains reasons to be moral whether or not morality directs us to promote the good. This, we contend, de-mystifies how there could be non-consequentialist reasons that are both moral and practical. (shrink)

This article presents an approach to how to make reasonable social choices when independent criteria (e.g., prioritarianism, religious freedom) fail to fully determine what to do. The article outlines different explanations of why independent criteria sometimes fail to fully determine what to do and illustrates how they can still be used to eliminate ineligible alternatives, but it is argued that the independent criteria cannot ground a reasonable social choice in these situations. To complement independent criteria when they fail to fully (...) determine what to do, it is suggested that society must engage in public deliberation by way of generating new reasons that can determine how to rank the alternatives. It is suggested that the approach to social choice presented here reveals a way of accepting the relevance of independent criteria for social choice without letting go of the idea that the attitudes of affected parties matter. (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)

In this article, I develop and defend a prioritarian principle of justice for the distribution of educational resources. I argue that this principle should be conceptualized as directing educators to confer a general benefit, where that benefit need not be mediated by improved academic outcomes. I go on to argue that it should employ a metric of all-things-considered flourishing over the course of the student's lifetime. Finally, I discuss the relationship between my proposed prioritarian principle and the meritocratic principle that (...) it is presumed to supplement. (shrink)

In this article, I assess the prospects for the limitarian thesis that someone has too much wealth if they exceed a specific wealth threshold. Limitarianism claims that there are good political and/or ethical reasons to prevent people from having such ‘surplus wealth’, for example, because it has no moral value for the holder or because allowing people to have surplus wealth has less moral value than redistributing it. Drawing on recent literature on distributive justice, I defend two types of limitarian (...) principles of justice. First, limitarian midlevel principles draw on the limitarian thesis to specify normative commitments for guiding institutional design and individual actions. Second, the limitarian presumption draws on that thesis to specify what a just allocation of wealth requires under epistemic constraints. Such a presumption says that without substantive reasons to the contrary, we should regard a distribution as unjust if some people’s wealth exceeds the limitarian threshold. Furthermore, I will argue that we must reject a possible but implausible interpretation of limitarianism as an ideal distributive pattern. Yet both as a midlevel principle and as a presumption, limitarianism can play an important role in theorizing about justice in the real world. (shrink)

Abstract:The paper seeks to defend Telic Egalitarianism (TE) by distinguishing two distinct categories into which typical objections to it fall. According to one category of objections (for example, levelling down) TE isgroundless. That is, there is simply no good reason to think that inequality as such is bad. The other type of objections to TE focuses on itscounterintuitiveimplications: it is forced to condemn inequalities between ourselves and long-dead Inca peasants, or between us and worse-off aliens from other planets. The paper (...) shows that once we unpack these two types of objections to TE they become much less persuasive. (shrink)

The good of those who are worse off matters more to the overall good than the good of those who are better off does. But being worse off than one’s fellows is not itself bad; nor is inequality itself bad; nor do differences in well-being matter more when well-being is lower in an absolute sense. Instead, the good of the relatively worse-off weighs more heavily in the overall good than the good of the relatively better-off does, in virtue of the (...) fact that the former are relatively worse off. This paper articulates and defends the view just described. (shrink)

This paper argues that egalitarian theories should be judged by the degree to which they meet four different challenges. Fundamentalist egalitarianism, which contends that certain inequalities are intrinsically bad or unjust regardless of their consequences, fails to meet these challenges. Building on discussions by T.M. Scanlon and David Miller, we argue that egalitarianism is better understood in terms of commitments to six egalitarian objectives. A consequence of our view, in contrast to Martin O'Neill's “non-intrinsic egalitarianism,“ is that egalitarianism is better (...) understood as a family of views than as a single ethical position. (shrink)

In their paper ‘Why It Matters That Some Are Worse Off Than Others: An Argument against the Priority View’, Michael Otsuka and Alex Voorhoeve argue that prioritarianism is mistaken. I argue that their case against prioritarianism has much weaker foundations than it might at first seem. Their key argument is based on the claim that prioritarianism ignores the fact of the ‘separateness of persons’. However, prioritarianism, far from ignoring that fact, is a plausible response to it. It may be that (...) prioritarianism disregards the fact of the ‘unity of the individual’. But even if this is true, that doesn’t straightforwardly tell against prioritarianism as a view about distributive justice. In the end, Otsuka and Voorhoeve’s argument relies on a non-decisive intuition that they appeal to early in their paper. Their conclusion, as a result, is not compelling. (shrink)

This paper shows that versions of prioritarianism that focus at least partially on well-being levels at certain times conflict with conventional views of prudential value and prudential rationality. So-called timeslice prioritarianism, and pluralist views that ascribe importance to timeslices, hold that a benefit matters more, the worse off the beneficiary is at the time of receiving it. We show that views that evaluate outcomes in accordance with this idea entail that an agent who delays gratification makes an outcome worse, even (...) if it is better for the agent and worse for no one else. We take this to show that timeslice prioritarianism and some pluralist views violate Weak Pareto, and we argue that these versions of prioritarianism are implausible. (shrink)

Much of the philosophical literature on health inequalities seeks to establish the superiority of one or another conception of luck egalitarianism. In recent years, however, an increasing number of self-avowed egalitarian philosophers have proposed replacing luck egalitarianism with alternatives that stress the moral relevance of distinct relationships, rather than the moral relevance of good or bad luck. After briefly explaining why I am not attracted to luck egalitarianism, I seek in this chapter to distinguish and clarify three views that have (...) been characterized in the philosophical literature as forms of relational egalitarianism. I call these three relational views equality of treatment, equality of concern, and social egalitarianism. I will explain why each claims to be a form of egalitarianism and why these three views should not be seen as competitors. I will argue that each brand of relational egalitarianism describes a plausible plank of distributive justice that bears on the evaluation of health inequalities and on the political institutions that create, sustain, or exacerbate them. To illustrate this pluralistic relational egalitarian approach, I will draw on a case study by Horton and Barker (this volume) to discuss how each of the three planks might be brought to bear on the evaluation of oral health disparities among the children of migrant Latino farmworkers in California. (shrink)

Sufficientarians claim that what matters most is that people have enough. I develop and defend a revised sufficientarian conception of justice. I claim that it furnishes the best specification of a general humanitarian ideal of social justice: our main moral concern should be helping those who are badly off in absolute terms. Rival humanitarian views such as egalitarianism, prioritarianism and the difference principle face serious objections from which sufficientarianism is exempt. Moreover, a revised conception of sufficientarianism can meet the most (...) prominent undefeated challenges to the view. I contend that prevailing versions of sufficientarianism have not satisfactorily defined the sufficiency threshold, and so I offer an original specification of the threshold. I also address perhaps the most common objection to sufficientarianism, namely that sufficientarian regimes will channel all of society's resources towards elevating people to the sufficiency threshold regardless of the gains foregone by those above the threshold. (shrink)

Morality is demanding; this is a platitude. It is thus no surprise when we find that moral theories too, when we look into what they require, turn out to be demanding. However, there is at least one moral theory – consequentialism – that is said to be beset by this demandingness problem. This calls for an explanation: Why only consequentialism? This then leads to related questions: What is the demandingness problematic about? What exactly does it claim? Finally, there is the (...) question of what we do if we accept that there is a demandingness problem for consequentialism: How can consequentialists respond? The present chapter sets out to answer these questions (or at least point to how they could be answered). (shrink)

In a recent article, Michael Otsuka and Alex Voorhoeve argue that prioritarianism fails to account for the shift in moral significance in gains to individuals in interpersonal as compared to intrapersonal cases. In this article, I show that the priority view escapes this objection but in a way that deprives it of (some of) its anti-egalitarian stance. Despite Otsuka and Voorhoeve, prioritarianism, rightly understood, provides consistent and attractive recommendations in both single- and multi-person cases. Yet prioritarians, the article goes on (...) to show, cannot do so while availing themselves of the leveling down objection (LDO) to egalitarianism. They may not do so because similarly to egalitarianism, prioritarianism also must reject the principle of personal good. That is, egalitarians and prioritarians may sometime recommend certain actions and outcomes even when these are better for no one. Prioritarians may survive the Otsuka–Voorhoeve critique, but to do so they must abandon their anti-egalitarian stance (or at the very least, the LDO). (shrink)

In this article, we provide a comprehensive analysis and a normative assessment of rationing through inconvenience as a form of rationing. By “rationing through inconvenience” in the health sphere, we refer to a nonfinancial burden that is either intended to cause or has the effect of causing patients or clinicians to choose an option for health-related consumption that is preferred by the health system for its fairness, efficiency, or other distributive desiderata beyond assisting the immediate patient. We argue that under (...) certain conditions, rationing through inconvenience may turn out to serve as a legitimate and, compared to direct rationing, even a preferable tool for rationing; we propose a research agenda to identify more precisely when that might be the case and when, alternatively, rationing through inconvenience remains ethically undesirable. After defining and illustrating rationing through inconvenience, we turn to its moral advantages and disadvantages over other rationing methods. We take it as a starting assumption that rationing, understood as scarce-resource prioritization, is inevitable and, in a society that has goals beyond optimizing health care for individual patients—such as improving societal health care, education, or overall welfare—prudent and fair. (shrink)

Derek Parfit held that in evaluating the future, we should ignore the difference between necessary persons and merely possible persons. In this article, I look at one of the most prominent alternatives to Parfit's view, namely Michael Otsuka and Larry Temkin ‘shortfall complaints’ view. In that view, we aggregate future persons’ well-being and deduct intrapersonal shortfall complaints, giving extra weight to the complaints of necessary persons. I offer here a third view. I reject Parfit's no difference view in that I (...) register a difference between necessary and possible persons. But I also reject the Shortfall View and replace its intra-personal complaints with an inter-personal complaints mechanism. I argue that the value of a population is its aggregate prioritarian value minus the egalitarian complaints that necessary persons hold. I show that the egalitarian view has all the explanatory power of the Shortfall view in easy cases, while significantly improving on it in three sorts of tough cases. (shrink)

Our aim in this paper is to suggest that most current theories of global justice fail to adequately recognise the importance of global public goods. Broadly speaking, this failing can be attributed at least in part to the complexity of the global context, the individualistic focus of most theories of justice, and the localised nature of the theoretical foundations of most theories of global justice. We argue ? using examples (particularly that of protecting antibiotic efficacy) ? that any truly effective (...) theory of global justice must recognise the importance of global public goods. Global public goods confer significant benefits to individuals yet can only be effectively promoted and preserved through collective action and the restriction of individual choice; something which most theories of justice are structurally unequipped to sufficiently promote. (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)

In 2016 the Chinese government initiated a nationwide campaign aiming to eliminate poverty in China by 2020. Over 20% of listed firms in China have made significant contributions to the campaign. Using hand-collected data on listed firms’ contributions to the campaign and multivariate analyses, we examine whether managers’ and politicians’ personal incentives play an important role in firms’ contributions to the campaign. The results show that firms are more likely to contribute if they are state-owned and managers are appointed by (...) governments, if managers have a higher risk of being targeted in a concurrent anti-corruption campaign, if the political leaders in their province are new or intend to seek promotion, and if managers or directors have experienced poverty in their early life. The results suggest that it is important to consider managers’ and politicians’ personal incentives in CSR activities that could have a grand social impact. (shrink)

No net loss approaches to environmental policy claim that policy should maintain aggregate levels of natural capital. Substitutability between natural assets allows losses in some assets to be compensated for by gains in others while maintaining overall levels of natural capital. This paper argues that significant goods that matter to people’s well-being will be lost through a policy of no net loss. The concepts of natural capital and ecosystem services that underpin the no net loss approach to environmental policy cannot (...) capture important dimensions of value that are central to human well-being. (shrink)

Despite the prominence of thresholds and limits in theories of distributive justice, there is no general account of their role within such theories. This has allowed an ongoing lack of clarity and misunderstanding around threshold views in distributive justice. In this thesis, I develop an account of the conceptual structure of such views. Such an account helps understand and characterize threshold views, can subsume what may seem to be different debates about such views under one conceptual header, and can be (...) used to further examine and develop patterns of justice that draw on thresholds. In light of this account, I propose a novel characterization of sufficientarianism which sheds new light on the distinctiveness of sufficientarianism as a distributive principle and on the common objections to sufficientarianism. Moreover, I examine and defend limitarianism, which is the view that people should not have more than a certain amount of wealth. In particular, I argue in favour of limitarianism as a midlevel principle for guiding institutional design and individual actions and, furthermore, as a specification of what a just allocation of wealth requires under epistemic constraints. (shrink)

How is freedom valuable? And how should we go about defining freedom? In this essay, I discuss a distinction between two general ways of valuing freedom: one appeals to the good (e.g., to freedom's contribution to well-being); the other appeals to how persons have reason to treat one another in virtue of their status as purposive beings (to the right). The analysis of these two values has many relevant implications and it is preliminary to a better understanding of the relationships (...) between freedom and justice. First, it contributes to shed light on the relationship between trust and the value of freedom, and on two attitudes towards freedom – promoting and respecting freedom. Second, it disambiguates between two versions of the claim that freedom has non-specific/content-independent value: one appeals to the good, the other to the right. And third, I show that certain implications concerning the definition of freedom follow from assuming an account of the value of freedom that exclusively appeals to the right, illustrating how the value of freedom can shape what freedom is. (shrink)

In many countries worldwide, especially in Sub-Saharan Africa, a shortage of physicians limits the provision of lifesaving interventions. One existing strategy to increase the number of physicians in areas of critical shortage is conditioning medical school scholarships on a precommitment to work in medically underserved areas later. Current practice is usually to demand only one year of service for each year of funded studies. We show the effectiveness of scholarships conditional on such precommitment for increasing physician supplies in underserved areas. (...) Then we defend these scholarships against ethical worries that they constitute slavery contracts; rely on involuntary, biased, or unauthorized early consent by a young signatory; put excessive strains on signed commitments; give rise to domination; and raise suspicion of slavery contracts. Importantly, we find that scholarships involving far longer commitment than current practice allows would also withstand these worries. Policymakers should consider introducing conditional scholarships, including long-term versions, as a means to increasing the supply of physicians to medically underserved areas. (shrink)

It is a common view that benefits to the worse off should be given priority when health benefits are distributed. This paper addresses how to understand who is worse off in this context when individuals are differently well off at different times. The paper argues that the view that this judgment about who is worse off should be based solely on how well off individuals are when their complete lives are considered (i.e. 'the complete lives view') is implausible in this (...) context. Instead, it is argued that a pluralistic stance toward this issue should be accepted. This pluralistic stance recognizes that also the view that only focuses on how well off individuals are now and in the future (i.e. 'the forward-looking view') is relevant. The argument is based on appeals to intuitive judgments concerning who is worse off in different cases and reference to various underlying reasons why priority to benefits to the worse off is justified. (shrink)

This book offers an original account of a distinctly republican theory of social and global justice. The book starts by exploring the nature and value of Hegelian recognition theory. It shows the importance of that theory for grounding a normative account of free and autonomous agency. It is this normative account of free agency which provides the groundwork for a republican conception of social and global justice, based on the core-ideas of freedom as non-domination and autonomy as non-alienation. As the (...) author argues, republicans should endorse a sufficientarian account of social justice, which focuses on the nature of social relationships and their effects on people's ability to act freely and realize their fundamental interests. On the global level, the book argues for the cosmopolitan extension of the republican principles of non-domination and non-alienation within a multi-level democratic system. In so doing, the book addresses a major gap in the existing literature, presenting an original theory of justice, which combines Hegelian recognition theory and republican ideas of freedom, and applying this hybrid theory to the global domain. Fabian Schuppert creates a grand synthesis uniting neo-republican insights on freedom with Hegelian recognition theory. The result is an account of agency that arises from the idea of non-domination whose aim it is to safeguard individual freedom. When combined with Hegelian recognition theory a social focus also emerges. This amalgam comments on many of the major disputes concerning global justice from a cosmopolitan perspective. Because of the broad scope and the many contemporary discussions engaged this book will be of keen interest to scholars as well as a welcome addition to the classroom. (shrink)

There is a rich tradition within game theory, decision theory, economics, and philosophy correlating practical rationality with impartiality, and spatial and temporal neutrality. I argue that in some cases we should give priority to people over both times and places, and to times over places. I also show how three plausible dominance principles regarding people, places, and times conflict, so that we cannot accept all three. However, I argue that there are some cases where we should give priority to times (...) over people, suggesting that there is impersonal value to the distribution of high quality life over different times. (shrink)

Equality of Opportunity is widely thought of as the normative ideal most relevant to the design of educational institutions. One widely discussed interpretation of this ideal is Rawls' principle of Fair Equality of Opportunity. In this paper I argue that theories, like Rawls, that give priority to the achievement of individual autonomy, are committed to giving that same priority to a principle of sufficient opportunity. Thus, the Rawlsian's primary focus when designing educational institutions should be on sufficiency and not equality. (...) The paper then argues this commitment has at least three attractive implications. Firstly, it enables defenders of Fair Equality of Opportunity to overcome Richard Arneson's powerful objections. Secondly, it suggests a revised version of the principle of Fair Equality of Opportunity that is more plausible. Thirdly, it has attractive practical implications for educational provision. (shrink)

This paper contributes to the growing discussion about how to mitigate pharmaceutical pollution, which is a threat to human, animal, and environmental health as well as a potential driver of antimicrobial resistance. It identifies market approval of pharmaceuticals as one of the most powerful ways to shape producer behavior and highlights that applying this tool raises ethical issues given that it might impact patients’ access to medicines. The paper identifies seven different policy options that progressively give environmental considerations increased priority (...) in the approval process, identifies ethically relevant interests affected by such policies, and makes explicit tensions and necessary tradeoffs between these interests. While arguing that the current European regulation gives insufficient weight to environmental considerations, the paper highlights concerns with the strongest policy options, on the grounds that these may very well endanger patients’ access to effective medication. (shrink)

Almost everyone believes that freedom from deprivation should have significant weight in specifying what justice between generations requires. Some theorists hold that it should always trump other distributive concerns. Other theorists hold that it should have some but not lexical priority. I argue instead that freedom from deprivation should have lexical priority in some cases, yet weighted priority in others. More specifically, I defend semi-strong sufficientarianism. This view posits a deprivation threshold at which people are free from deprivation, and an (...) affluence threshold at which people can live an affluent life, even though their lives may be even further improved beyond that point. I argue that freedom from deprivation in one generation lexically outweighs providing affluence in another generation; in all other cases, freedom from deprivation does not have lexical priority. (shrink)

Enormous gaps between HIV burden and health care availability in low-income countries raise severe ethical problems. This article analyzes four HIV-priority dilemmas with interest across contexts and health systems. We explore principled distributive conflicts and use the Atkinson index to make explicit trade-offs between health maximization and equality in health. We find that societies need a relatively low aversion to inequality to favor treatment for children, even with large weights assigned to extending the lives of adults: higher inequality aversion is (...) needed to share resources equally between high-cost and low-cost treatment; higher inequality aversion is needed to favor treatment rather than prevention, and the highest inequality aversion is needed to favor sharing treatment between urban and rural regions rather than urban provision of treatment. This type of ethical sensitivity analysis may clarify the ethics of health policy choice. (shrink)

The principle of fair equality of opportunity is regularly used to justify social policies, both in the philosophical literature and in public discourse. However, too often commentators fail to make explicit just what they take the principle to say. A principle of fair equality of opportunity does not say anything at all until certain variables are filled in. I want to draw attention to two variables, timing and currency. I argue that once we identify the few plausible ways we have (...) at our disposal for filling in those variables, it will become apparent that a reasonable version of the principle will be quite narrow. Its usefulness as a justificatory basis for social policies will be limited to those policies that target the distribution of competitive opportunities among people entering majority. (shrink)