Cet article propose une réponse critique à quelques thèmes du livre de Kyle Johannsen,A Conceptual Investigation of Justice. La discussion se penche sur l’analyse du pluralisme fondamental de la valeur proposée par Johannsen et met en cause cette même analyse. Je soutiens que l’analyse proposée par Johannsen ne parvient pas à expliquer comment des conflits entre des valeurs fondamentales peuvent être résolus et qu’il y a davantage de convergence entre des valeurs fondamentales que ne le reconnaît Johannsen.

This article presents two rejoinders to Frankfurt’s arguments against egalitarianism. In developing the first, I introduce a novel relational view of justice: relational sufficiency. This is the view that justice requires us to relate to one another as people with sufficient, but not necessarily equal, standing. I argue that if Frankfurt’s objections to distributive equality are sound, so are analogous objections to relational equality. However, in a range of cases involving comparative justice we should be relational egalitarians, not relational sufficientarians, (...) and that we must therefore reject Frankfurt’s objections to distributive equality. The second rejoinder takes the form of a demonstration that all of Frankfurt’s objections to distributive equality are unsound. In effect, the article rehabilitates the ideal of distributive equality in the face of Frankfurt’s objections. (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)

In any normal population, health is unequally distributed across different age groups. Are such age-based health inequalities unjust? A divide has recently developed within egalitarian theories of...

Public insurance is commonly assimilated with redistributive tools mobilized by the welfare state in the pursuit of an egalitarian ideal. This view contains some truth, since the result of insurance, at a given moment, is the redistribution of resources from the lucky to unlucky. However, Joseph Heath considers that the principle of efficiency provides a better normative explanation and justification of public insurance than the egalitarian account. According to this view, the fact that the state is involved in the provision (...) of specific insurance is explained and justified by the greater efficiency of the state, in comparison with markets, in addressing market failures such as moral hazard or adverse selection. Our argument is that while insurance, intrinsically and idealistically, may diverge from a redistributive scheme, it is nevertheless difficult to deny that insurance has nothing to do with equality. More precisely, we argue that insurance may be understood as an egalitarian tool if our understanding of equality is broadened to include relational equality. Our paper aims to briefly recap the debates surrounding public insurance as a redistributive tool, advancing the idea that public insurance may be a relational egalitarian tool. It then presents a number of relational arguments in favor of the involvement of the state in the provision of specific forms of insurance, arguments that have been overlooked given the domination of luck egalitarian approaches in these debates. (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)

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)

Critics of luck egalitarianism have claimed that, far from providing a justification for the public insurance functions of a welfare state as its proponents claim, the view objectionably abandons those who are deemed responsible for their dire straits. This article considers seven arguments that can be made in response to this ‘abandonment objection’. Four of these arguments are found wanting, with a recurrent problem being their reliance on a dubious sufficientarian or quasi-sufficientarian commitment to provide a threshold of goods unconditionally. (...) Three arguments succeed, showing that luck egalitarians have good reasons for assisting ‘negligent victims’ on account of changes that may occur in an individual between the time of their choice and their subsequent disadvantage, bad option luck, and doubts about free will and responsibility. Luck egalitarianism is therefore shown to offer strong support for public insurance. (shrink)

Debates over egalitarianism for the most part are not concerned with constraints on achieving an egalitarian society, beyond discussions of the deficiencies of egalitarian theory itself. This paper looks beyond objections to egalitarianism as such and investigates the relevant psychological processes motivating people to resist various aspects of egalitarianism. I argue for two theses, one normative and one descriptive. The normative thesis holds that egalitarians must take psychological constraints into account when constructing egalitarian ideals. I draw from non-ideal theories in (...) political philosophy, which aim to construct moral goals with current social and political constraints in mind, to argue that human psychology must be part of a non-ideal theory of egalitarianism. The descriptive thesis holds that the most fundamental psychological challenge to egalitarian ideals comes from what are called Just World Beliefs. A troubling result of Just World Beliefs, one that poses a prima facie obstacle to egalitarianism, is that people tend to dismiss or explain away any threats to their belief that the world is fundamentally just. The pervasiveness and severity of Just World Beliefs predicts that people will be resistant to egalitarian policies. My aim is to show how research on Just World Beliefs can help diagnose common problems for egalitarianism and assist in making realistic recommendations for bringing current societies closer to egalitarian ideals. (shrink)

This paper develops a recognition-theoretical analysis of human dignity. I argue that a life with dignity requires social esteem (recognition for one’s contribution to socially shared goals) as well as respect (recognition of one’s equal status). I illustrate this through an empirically informed discussion of three aspects of the current social organization of labour which threaten human dignity: unemployment, precarity and low pay. I also argue that in class societies the assertion of dignity as a positional good can undermine its (...) general progressive appeal. (shrink)

abstract This paper considers the question of whether unemployed individuals have a duty of fairness to accept retraining as a condition of receiving unemployment benefit. It is argued, in response to Stuart White, that, although there are some circumstances where individuals do have such a moral duty, for an egalitarian it is never the case that there is sufficient reason for enforcing such a duty by means of the law.

The question of when it is permissible to inflict risks on others without their consent is one that we all face in our everyday lives, but which is often brought to our attention in contexts of technological innovation and scientific uncertainty. Xenotransplantation, the transplantation of organs or tissues from animals to humans, has the potential to save or improve the lives of many patients but gives rise to the possibility of infectious agents being transferred from donor animals into the human (...) population. As well as being an important ethical issue in its own right it therefore provides a useful vehicle for exploring the more general question of how to balance the benefits of a practice against the risks to third parties. This paper focuses on the Rawlsian, justice-based analysis of the risks of xenotransplantation proposed by Robert Veatch. It argues that Veatch is right to take considerations of distributive justice into account, but that his particular approach is flawed. It is hoped that consideration of Veatch’s arguments, and of the underlying assumptions will suggest better ways of executing a justice-based approach. (shrink)

A prominent feature of the ongoing politics of welfare state restructuring is the development of workfare policies, defined as the attachment of a work condition to entitlement to basic income support. Workfare rejects unconditional rights of social citizenship, which formed the basis of social democratic political reforms and advocacy throughout the twentieth century. Nevertheless, workfare has received notable theoretical justification from egalitarian political theorists. This paper addresses four egalitarian arguments for workfare: the arguments from recipient self-respect, rational paternalism, fair reciprocity, (...) and equal opportunity for active citizenship. It attempts to demonstrate the tensions between each and egalitarian justification, and it is argued that none of the arguments successfully ground workfare policies in an egalitarian framework. (shrink)

Name der Zeitschrift: Deutsche Zeitschrift für Philosophie Jahrgang: 64 Heft: 5 Seiten: 757-767.

The paper presents an ethical analysis and constructive critique of the current practice of AI ethics. It identifies conceptual substantive and procedural challenges and it outlines strategies to address them. The strategies include countering the hype and understanding AI as ubiquitous infrastructure including neglected issues of ethics and justice such as structural background injustices into the scope of AI ethics and making the procedures and fora of AI ethics more inclusive and better informed with regard to philosophical ethics. These measures (...) integrate the perspective of AI justice into AI ethics, strengthening its capacity to provide comprehensive normative orientation and guidance for the development and use of AI that actually improves human lives and living together. (shrink)

Journal of Social Philosophy, EarlyView.

In this article, we argue that apart from evaluating the causes and the social determinants of health inequalities, an evaluation of the effects of health inequalities is due. For this, we propose the ideal of relational equality as an evaluative framework, and test to what extent health inequalities threaten this ideal of a society of equals. We identify three ways in which they do and argue that these risks are especially great for those lower down the socio-economic strata. We thus (...) conclude that equality in health is instrumental to social justice, and that socio-economic inequalities in health are not only unjust due to their causes but also due to their consequences. We continue to argue that our instrumental approach opens a perspective to mitigate the identified injustices by changing society, rather than reducing inequalities in health, and argue that this is an advantage in the light of the realistic assumption that of the socio-economic health inequalities will persist. The article thus offers a complementary approach to both the evaluation and the mitigation of the injustice of socio-economic inequalities in health. (shrink)

This article provides a survey of various topics in which questions about taxation feature alongside questions about justice. It seeks to argue mainly that taxation is a rather fragmentary domain of inquiry about which it is hard to envisage the development of views about what justice requires with respect to tax policy in general. Guided by this idea, the article attempts to highlight some aspects of taxation whose connection with justice has been under-explored by philosophers, as well as to acquaint (...) the reader with a sense of the more thoroughly researched areas. (shrink)

Luck egalitarianism has come under a lot of criticism for its apparent harshness towards negligent victims of voluntary actions (the harshness objection) and its inability to respond to morally-acceptable voluntary acts that lead to disadvantage (the discrimination objection). This paper surveys a series of responses in the luck egalitarian literature, showing that for the most part each one is unable to respond, on its own, to the crux of the objections. These responses often face a dilemma: Either they must bite (...) the bullet on the objections to retain their luck egalitarian commitments, or they must propose a reply to the objection that diverges from their core luck egalitarian principles. In this paper, I advance a preliminary framework for grounding luck egalitarian theories of justice based upon a two-level model and what I shall call the Fact of Inherent Normativity. Two-level luck egalitarianism makes fundamental rights and basic needs de facto insensitive to responsibility at the first level, while retaining the scope for responsibility for the distribution of second-level goods. The account remains distinctly luck egalitarian, while leaving scope for the consideration of rights, respect, and a host of other morally relevant considerations within the luck egalitarian framework. Luck egalitarianism, properly understood as a two-level theory, can successfully respond to objections against its harshness and propensity to discriminate. (shrink)

This paper aims to square our considered judgements about the moral significance of healthcare with various empirical and conceptual challenges about its role in a theory of justice. I do so by defending the moral significance of healthcare by reference to a central but neglected dimension – healthcare’s expressive function. Over and above its influence on health outcomes and other metrics of justice (such as opportunity or welfare), and despite its relatively limited impact on population health outcomes, healthcare expresses respect (...) for individuals in a distinctive and morally salient way. Grounding the moral significance of healthcare in this way not only highlights an important distinguishing feature of healthcare, but it also makes our support for healthcare immune from several powerful objections against its significance. This conclusion has important implications for theorists of (health) justice and for political philosophers more widely, highlighting the appropriate role of healthcare within public policy and normative theorising about theories of justice. (shrink)

Most theories of justice rest on the idea that emotions need to be contained or set aside and that rationality serves as the best, if not exclusive, criterion for identifying the principles of a fair distribution. In recent years, however, two important claims have been made. One is that rationality and emotions are not in conflict with one another, but should be conceived of as strictly interconnected; the other is that social justice is not just about distribution, but also – (...) or especially – about social relations. This paper aims to bridge these claims and argues that (a) the role of emotions should be recognised by theories of justice, as it is compatible with the importance such theories attribute to rationality, and (b) an inquiry into emotions is particularly important to investigate the socio-relational dimension of justice. Moreover, the paper claims that (c) in order to adequately investigate the role of emotions in social justice, it is important to acknowledge that emotions are structurally mediated and shaped by powerful transformative forces, among which technologies – especially so-called socially disruptive technologies (SDTs) – prove to be particularly relevant. The paper argues that SDTs have a fundamental role in shaping social relations, shared commitments, and the emotions that follow from them or enable them. (shrink)

The increasing implementation of and reliance on machine-learning (ML) algorithms to perform tasks, deliver services and make decisions in health and healthcare have made the need for fairness in ML, and more specifically in healthcare ML algorithms (HMLA), a very important and urgent task. However, while the debate on fairness in the ethics of artificial intelligence (AI) and in HMLA has grown significantly over the last decade, the very concept of fairness as an ethical value has not yet been sufficiently (...) explored. Our paper aims to fill this gap and address the AI ethics principle of fairness from a conceptual standpoint, drawing insights from accounts of fairness elaborated in moral philosophy and using them to conceptualise fairness as an ethical value and to redefine fairness in HMLA accordingly. To achieve our goal, following a first section aimed at clarifying the background, methodology and structure of the paper, in the second section, we provide an overview of the discussion of the AI ethics principle of fairness in HMLA and show that the concept of fairness underlying this debate is framed in purely distributive terms and overlaps with non-discrimination, which is defined in turn as the absence of biases. After showing that this framing is inadequate, in the third section, we pursue an ethical inquiry into the concept of fairness and argue that fairness ought to be conceived of as an ethical value. Following a clarification of the relationship between fairness and non-discrimination, we show that the two do not overlap and that fairness requires much more than just non-discrimination. Moreover, we highlight that fairness not only has a distributive but also a socio-relational dimension. Finally, we pinpoint the constitutive components of fairness. In doing so, we base our arguments on a renewed reflection on the concept of respect, which goes beyond the idea of equal respect to include respect for individual persons. In the fourth section, we analyse the implications of our conceptual redefinition of fairness as an ethical value in the discussion of fairness in HMLA. Here, we claim that fairness requires more than non-discrimination and the absence of biases as well as more than just distribution; it needs to ensure that HMLA respects persons both as persons and as particular individuals. Finally, in the fifth section, we sketch some broader implications and show how our inquiry can contribute to making HMLA and, more generally, AI promote the social good and a fairer society. (shrink)

By meeting needs for individualized love and relatedness, the care we receive deeply shapes our social and economic chances and therefore represents a form of luck. Hence, distributive justice requires a fair distribution of care in society. I look at different ways of ensuring this and argue that full redistribution of care is beyond our reach. I conclude that a strong individual morality informed by an ethics of care is a necessary complement of well-designed institutions.

In this paper, we start by comparing the two agents, Ann and Bob, who are involved in two car crashes. Whereas Ann crashes her car through no fault of her own, Bob crashes as a result of reckless driving. Unlike Ann, Bob is held criminally responsible, and the insurance company refuses to cover the car’s damages. Nonetheless, Ann and Bob both receive emergency hospital treatment that a third party covers, regardless of any assessment of personal responsibility. What warrants such apparent (...) exceptionalism with respect to personal responsibility in the healthcare context? We turn our attention to an understudied aspect of the debate on personal health responsibility, namely, the conceptualisation of the person in need of emergency hospital treatment. Drawing on the research of Joshua Knobe and Shaun Nichols, we propose that a context-dependent conceptualisation of the person may help explain a reluctance to ascribe responsibility to the individual for negative health outcomes. (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)

L’analyse empirique des inégalités porte en général sur les ressources, tandis que les théories philosophiques de la justice se divisent entre celles qui se concentrent sur les ressources et les opportunités, d’un côté, et celles qui se focalisent sur les relations sociales, de l’autre. Cet article propose une représentation de la société qui intègre à la fois les ressources et les relations sociales au sein d’un réseau d’interactions sociales qui déterminent dans quelle mesure les individus s’épanouissent ou non au cours (...) de leur vie. Cette représentation invite à repenser l’analyse des inégalités et de la justice sociale, et suggère qu’il est possible d’identifier des tensions et des synergies entre les différentes composantes du réseau social. (shrink)

Many countries have imposed strict regulations on the genetic information to which insurers have access. Commentators have warned against the emerging body of legislation for different reasons. This paper demonstrates that, when confronted with the argument that genetic information should be available to insurers for health insurance underwriting purposes, one should avoid appeals to rights of genetic privacy and genetic ignorance. The principle of equality of opportunity may nevertheless warrant restrictions. A choice-based account of this principle implies that it is (...) unfair to hold people responsible for the consequences of the genetic lottery, since we have no choice in selecting our genotype or the expression of it. However appealing, this view does not take us all the way to an adequate justification of inaccessibility of genetic information. A contractarian account, suggesting that health is a condition of opportunity and that healthcare is an essential good, seems more promising. I conclude that if or when predictive medical tests (such as genetic tests) are developed with significant actuarial value, individuals have less reason to accept as fair institutions that limit access to healthcare on the grounds of risk status. Given the assumption that a division of risk pools in accordance with a rough estimate of people's level of (genetic) risk will occur, fairness and justice favour universal health insurance based on solidarity. (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)

Making particular use of Shale’s analysis, this paper discusses the notion of leadership in the context of palliative medicine. Whilst offering a critical perspective, I build on the philosophy of palliative care offered by Randall and Downie and suggest that the normative structure of this medical speciality has certain distinctive features, particularly when compared to that of medicine more generally. I discuss this in terms of palliative medicine’s distinctive morality or ethos, albeit one that should still be seen in terms (...) of medical morality or the ethos of medicine. I argue that, in the context of multi-disciplinary teamwork, the particular ethos of palliative medicine means that healthcare professionals who work within this speciality are presented with distinct opportunities for leadership and the dissemination of the moral and ethical norms that guide their practice. I expand on the nature of this opportunity by further engaging with Shale’s work on leadership in medicine, and by more fully articulating the notion of moral ethos in medicine and its relation to the more formal notion of medical ethics. Finally, and with reference to the idea of medical education as both on going and as an apprenticeship, I suggest that moral and ethical leadership in palliative medicine may have an inherently educational quality and a distinctively pedagogical dimension. The nature of palliative medicine is such that it often involves caring for patients who are still receiving treatment from other specialists. Whilst this can create tension, it also provides an opportunity for palliative care professionals to disseminate the philosophy that underpins their practice, and to offer leadership with regard to the moral and ethical challenges that arise in the context of End of Life Care. (shrink)

This article presents the notions of ethos and eidos as field level concepts for the sociology of morality and the anthropology of ethics. This is accomplished in the context of Bourdieuan social theory and, therefore, from the broad standpoint of practice theory. In the first instance these terms are used to refer to the normative structures of social fields and are conceived so as to represent the way in which such structures fall between two planes, that of the implicit and (...) the explicit. Subsequently, they are used to further understand a distinction between morality—roughly, the implicit moral order of a social field—and ethics—the more explicit and often codified elements of a social field’s normative structure. When presented in relation to academic philosophical inquiries into the ethical issues in healthcare and the life sciences—meaning the disciplines of applied ethics in general and applied ethics in particular—the analytic perspective these terms facilitate enables us to represent the fundamental conditions required for academic enquiry; taken together the ethos and eidos of an intellectual field constitute the requisite background of its normative epistemic and methodological commitments, thereby providing the structures of disciplined intellectual practices. Seen in this light it not only becomes possible to grasp applied ethics as a socially structured practice but to understand it in terms that can also be used to frame our everyday moral practices. In this way applied ethics can be acknowledged as a relatively unique part of our contemporary moral culture. (shrink)

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)

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)

The concept of the ‘benefit cheat’ plays a critical role in political rhetoric and public policy and it has been deployed to justify changes to the benefit system that have had a very negative impact on well being and justice. The authors argue that the concept is dangerous, adding to the existing burdens of poverty and exclusion and that it must be eradicated by a reorganisation of the welfare system. Dignity and a spirit of equality must be the starting point (...) for any system of welfare that aims to promote universal well being. (shrink)

Construed as a theory of justice, relational egalitarianism says that justice requires that people relate as equals. Construed as a theory of what makes democracy valuable, it says that democracy is a necessary, or constituent, part of the value of relating as equals. Typically, relational egalitarians want their theory to provide both an account of what justice requires and an account of what makes democracy valuable. We argue that relational egalitarians with this dual ambition face the justice-democracy dilemma: Understanding social (...) relations in such a way that renders relational egalitarianism plausible as an answer to what makes democracy valuable comes at the price of understanding social relations in a way that makes it less plausible as a theory of justice, and vice versa. We also argue that there is no easy way out of the dilemma and that relational egalitarians, who want relational equality to provide both accounts mentioned, may simply have to set their ambitions lower on behalf of relational equality. (shrink)

This thesis defends utilitarianism: the view that as far as morality goes, one ought to choose the option which will result in the most overall well-being. Utilitarianism is widely rejected by philosophers today, largely because of a number of influential objections. In this thesis I deal with three of them. Each is found in Bernard Williams’s ‘A Critique of Utilitarianism’ (1973). The first is the Integrity Objection, an intervention that has been influential whilst being subject to a wide variety of (...) interpretations. In Chapter Two I give my interpretation of Williams’s Integrity objection; in Chapter Three I discuss one common response to it, and in Chapters Four and Five I give my own defence of utilitarianism against it. In Chapter Six I discuss a second objection: the problem of pre-emption. This problem is also found in Williams, but has received greater attention through the work of other authors in recent years. It suggests that utilitarianism is unable to deal with some of the modern world’s most pressing moral problems, and raises an internal tension between the twin utilitarian aims of making a difference and achieving the best outcomes. In Chapter Seven I discuss a third objection: that utilitarianism is insufficiently egalitarian. I find this claim to be unwarranted, in light of recent social science and philosophy. My responses to Williams’s objections draw upon resources from the socialist tradition – in particular, that tradition’s emphasis on the importance of social connections between individuals. Socialists have often been hostile to utilitarianism, in part for socialist-inflected versions of Williams’s objections. Thus, in responding to these objections I aim to demonstrate that socialist thought contains the means to defuse not only mainstream philosophy’s rejection of utilitarianism but also its own, and thus to re-open the possibilities for a productive engagement between the two traditions. (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)

G.A. Cohen is famous for his critique of John Rawls’s view that principles of justice are restricted in scope to institutional structures. In recent work, however, Cohen has suggested that Rawlsians get more than just the scope of justice wrong: they get the concept wrong too. He claims that justice is a fundamental value, i.e. a moral input in our deliberations about the content of action-guiding regulatory principles, rather than the output. I argue here that Cohen’s arguments for extending the (...) scope of justice equivocate across his distinction between fundamental principles of justice, i.e. principles that tell us what justice is; and regulatory principles of justice, i.e. principles that tell us what is required of us, all things – including justice – considered. Though Cohen initially had the regulatory sense of the word ‘justice’ in mind when critiquing the basic structure restriction, his replies to the problem of demandingness presuppose his own, fundamental sense of the word ‘justice’. The upshot is that he escapes demandingness at the cost of sacrificing regulatory justice’s capacity to provide clear guidance. I conclude by considering Peter Singer’s efforts to deal with demandingness in his own work on global poverty. Since Singer manages to deal with demandingness without giving up clarity, his work is a good a place to start in the search for regulatory principles that are suitable for the context of personal choice. (shrink)

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

A partir de las críticas que el igualitarismo fraternal lanzó contra el igualitarismo de la suerte, G. A. Cohen propuso un compromiso a través del denominado modelo de campamento. Puesto que dicho trade-off no quedó formalizado, en este artículo se intenta aportar algunos elementos en tal dirección. En concreto, se argumenta: a) que Cohen tiende un primer puente hacia el igualitarismo fraternal al distinguir los aspectos de equidad y legitimidad en una concepción de lo justo, conjuntamente con la afirmación de (...) que la suerte en las opciones nunca preserva la justicia; b) que los principios igualitario y comunitario, que Cohen postula como deseables para el socialismo, operan sobre la base de la distinción equidad-legitimidad, de modo que las desigualdades generadas por elecciones genuinas y mala suerte en las opciones son justas en tanto resultan legítimas pero no son justas en términos de equidad y, en consecuencia, las desigualdades que rasgan el tejido social son causalmente fundamentales mientras que el principio comunitario es normativamente fundamental; y c) que los elementos comunitarios que impulsan el compromiso de Cohen ya están presentes en sus nociones de igualdad voluntaria, ethos igualitario, lectura estricta del Principio de Diferencia rawlsiano y comunidad justificatoria. (shrink)

Equality is typically presumed to be an end of justice; however, in this chapter, we argue that it is better understood as a condition of justice. Our argument draws on the Just World Fallacy, the phenomenon of people mistakenly believing fortuitous patterns of reward or harm to be reflective of justice. This phenomenon can undermine relationships of equality even where differences in reward or harm are ostensibly deserved. If everyone received equal pay, then the propensity for people to defer to (...) the more successful or derogate the less successful would be diminished, and thus there would be greater scope for people to enter into the sorts of relationships of equal respect and regard that just communities require. (shrink)