Though the revised edition of A Theory of Justice, published in 1999, is the definitive statement of Rawls's view, so much of the extensive literature on Rawls's theory refers to the first edition.

In this lively and accessible book, Matt Matravers considers the highly contested role of responsibility in politics, morality, and the law. He asks, what are we doing when we hold people responsible in deciding questions of distributive justice or of punishment? and considers the role of philosophy in answering this very contemporary question.

Whether it is fair to use personal responsibility of patients for their own health as a rationing criterion in healthcare is a controversial matter. A host of difficulties are associated with the concept of personal responsibility in the field of medicine. These include, in particular, theoretical considerations of justice and such practical issues as multiple causal factors in medicine and freedom of health behaviour. In the article, personal responsibility is evaluated from the perspective of several theories of justice. It is (...) argued that in a healthcare system based on both equality of opportunity and solidarity, responsible health behaviour can—in principle—be justifiably expected. While the practical problems associated with personal responsibility are important, they do not warrant the common knee-jerk refusal to think more deeply about responsibility for health as a means of allocating healthcare resources. In conclusion, the possibility of introducing personal responsibility as a fair rationing criterion is briefly sketched. (shrink)

Although the responsibility for health debate has intensified in several ways between Norman Daniels’ 1985 Just healthcare and Just health: meeting health needs fairly of 2008, comparatively little space is dedicated to the issue in Just health, and Daniels notes repeatedly that his account “says nothing about personal responsibility for health”. Daniels considers health responsibility mainly in a particular luck-egalitarian version which he rejects because of its potentially unfeasible, penalising and inhumane character. But I show that he nonetheless acknowledges and (...) endorses explicitly other dimensions of health responsibility. I develop a wider, more nuanced and less punitive concept of health responsibility, which expands Daniels’ brief consideration and is compatible with the overall approach set out in Just health. In its application to preventative medicine and health promotion in particular, the concept is suited to support and complement the notion that “health is special”, which is central in Just health. The concept of health responsibility as co-responsibility specifies the subjects and objects of health responsibilities. It permits the attribution of responsibility without blame and disconnects the question of assigning responsibility from decisions about entitlement to treatment or different status in prioritisation decisions. This approach secures conceptual plausibility and clarity of the concept of health responsibility, is of use in policy making, and can help reduce political tensions. (shrink)

This paper compares and contrasts three different substantive principles of justice for making health care priority-setting or “rationing” decisions: need principles, maximising principles and egalitarian principles. The principles are compared by tracing out their implications for a hypothetical rationing decision involving four identified patients. This decision has been the subject of an empirical study of public opinion based on small-group discussions, which found that the public seem to support a pluralistic combination of all three kinds of rationing principle. In conclusion, (...) it is suggested that there is room for further work by philosophers and others on the development of a coherent and pluralistic theory of health care rationing which accords with public opinions. (shrink)

Plato and Kant advance a constitutional model of the soul, in which reason and appetite or passion have different structural and functional roles in the generation of motivation, as opposed to the familiar Combat Model in which they are portrayed as independent sources of motivation struggling for control. In terms of the constitutional model we may explain what makes an action different from an event. What makes an action attributable to a person, and therefore what makes it an action, is (...) that it issues from the person''s constitution, and therefore from the person as a whole, rather than from some force working on or in the person. This in turn implies an account of what makes an action good: what makes an action good is that it is deliberated upon and chosen in a way that unifies the person into a constitutional system. Through deliberative action we constitute ourselves as unified agents. Platonic justice and Kant''s categorical imperative are shown to be normative standards for action because they are principles of self-constitution. (shrink)

Unhealthy lifestyle contributes significantly to the burden of disease. Scarce medical resources that could alternatively be spent on interventions to prevent or cure sufferings for which no one is to blame, are spent on prevention or treatment of disease that could be avoided through individual lifestyle changes. This may encourage policy makers and health care professionals to opt for a criterion of individual responsibility for medical suffering when setting priorities. The following article asks whether responsibility-based reasoning should be accepted as (...) relevant for fair and legitimate healthcare rationing. The luck-egalitarian argument that inequalities in health expectancies that derive from unchosen features of people’s circumstances are unjust and should be compensated, while inequalities that reflect personal choices of lifestyle may not, is discussed. It seems that while a backward-looking interpretation of individual responsibility cannot be relevant as a criterion of priority setting, a forward-looking conception of responsibility may be approved.Within all modern societies healthcare authorities are facing difficult priority setting problems. Various criteria for rationing medical intervention have been proposed due to scarcity of resources. Until now, individual responsibility for medical suffering has been given little attention in the public or in academic debate. This is about to change. As Alexander Cappelen and Ole Norheim have pointed out in a recent article in this journal, unhealthy lifestyle contributes increasingly to the burden of disease. A better understanding of the responsibility argument is important for the assessment of policies aimed at meeting this challenge.1 In this article the following question is addressed: should responsibility-based arguments be accepted as relevant to meeting healthcare rationing fairly and legitimately? I will argue that while a backward-looking conception of individual responsibility should not be endorsed, a forward-looking notion of responsibility may be approved. (shrink)

Since the 1940s Americans and Britons have come to enjoy an era of rising material abundance. Yet this has been accompanied by a range of social and personal disorders, including family breakdown, addiction, mental instability, crime, obesity, inequality, economic insecurity, and declining trust.Avner Offer argues that well-being has lagged behind affluence in these societies, because they present an environment in which consistent choices are difficult to achieve over different time ranges and in which the capacity for personal and social commitment (...) is undermined by the flow of novelty. His approach draws on economics and social science, makes use of the latest cognitive research, and provides a detailed and reasoned critique of modern consumer society, especially the assumption that freedom of choice necessarily maximizes individual and social well-being.The book falls into three parts. Part one analyses the ways in which economic resources map on to human welfare, why choice is so intractable, and how commitment to people and institutions is sustained. It argues that choice is constrained by prior obligation and reciprocity. The second section then applies these conceptual arguments to comparative empirical studies of advertising, of eating and obesity, and of the production and acquisition of appliances and automobiles. Finally, in part three, Offer investigates social and personal relations in the USA and Britain, including inter-personal regard, the rewards and reversals of status, the social and psychological costs of inequality, and the challenges posed to heterosexual love and to parenthood by the rise of affluence. (shrink)

This innovative approach to freedom starts from an account of what we mean by describing someone, in a psychological vein, as a free subject. Pettit develops an argument as to what it is that makes someone free in that basic sense; and then goes on to derive the implications of the approach for issues of freedom in political theory. Freedom in the subject is equated with the person's being fit to be held responsible and to be authorized as a partner (...) in interaction. This book is unique among contemporary approaches - although it is true to the spirit of classical writers like Hobbes and Kant - in seeking a theory that applies to psychological issues of free agency and free will as well as to political issues in the theory of the free state and the free constitution. The driving thesis is that it is only by connecting up the different issues of freedom, psychological and political, that we can fully appreciate the nature of the questions involved, and the requirements for their resolution. The book does not not seek a comprehensive reach just for its own sake, but rather for the sake of the illumination it provides._ _ _A Theory of Freedom_ is a ground-breaking volume which will be of wide interest to scholars and students in political philosophy and political science. (shrink)

The doyen of living English philosophers, by these reflections, took hold of and changed the outlook of a good many other philosophers, if not quite enough. He did so, essentially, by assuming that talk of freedom and responsibility is talk not of facts or truths, in a certain sense, but of our attitudes. His more explicit concern was to look again at the question of whether determinism and freedom are consistent with one another -- by shifting attention to certain personal (...) rather than moral attitudes, first of all gratitude and resentment. In the end, he arrived at a kind of Compatibilist or, as he says, Optimist conclusion. That is no doubt a recommendation but not the largest recommendation of this splendidly rich piece of philosophy. (shrink)

Background Policies to use financial incentives to encourage healthy behaviour are controversial. Much of this controversy is played out in the mass media, both reflecting and shaping public opinion. Objective To describe UK mass media coverage of incentive schemes, comparing schemes targeted at different client groups and assessing the relative prominence of the views of different interest groups. Design Thematic content analysis. Subjects National and local news coverage in newspapers, news media targeted at health-care providers and popular websites between January (...) 2005 and February 2010. Setting UK mass media. Results The study included 210 articles. Fifteen separate arguments favourable towards schemes, and 19 unfavourable, were identified. Overall, coverage was more favourable than unfavourable, although most articles reported a mix of views. Arguments about the prevalence and seriousness of the health problems targeted by incentive schemes were uncontested. Moral and ethical objections to such schemes were common, focused in particular on recipients such as drug users or the overweight who were already stereotyped as morally deficient, and these arguments were largely uncontested. Arguments about the effectiveness of schemes and their potential for benefit or harm were areas of greater contestation. Government, public health and other health-care provider interests dominated favourable coverage; oppo- sition came from rival politicians, taxpayersÕ representatives, certain charities and from some journalists themselves. Conclusions Those promoting incentive schemes for people who might be regarded as ÔundeservingÕ should plan a media strategy that anticipates their public reception. (shrink)