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. This reissue makes the first edition once again available for scholars and serious students of Rawls's work.

Too often, we as individuals do things that harm us, that seriously interfere with our being able to live in the way that we want. We eat food that makes us obese, that promotes diabetes, heart failure and other serious illness, while at the same time, we want to live long and healthy lives. Too many of us smoke cigarettes, even while acknowledging we wish we had never begun. We behave in ways that undercut our ability to reach some of (...) our most valued goals, despite education and despite incentives to choose the right thing. What should be done?If I were to try to harm someone else in a way that alters his future seriously and perhaps irrevocably for the worse, I would be stopped. When it comes to hurting myself, though, we have a common belief that it is wrong to interfere, even if I foresee that I will very much regret what I have done, often when it is too late to fix what I have let happen. I think this makes no sense. If it is permissible, even obligatory, to stop me when I do something that seriously interferes with someone else's chances of achieving the life he wants, I think …. (shrink)

Although the effectiveness of some tobacco programs and policies has been clearly demonstrated in reducing the overall population smoking prevalence, the health benefits are not equally distributed across all socio-economic classes; a situation that clearly runs against the equalitarian ethos of most modern states. In this article, we evaluate the benefits of using Sen’s Capability Approach as a theory of social justice to guide public health program and policy development in a way that would prevent the further increase of inequalities (...) in health outcomes. Starting from four consensual goals of tobacco control practice (i.e. that individuals live a smoke-free life, that smokers quit smoking, that non-smokers are protected from exposure to second-hand smoke and that smoking cessation support is accessible) we found that besides the standard interventions (e.g. education on the harms of smoking, policies to reduce exposure to SHS) an iniquity-proof tobacco control program needs also to address the lack of options of underprivileged people in affordable smoke-free settings and in leisure activities. We conclude that an ethical tobacco prevention program needs to address the broader social determinants of health such as the socio-economic policies that put a strain on people’s capacity to shun or quit smoking. (shrink)

This paper argues that the medical conception of health as absence of disease is a value-free theoretical notion. Its main elements are biological function and statistical normality, in contrast to various other ideas prominent in the literature on health. Apart from universal environmental injuries, diseases are internal states that depress a functional ability below species-typical levels. Health as freedom from disease is then statistical normality of function, i.e., the ability to perform all typical physiological functions with at least typical efficiency. (...) This conception of health is as value-free as statements of biological function. The view that health is essentially value-laden, held by most writers on the topic, seems to have one of two sources: an assumption that health judgments must be practical judgments about the treatment of patients, or a commitment to "positive" health beyond the absence of disease. I suggest that the assumption is mistaken, the commitment possibly misdescribed. (shrink)

The Italian government recently criticized the UK’s “traffic light” food labelling system for unfairly discriminating against some traditional Italian foods such as mozzarella, Parma ham, and Parmesan cheese . This type of labelling highlights the percentages of fat, saturated fat, salt, sugar, and calories of each food and classifies them by using red, amber, and green colors depending on the level of each nutrient. While it is true that some Italian foods do contain a high level of fat or salt (...) , the Italian government pointed out that traffic light labelling sometimes privileges certain processed foods or fizzy drinks with artificial sweeteners over .. (shrink)

According to recently influential conceptions of public reasoning, citizens have the right to demand of each other ‘public justifications’ for controversial political action. On this view, only arguments that all reasonable citizens can affirm from within their diverse ethical standpoints can count as legitimate justifications for political action. Both proponents and critics often assume that the case for this expectation derives from the special justificatory burden created by the systematically coercive character of political action. This paper challenges that assumption. While (...) conceding that citizens who propose to deploy the coercive apparatus of the state to enforce controversial legislation owe their fellows a justification that overcomes the strong presumption against coercing agents, it denies that this consideration can explain why public justifications are also required. Having argued that the public justification requirement is not among the justification conditions for public coercion, the paper then proposes an alternative rationale for the expectation that political action be publicly justified. On this alternative, the case for the public justification requirement depends on democratic citizens’ standing as legislative co-authors, and not on considerations having to do with their liability as private individuals to coercion at the hands of the state. (shrink)

According to recently influential conceptions of public reasoning, citizens have the right to demand of each other ‘public justifications’ for controversial political action. On this view, only arguments that all reasonable citizens can affirm from within their diverse ethical standpoints can count as legitimate justifications for political action. Both proponents and critics often assume that the case for this expectation derives from the special justificatory burden created by the systematically coercive character of political action. This paper challenges that assumption. While (...) conceding that citizens who propose to deploy the coercive apparatus of the state to enforce controversial legislation owe their fellows a justification that overcomes the strong presumption against coercing agents, it denies that this consideration can explain why public justifications are also required. Having argued that the public justification requirement is not among the justification conditions for public coercion, the paper then proposes an alternative rationale for the expectation that political action be publicly justified. On this alternative, the case for the public justification requirement depends on democratic citizens’ standing as legislative co-authors, and not on considerations having to do with their liability as private individuals to coercion at the hands of the state. (shrink)

Governments and policy-makers have of late displayed renewed attention to behavioural research in an attempt to achieve a range of policy goals, including health promotion. In particular, approaches which could be labelled as ‘nudges’ have gained traction with policy-makers. A range of objections to nudging have been raised in the literature. These include claims that nudges undermine autonomy and liberty, may lead to a decrease in responsibility in decision-making, lack transparency, involve deception, and involve manipulation, potentially occasioning coercion. In this (...) article I focus on claims of coercion, examining nudges within two of the main approaches to coercion—the pressure approach and the more recent enforcement approach. I argue that coercion entails an element of control over the behaviour of agents which is not plausibly displayed by the kinds of serious examples of nudges posited in the literature. (shrink)

Next SectionIn an online study conducted separately in the UK and the US, participants rated the acceptability and fairness of four interventions: two types of financial incentives and two types of medical interventions. These were stated to be equally effective in improving outcomes in five contexts: weight loss and smoking cessation programmes, and adherence in treatment programmes for drug addiction, serious mental illness and physiotherapy after surgery. Financial incentives were judged less acceptable and to be less fair than medical interventions (...) across all five contexts. Context moderated the relative preference between rewards and penalties: participants from both countries favoured rewards over penalties in weight loss and treatment for serious mental illness. Only among US participants was this relative preference moderated by perceived responsibility of the target group. Overall, participants supported funding more strongly for interventions when they judged members of the target group to be less responsible for their condition, and vice versa. These results reveal a striking similarity in negative attitudes towards the use of financial incentives, rewards as well as penalties, in improving outcomes across a range of contexts, in the UK and the USA. The basis for such negative attitudes awaits further study. (shrink)

THE ARTICLE DEMONSTRATES FOR SOMATIC MEDICINE AS WELL AS PSYCHIATRY AND PSYCHOTHERAPY THAT THE CONCEPT OF DISEASE IS AT LEAST PARTIALLY DEPENDENT ON IDEOLOGICAL CONSIDERATIONS. THE PAPER SURVEYS REPRESENTATIVE VIEWS AND EXPLORES THE BEARING OF THE CONCEPTS OF NORMS, FUNCTIONS, VALUES ON THE SPECIFICATION OF DISEASE.

Vaccination policy is an ethically challenging domain of public policy. It is a matter of collective importance that reaches into the most private sphere of citizens and unavoidably conflicts with individual-based ethics. Policy makers need to walk a tight rope in order to complement utilitarian public health values with individual autonomy rights, protection of privacy, non-discrimination and protection of the worst-off. Whether vaccination is voluntary or compulsory, universal or targeted, every option faces complex ethical hurdles because of the interdependence of (...) humans in infectious disease matters. In this article, we explore the following three policy questions. (i) Ethically, which policy measures should be addressed when vaccination coverage is insufficient in a population? Information campaigns, legal compulsion, or the use of financial incentives can all be effective, but also controversial policy options. (ii) Is it ethical to target vaccination programs at certain risk-groups? If such measures are necessary, we argue that policymakers will often have to decide which is more important to uphold: non-discrimination or the protection of privacy. And (iii), what is the ethical significance of adverse herd immunity effects? Some vaccination programs will improve average population health, but will at the same time increase the risk of severe morbidity and mortality for individuals in the worst-off groups of society. (shrink)

This paper explores the analogy between food label information and genetic information, in order to defend the right not to know judgmental nutritional information, such as the one conveyed by traffic light labels and other, more aggressive, recent proposals. Traffic light labeling judges the nutritional quality of food by means of colored flags on the front pack . It involves a simplification of the link between food quality and health outcomes. Unlike GDAs ,1 it does not present the consumer with (...) neutral nutritional information, but conveys an interpretation of the link between nutritional qualities and .. (shrink)

How should we define ‘health’ and ‘disease’? There are three main positions in the literature. Naturalists desire value-free definitions based on scientific theories. Normativists believe that our uses of ‘health’ and ‘disease’ reflect value judgments. Hybrid theorists offer definitions containing both normativist and naturalist elements. This paper discusses the problems with these views and offers an alternative approach to the debate over ‘health’ and ‘disease’. Instead of trying to find the correct definitions of ‘health’ and ‘disease’ we should explicitly talk (...) about the considerations that are central in medical discussions, namely state descriptions and normative claims . This distinction avoids the problems facing the major approaches to defining ‘health’ and ‘disease’, and it more clearly captures what matters in medical discussions. (shrink)

abstract In this paper moralism is defined as the illicit use of moral considerations. Three different varieties of moralism are then discussed — moral absolutism, excessive standards and demandingness, and presenting non‐moral considerations as moral ones. Both individuals and theories can be regarded as moralistic in some of these senses. Indeed, some critics of consequentialism have regarded that theory as moralistic. The author then describes the problems associated with each sense of ‘moralism’ and how casuistry evolved to try to deal (...) with some of these problems. The author also defends consequentialism against one charge of moralism [1]. (shrink)

abstract In this paper moralism is defined as the illicit use of moral considerations. Three different varieties of moralism are then discussed — moral absolutism, excessive standards and demandingness, and presenting non‐moral considerations as moral ones. Both individuals and theories can be regarded as moralistic in some of these senses. Indeed, some critics of consequentialism have regarded that theory as moralistic. The author then describes the problems associated with each sense of ‘moralism’ and how casuistry evolved to try to deal (...) with some of these problems. The author also defends consequentialism against one charge of moralism [1]. (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)