Individuals who become ill as a result of personal lifestyle choices often shift the monetary costs of their healthcare needs to the taxpaying public or to fellow members of a private insurance pool. Some argue that policies permitting such cost shifting are unfair. Arguments for this view may seem to draw support from luck egalitarian accounts of distributive justice. This essay argues that the luck egalitarian framework provides no such support. To allocate healthcare costs on the basis of personal responsibility (...) would arbitrarily and publicly burden socially detectable risk-takers while undetectable risk-takers continue to get a free ride. That problem is unavoidable even on the assumption that distributive institutions outside the healthcare sector are fully just. In actual, farfrom-just societies, imposing personal liability for the costs of voluntary risk taking would be wrong for an additional reason. Doing so would tend to magnify existing distributive injustices. These conclusions draw attention to two common ‘moral fallacies of the second best’ that can arise when applying ideal normative theory to matters of institutional design and in real-world policy contexts. (shrink)

Virtually any appraisal of a person’s welfare, integrity, or moral status, as well as the moral and political theories built on such appraisals, will rely crucially on the presumption that her preferences and values are in some important sense her own. In particular, the nature and value of political freedom is intimately connected with the presupposition that actions one is left free to do flow from desires and values that are truly an expression of the ‘self-government’ of the agent. However, (...) we all know that no person is self-made in the sense of being a fully formed and intact ‘will’ blossoming out of nowhere. Our values and preferences are explained by essential reference to a variety of influences that have come to bear on our development throughout our personal histories. What is needed, then, is to establish an account of self-determination or autonomy that would help determine just when and if the values and preferences we find ourselves with deserve the centrality that moral and political theories place on them. (shrink)

I [try] to understand identification by appeal to phenomena of deciding to treat, and of treating, a desire of one's as reason-giving in one's practical reasoning, planning, and action. Is identification, so understood, "fundamental," as Frankfurt says, "to any philosophy of mind and of action"? Well, we have seen reason to include in our model of intentional agency such phenomena of deciding to treat, and of treating, certain of one's desires as reason-giving. Identification, at bottom, consists in such phenomena — (...) or so I have proposed. Given that such phenomena are important in our practical lives, we may agree with Frankfurt that identification is, in this sense, "fundamental.". (shrink)

Free Public Reason examines the idea of public justification, stressing its importance but also questioning the coherence of the concept itself. Although public justification is employed in the work of theorists such as John Rawls, Jeremy Waldron, Thomas Nagel, and others, it has received little attention on its own as a philosophical concept. In this book Fred D'Agostino shows that the concept is composed of various values, interests, and notions of the good, and that no ranking of these is possible. (...) The notion of public justification itself is thus shown to be contestable. In demonstrating this, D'Agostino undermines many current political theories that rely on this concept. Having broken down the foundations of public justification, D'Agostino then offers an alternative model of how a workable consensus on its meaning might be reached through the interactions of a community of interpreters or delegates at a constitutional convention. (shrink)

This paper presents a conception of the self partially in terms of a particular notion of preference. It develops a coherentist account of when one's preferences are "authorized", or sanctioned as one's own, and presents a coherence theory of autonomous action. The view presented solves certain problems with hierarchical accounts of freedom, such as Harry Frankfurt's.

We are purposive agents; but we—adult humans in a broadly modern world—are more than that. We are reflective about our motivation. We form prior plans and policies that organize our activity over time. And we see ourselves as agents who persist over time and who begin, develop, and then complete temporally extended activities and projects. Any reasonably complete theory of human action will need in some way to advert to this trio of features—to our reflectiveness, our planfulness, and our conception (...) of our agency as temporally extended. These are, further, features that have great significance for the kinds of lives we can live. For these two reasons I will say that these are among the core features of human agency. A theory of human action needs to say what these core features consist in and how they are related to each other. And such a theory needs also to clarify the relation between these core features of our agency and the possibility that we are fully embedded in an event causal order. (shrink)

It is my view that one essential difference between persons and other creatures is to be found in the structure of a person's will. Besides wanting and choosing and being moved to do this or that, men may also want to have certain desires and motives. They are capable of wanting to be different, in their preferences and purposes, from what they are. Many animals appear to have the capacity for what I shall call "first-order desires" or "desires of the (...) first order," which are simply desires to do or not to do one thing or another. No animal other than man, however, appears to have the capacity for reflective self-evaluation that is manifested in the formation of second-order desires. (shrink)

John Roemer points out that there are two views of equality of opportunity that are widely held today. The first, which he calls the nondiscrimination principle, states that in the competition for positions in society, individuals should be judged only on attributes relevant to the performance of the duties of the position in question. Attributes such as race or sex should not be taken into account. The second states that society should do what it can to level the playing field (...) among persons who compete for positions, especially during their formative years, so that all those who have the relevant potential attributes can be considered. -/- Common to both positions is that at some point the principle of equal opportunity holds individuals accountable for achievements of particular objectives, whether they be education, employment, health, or income. Roemer argues that there is consequently a “before” and an “after” in the notion of equality of opportunity: before the competition starts, opportunities must be equalized, by social intervention if need be; but after it begins, individuals are on their own. The different views of equal opportunity should be judged according to where they place the starting gate which separates “before” from “after.” Roemer works out in a precise way how to determine the location of the starting gate in the different views. (shrink)

Previous edition, 1st, published in 1971.

Since it appeared in 1971, John Rawls's A Theory of Justice has become a classic. The author has now revised the original edition to clear up a number of difficulties he and others have found in the original book. Rawls aims to express an essential part of the common core of the democratic tradition--justice as fairness--and to provide an alternative to utilitarianism, which had dominated the Anglo-Saxon tradition of political thought since the nineteenth century. Rawls substitutes the ideal of the (...) social contract as a more satisfactory account of the basic rights and liberties of citizens as free and equal persons. "Each person," writes Rawls, "possesses an inviolability founded on justice that even the welfare of society as a whole cannot override." Advancing the ideas of Rousseau, Kant, Emerson, and Lincoln, Rawls's theory is as powerful today as it was when first published. (shrink)

In this book by the award-winning author of Just Healthcare, Norman Daniels develops a comprehensive theory of justice for health that answers three key questions: what is the special moral importance of health? When are health inequalities unjust? How can we meet health needs fairly when we cannot meet them all? Daniels' theory has implications for national and global health policy: can we meet health needs fairly in ageing societies? Or protect health in the workplace while respecting individual liberty? Or (...) meet professional obligations and obligations of justice without conflict? When is an effort to reduce health disparities, or to set priorities in realising a human right to health, fair? What do richer, healthier societies owe poorer, sicker societies? Just Health: Meeting Health Needs Fairly explores the many ways that social justice is good for the health of populations in developed and developing countries. (shrink)

This book provides a comprehensive, systematic theory of moral responsibility. The authors explore the conditions under which individuals are morally responsible for actions, omissions, consequences, and emotions. The leading idea in the book is that moral responsibility is based on 'guidance control'. This control has two components: the mechanism that issues in the relevant behavior must be the agent's own mechanism, and it must be appropriately responsive to reasons. The book develops an account of both components. The authors go on (...) to offer a sustained defense of the thesis that moral responsibility is compatible with causal determinism. (shrink)

This important new book develops a new concept of autonomy. The notion of autonomy has emerged as central to contemporary moral and political philosophy, particularly in the area of applied ethics. professor Dworkin examines the nature and value of autonomy and uses the concept to analyse various practical moral issues such as proxy consent in the medical context, paternalism, and entrapment by law enforcement officials.

Most people assume that, even though some degenerative or criminal behavior may be caused by influences beyond our control, ordinary human actions are not similarly generated, but rather are freely chosen, and we can be praiseworthy or blameworthy for them. A less popular and more radical claim is that factors beyond our control produce all of the actions we perform. It is this hard determinist stance that Derk Pereboom articulates in Living Without Free Will. Pereboom argues that our best scientific (...) theories have the consequence that factors beyond our control produce all of the actions we perform, and that because of this, we are not morally responsible for any of them. He seeks to defend the view that morality, meaning and value remain intact even if we are not morally responsible, and furthermore, that adopting this perspective would provide significant benefit for our lives. (shrink)

Lifestyle diseases constitute an increasing proportion of health problems and this trend is likely to continue. A better understanding of the responsibility argument is important for the assessment of policies aimed at meeting this challenge. Holding individuals accountable for their choices in the context of health care is, however, controversial. There are powerful arguments both for and against such policies. In this article the main arguments for and the traditional arguments against the use of individual responsibility as a criterion for (...) the distribution of scarce health resources will be briefly outlined. It is argued that one of the most prominent contemporary normative traditions, liberal egalitarianism, presents a way of holding individuals accountable for their choices that avoids most of the problems pointed out by the critics. The aim of the article is to propose a plausible interpretation of liberal egalitarianism with respect to responsibility and health care and assess it against reasonable counter-arguments. (shrink)

The core of this book is a novel theory of distributive justice premised on the fundamental moral equality of persons. In the light of this theory, Rakowski considers three types of problems which urgently require solutions-- the distribution of resources, property rights, and the saving of life--and provides challenging and unconventional answers. Further, he criticizes the economic analysis of law as a normative theory, and develops an alternative account of tort and property law.

We are purposive agents; but we—adult humans in a broadly modern world—are more than that. We are reflective about our motivation. We form prior plans and policies that organize our activity over time. And we see ourselves as agents who persist over time and who begin, develop, and then complete temporally extended activities and projects. Any reasonably complete theory of human action will need in some way to advert to this trio of features—to our reflectiveness, our planfulness, and our conception (...) of our agency as temporally extended. These are, further, features that have great significance for the kinds of lives we can live. For these two reasons I will say that these are among the core features of human agency. A theory of human action needs to say what these core features consist in and how they are related to each other. And such a theory needs also to clarify the relation between these core features of our agency and the possibility that we are fully embedded in an event causal order. (shrink)

Which inequalities in longevity and health among individuals, groups, and nations are unfair? And what priority should health policy attach to narrowing them? These essays by philosophers, economists, epidemiologists, and physicians attempt to determine how health inequalities should be conceptualized, measured, ranked, and evaluated.

Combatting chronic, lifestyle-related disease has become a healthcare priority in the developed world. The role personal responsibility should play in healthcare provision has growing pertinence given the growing significance of individual lifestyle choices for health. Media reporting focussing on the ‘bad behaviour’ of individuals suffering lifestyle-related disease, and policies aimed at encouraging ‘responsibilisation’ in healthcare highlight the importance of understanding the scope of responsibility ascriptions in this context. Research into the social determinants of health and psychological mechanisms of health behaviour (...) could undermine some commonly held and tacit assumptions about the moral responsibility of agents for the sorts of lifestyles they adopt. I use Philip Petit's conception of freedom as ‘fitness to be held responsible’ to consider the significance of some of this evidence for assessing the moral responsibility of agents. I propose that, in some cases, factors outside the agent's control may influence behaviour in such a way as to undermine her freedom along the three dimensions described by Pettit: freedom of action; a sense of identification with one's actions; and whether one's social position renders one vulnerable to pressure from more powerful others. (shrink)

In the last fifty years, average overall health status has increased more or less in parallel with a much celebrated decline in mortality, attributed mostly to poverty reduction, sanitation, nutrition, housing, immunization, and improved medical care. It is becoming increasingly clear, however, that these achievements were not equally distributed. In most countries, while some social groups have benefited significantly, the situation of others has stagnated or may even have worsened.If health is a prerequisite to a person functioning as an agent, (...) inequalities in health constitute inequalities in people's capability to function -- a denial of equality of opportunity. So why should a concern with health equity be singled out from the pursuit of social justice more generally? Can existing theories of justice provide an adequate account of health equity? And what ethical problems arise in evaluating health inequalities? These are some of the important questions that this book addresses in building an interdisciplinary understanding of health equity. With contributions from distinguished philosophers, anthropologists, economists, and public-health specialists, it centres on five major themes: what is health equity?; health equity and social justice; responsibilities for health; ethical issues in health evaluation; and anthropological perspectives. (shrink)

How much of the income-based gaps in cognitive ability and academic achievement could be closed by a two-year, center-based early childhood education intervention? Data from the Infant Health and Development Program, which randomly assigned treatment to low-birth-weight children from both higher-and low-income families between ages one and three, shows much larger impacts among low-than higher-income children. Projecting IHDP impacts to the U.S. population's IQ and achievement trajectories suggests that such a program offered to low-income children would essentially eliminate the income-based (...) gap at age three and between a third and three-quarters of the age five and age eight gaps. © 2013 by the Board of Regents of the University of Wisconsin System. (shrink)