In recent years some moral philosophers and political theorists, who have come to be called “luck egalitarians,” have urged that the essence of social justice is the moral imperative to improve the condition of people who suffer from simple bad luck. Prominent theorists who have attracted the luck egalitarian label include Ronald Dworkin, G. A. Cohen, and John Roemer.1 Larry Temkin should also be included in this group, as should Thomas Nagel at the time that he wrote Equality and Partiality.2 (...) However, each of these theorists asserts a different position. The common ground, if any, is obscure. The idea of luck that is invoked is not transparently clear. Anyway, the term “luck egalitarianism” was coined by a critic of the doctrine, and tendentiously defined to denote an extreme version of the view that looks implausible from the start.3 With some justice Ronald Dworkin, perhaps the chief architect of the luck egalitarian position, has denied that he is a luck egalitarian. (shrink)

In this critique, Martha Nussbaum argues that our dominant theories of development have given us policies that ignore our most basic human needs for dignity and self-respect.

Liam Shields systematically clarifies and defends the political philosophy of Sufficientarianism, which insists that securing enough of some things, such as food, healthcare and education, is a crucial demand of justice. By engaging in practical debates about critical issues such as child-rearing and global justice, the author sheds light on the potential implications of suffientarianism on the social policies that affect our daily lives.

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

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)

According to luck egalitarianism, inequalities are justified if and only if they arise from choices for which it is reasonable to hold agents responsible. This position has been criticised for its purported harshness in responding to the plight of individuals who, through their own choices, end up destitute. This paper aims to assess the Harshness Objection. I put forward a version of the objection that has been qualified to take into account some of the more subtle elements of the luck (...) egalitarian approach. Revising the objection in this way suggests that the Harshness Objection has been overstated by its proponents: because luck egalitarians are sensitive to the influence of unequal brute luck on individuals’ choices, it is unlikely that there will be any real world cases in which the luck egalitarian would not have to provide at least partial compensation. However, the Harshness Objection still poses problems for the luck egalitarian. First, it is not clear that partial compensation will be sufficient to avoid catastrophic outcomes. Second, the Harshness Objection raises a theoretical problem in that a consistent luck egalitarian will have to regard it as unjust if any assistance is provided to the victim of pure option luck, even if such assistance could be provided at no cost. I consider three strategies the luck egalitarian could pursue to accommodate these concerns and conclude that none of these strategies can be maintained without either violating basic luck egalitarian principles or infringing upon individual liberty. (shrink)

Kasper Lippert-Rasmussen tackles all the major questions concerning luck egalitarianism, providing deep, penetrating and original discussion of recent academic discourses on distributive justice as well as responses to some of the main objections in the literature. It offers a new answer to the “Why equality?” and “Equality of what?” questions, and provides a robust luck egalitarian response to the recent criticisms of luck egalitarianism by social relations egalitarians. This systematic, theoretical introduction illustrates the broader picture of distributive justice and enables (...) the reader to understand the core intuitions underlying, or conflicting with, luck egalitarianism. (shrink)

Health, Luck, and Justice is the first attempt to systematically apply luck egalitarianism to the just distribution of health and health care.

Egalitarians have traditionally been suspicious of equality of opportunity, but recently there has been a sea-change in thinking about that concept. Shlomi Segall brings together these developments and offers a new account of 'radical equality of opportunity', which removes all obstacles (to one's opportunity-set) that lie outside one's control.

Ordinarily, we take moral responsibility to come in degrees. Despite this commonplace, theories of moral responsibility have focused on the minimum threshold conditions under which agents are morally responsible. But this cannot account for our practices of holding agents to be more or less responsible. In this paper we remedy this omission. More specifically, we extend an account of reasons-responsiveness due to John Martin Fischer and Mark Ravizza according to which an agent is morally responsible only if she is appropriately (...) receptive to and reactive to reasons for action. Building on this, we claim that the degree to which an agent is responsible will depend on the degree to which she is able to recognize and react to reasons. To analyze this, we appeal to relations of comparative similarity between possible worlds, arguing that the degree to which an agent is reasons-reactive depends on the nearest possible world in which given sufficient reason to do otherwise, she does so. Similarly, we argue that the degree to which an agent is reasons-receptive will depend on the intelligibility of her patterned recognition of reasons. By extending an account of reasons-responsiveness in these ways, we are able to rationalize our practice of judging people to be more or less responsible. (shrink)

The distribution of scarce healthcare resources is an increasingly important issue due to factors such as expensive ‘high tech’ medicine, longer life expectancies and the rising prevalence of chronic illness. Furthermore, in the current healthcare context lifestyle-related factors such as high blood pressure, tobacco use and obesity are believed to contribute significantly to the global burden of disease. As such, this paper focuses on an ongoing debate in the academic literature regarding the role of responsibility for illness in healthcare resource (...) allocation: should patients with self-caused illness receive lower priority in access to healthcare resources? This paper critically describes the lower priority debate's 12 key arguments and maps out their relationships. This analysis reveals that most arguments have been refuted and that the debate has stalled and remains unresolved. In conclusion, we suggest progression could be achieved by inviting multidisciplinary input from a range of stakeholders for the development of evidence-based critical evaluations of existing arguments and the development of novel arguments, including the outstanding rebuttals. (shrink)

Some theorists, especially egalitarians, seek to ‘apply’ theories of justice to a specific area or good, such as health, and assess the distribution of that good at the bar of justice. On the one hand, this is understandable, given that egalitarians are often interested in making policy recommendations and these would have to be area-specific. On the other hand, it is surprising in light of the fact that theories of justice normally envisage the ‘total package of goods’ or an overall (...) good as the distribuendum. This article aims to show that this approach is problematic at least in the area of health. (shrink)

This paper argues against incorporating assessments of individual responsibility into healthcare policies by expanding an existing argument and offering a rebuttal to an argument in favour of such policies. First, it is argued that what primarily underlies discussions surrounding personal responsibility and healthcare is not causal responsibility, moral responsibility or culpability, as one might expect, but biases towards particular highly stigmatised behaviours. A challenge is posed for proponents of taking personal responsibility into account within health policy to either expand the (...) debate to also include socially accepted behaviours or to provide an alternative explanation of the narrowly focused discussion. Second, a critical response is offered to arguments that claim that policies based on personal responsibility would lead to several positive outcomes including healthy behaviour change, better health outcomes and decreases in healthcare spending. It is argued that using individual responsibility as a basis for resource allocation in healthcare is unlikely to motivate positive behaviour changes, and is likely to increase inequality which may lead to worse health outcomes overall. Finally, the case of West Virginia's Medicaid reform is examined, which raises a worry that policies focused on personal responsibility have the potential to lead to increases in medical spending overall. (shrink)

In her excellent and comprehensive article, Friesen argues that utilising personal responsibility in healthcare is problematic in several ways: it is difficult to ascribe responsibility to behaviour; there is a risk of prejudice and bias in deciding which behaviours a person should be held responsible for; it may be ineffective at reducing health costs. In this short commentary, I will elaborate the critique of personal responsibility in health but suggest one way in which it could be used ethically. In doing (...) so, I will introduce the concepts of reasonable risk and golden opportunity. I previously argued that it is both difficult to disentangle responsibility and that we risk prejudice and bias in singling out behaviours that are socially disapproved of.1 So I am sympathetic to Friesen’s concerns. I also discussed another way in which ascribing personal responsibility for health is problematic which Friesen does not discuss and which, in my view, is the most concerning and further supports her arguments. It represents a back door assault on liberalism and neutrality towards concepts of the good life. Even if one were to accurately and in an unbiased way divine the personal contribution to disease, the greatest problem would remain: those who voluntarily take on risk would be penalised. That is, such a system would be risk-averse. Those lives which avoided risk would be prioritised, while those who chose to take on risky activities in their conception of the good life would be penalised. Yet risk is necessary, both for the good life, and social progress. Columbus, Edmund Hilary, Florence Nightingale, Ernest Hemingway and countless monumental figures in human history took risks in order to achieve something great. Should we aim for a society of trembling, teetotalling health nuts? Surely that prospect is horrific. It is horrific because it elevates health …. (shrink)

In everyday life, we assume that there are degrees of blameworthiness and praiseworthiness. Yet the debate about the nature of moral responsibility often focuses on the “yes or no” question of whether indeterminism is required for moral responsibility, while questions about what accounts for more or less blameworthiness or praiseworthiness are underexplored. In this paper, I defend the idea that degrees of blameworthiness and praiseworthiness can depend in part on degrees of difficulty and degrees of sacrifice required for performing the (...) action in question. Then I turn to the question of how existing accounts of the nature of moral responsibility might be seen to accommodate these facts. In each case of prominent compatibilist and incompatibilist accounts that I consider, I argue that supplementation with added dimensions is required in order to account for facts about degrees of blameworthiness and praiseworthiness. For example, I argue that the reasons-responsiveness view of Fischer and Ravizza requires supplementation that takes us beyond even fine-grained measures of degrees of reasons-responsiveness in order to capture facts about degrees of difficulty to extend the reasons-responsiveness view by appealing to such measures). I conclude by showing that once we recognize the need for these additional parameters, we will be in a position to explain away at least some of the appeal of incompatibilist accounts of moral responsibility. (shrink)

In bioethics, discussions of justice have tended to focus on questions of fairness in access to health care: is there a right to medical treatment, and how should priorities be set when medical resources are scarce. But health care is only one of many factors that determine the extent to which people live healthy lives, and fairness is not the only consideration in determining whether a health policy is just. In this pathbreaking book, senior bioethicists Powers and Faden confront foundational (...) issues about health and justice. How much inequality in health can a just society tolerate. The audience for the book is scholars and students of bioethics and moral and political philosophy, as well as anyone interested in public health and health policy. (shrink)

This article proposes an analysis of the doctrine of sufficiency. According to my reading, the doctrine's basic positive claim is ‘prioritarian’: benefiting x is of special moral importance where (and only where) x is badly off. Its negative claim is anti-egalitarian: most comparative facts expressed by statements of the type ‘x is worse off than y’ have no moral significance at all. This contradicts the ‘classical’ priority view according to which, although equality per se does not matter, whenever x is (...) worse off than y, at least some priority should be assigned to helping x. Section I elaborates and defends this reconstruction of the doctrine of sufficiency, and section II shows that the privileged utility level presumed within the sufficiency framework exists. (shrink)

G. A. Cohen was one of the most gifted, influential, and progressive voices in contemporary political philosophy. At the time of his death in 2009, he had plans to bring together a number of his most significant papers. This is the first of three volumes to realize those plans. Drawing on three decades of work, it contains previously uncollected articles that have shaped many of the central debates in political philosophy, as well as papers published here for the first time. (...) In these pieces, Cohen asks what egalitarians have most reason to equalize, he considers the relationship between freedom and property, and he reflects upon ideal theory and political practice. Included here are classic essays such as "Equality of What?" and "Capitalism, Freedom, and the Proletariat," along with more recent contributions such as "Fairness and Legitimacy in Justice," "Freedom and Money," and the previously unpublished "How to Do Political Philosophy." On ample display throughout are the clarity, rigor, conviction, and wit for which Cohen was renowned. Together, these essays demonstrate how his work provides a powerful account of liberty and equality to the left of Ronald Dworkin, John Rawls, Amartya Sen, and Isaiah Berlin. (shrink)

John Rawls's work (1971) has greatly contributed to rehabilitating equality as a basic social value, after decades of utilitarian hegemony,particularly in normative economics, but Rawls also emphasized that full equality of welfare is not an adequate goal either. This thesis was echoed in Dworkin's famous twin papers on equality (Dworkin 1981a,b), and it is now widely accepted that egalitarianism must be selective. The bulk of the debate on ‘Equality of What?’ thus deals with what variables ought to be submitted for (...) selection and how this selection ought to be carried out. (shrink)

John Rawls's work has greatly contributed to rehabilitating equality as a basic social value, after decades of utilitarian hegemony,particularly in normative economics, but Rawls also emphasized that full equality of welfare is not an adequate goal either. This thesis was echoed in Dworkin's famous twin papers on equality, and it is now widely accepted that egalitarianism must be selective. The bulk of the debate on ‘Equality of What?’ thus deals with what variables ought to be submitted for selection and how (...) this selection ought to be carried out. (shrink)

Traditionally, theories of moral responsibility feature only the minimally sufficient conditions for moral responsibility. While these theories are well-suited to account for the threshold of responsibility, it’s less clear how they can address questions about the degree to which agents are responsible. One feature that intuitively affects the degree to which agents are morally responsible is how difficult performing a given action is for them. Recently, philosophers have begun to develop accounts of scalar moral responsibility that make use of this (...) notion of difficulty (Coates and Swenson 2013; Nelkin 2016). In this paper, I argue that these accounts, although innovative, are incomplete. The degree to which agents are morally responsible is determined not only by the difficulties that agents face but also by the quality of the reasons for which they act. (shrink)

Many have thought that an important feature of any just society is the establishment and maintenance of a suitable basic minimum: some set of welfare achievements, resources, capabilities, and so on that are guaranteed to all. However, if a basic minimum is a plausible requirement of justice, we must have a theory — a theory of what, precisely, the state owes in terms of these basic needs or achievements and what, precisely, is the proper structure of the obligation to provide (...) them. In Section 1, I will critically examine one recent influential account of the basic minimum: Martha Nussbaum's `human capabilities approach'. I argue that Nussbaum's account has several structural features, few of which are independently plausible, and which create insuperable difficulties when viewed in combination. The failure of Nussbaum's account is instructive, however. It provides motivation for the positive account I sketch in Section 2. Key Words: Martha Nussbaum • welfare • capabilities • autonomy. (shrink)

This paper provides a critical examination of the strongest defenses of the pure lifetime view, according to which justice requires taking only people's whole lives as relevant when assessing and establishing their distributive entitlements and obligations. The paper proposes that we reject a pure lifetime view and replace it with an alternative view, on which some time-specific considerations--that is to say, considerations about how people fare at specific points in time--have nonderivative weight in determining what our obligations are to them.

Should governments give special rights to ethnic and cultural minorities? Should rich countries open their borders to economic immigrants or transfer resources to poor countries? When framing and implementing economic and environmental policies, should current generations take into account the interests of future generations? If our political community committed a wrong against another group a hundred years ago, do we owe reparations to current members of that group? These are just some of the pressing questions which are fully explored in (...) this accessible new analysis of justice in the contemporary world. They force us to reconsider the extent of our obligations to our fellow citizens, future generations and foreigners. Justice in a Changing World introduces the moral debates around issues such as immigration, national self-determination, cultural rights and reparations, as well as resource transfers from one generation to the next and from rich to poor countries, through the lenses of liberalism, communitarianism and libertarianism. In so doing, it helps to unravel the complexity of key ethical dilemmas facing us today. The book will be a valuable resource for students of political theory, and will appeal to anyone wishing to reflect on their deepest values and commitments by putting them to the test of practical politics. (shrink)