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)

Incentive schemes, which offer recipients benefits if they meet particular requirements, are being used across the world to encourage healthier behaviours. From the perspective of equality, an important concern about such schemes is that since people often do not have equal opportunity to fulfil the stipulated conditions, incentives create opportunity for further unfair advantage. Are incentive schemes that are available only to disadvantaged groups less susceptible to such egalitarian concerns? While targeted schemes may at first glance seem well placed to (...) help improve outcomes among disadvantaged groups and thus reduce inequalities, I argue in this paper that they are susceptible to significant problems. At the same time, incentive schemes may be less problematic when they operate in ways that differ from the ‘standard’ incentive mechanism; I discuss three such mechanisms. (shrink)

Empirical research shows the significant negative effects inequality has on aspects such as public health, vulnerability to violence, and social trust. While the majority of researchers agree that there exist specific social determinants of health as well as a distinct social gradient in health , there is wide disagreement both over what the exact causal relationship between social inequalities and health is, and what the adequate policy responses especially to the SGH are. For policy-oriented theorists, the question arises which normative (...) implications these empirical findings offer for philosophers working on equality.This paper argues that the first lesson philosophers should take away from the empirical literature is that the issue that needs to be addressed is harmful social inequality, rather than unequal material distributions, or unequal opportunities and starting gates as such. That is to say, inequality with respect to a specific feature X is not—in itself—the problem, but the problem are the negative effects of certain harmful forms of complex social inequalities. For our normative analysis this entails that we should focus on the conceptualization of the ideal of social equality, and the kinds of relationships and institutional arrangements compatible with it. (shrink)

This paper, which is based on an extensive analysis of the literature, gives a brief overview of the main ways in which solidarity has been employed in bioethical writings in the last two decades. As the vagueness of the term has been one of the main targets of critique, we propose a new approach to defining solidarity, identifying it primarily as a practice enacted at the interpersonal, communal, and contractual/legal levels. Our three-tier model of solidarity can also help to explain (...) the way in which crises of solidarity can occur, notably when formal solidaristic arrangements continue to exist despite ‘lower tiers’ of solidarity practices at inter-personal and communal levels having ‘broken away’. We hope that this contribution to the growing debate on the potential for the value of solidarity to help tackle issues in bioethics and beyond, will stimulate further discussion involving both conceptual and empirically informed perspectives. (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)

The article has two aims. First, to show that a version of luck egalitarianism that includes relational goods amongst its distribuenda can, as a matter of internal logic, account for one of the core beliefs of relational egalitarianism. Therefore, there will be important extensional overlap, at the level of domestic justice, between luck egalitarianism and relational egalitarianism. This is an important consideration in assessing the merits of and relationship between the two rival views. Second, to provide some support for including (...) relational goods, including those advocated by relational egalitarianism, on the distribuenda of justice and therefore to put in a good word for the overall plausibility of this conception of justice. I show why relational egalitarians, too, have reason to sympathise with this proposal. (shrink)

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)

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)