Individuals often face administrative hurdles in attempting to access health care, public programmes, and other legal statuses and entitlements. These ordeals are the products, directly or indirectly, of institutional and policy design choices. I argue that evaluating whether such ordeals are justifiable or desirable instruments of social policy depends on assessing, beyond their targeting effects, the process-related burdens they impose on those attempting to navigate them and these burdens’ distributive effects. I here examine specifically how ordeals that levy time costs (...) reduce and constrain individuals’ free time, and how such time-cost ordeals may thereby create, deepen and compound disadvantages. (shrink)

This paper is a revised version of the Royal Institute of Philosophy’s Annual Lecture, 2016. It discusses the demands of critical reasoning in ethical arguments, and focuses in particular on the assessment of justice. It disputes the belief that reasoning about choice remains unfinished until an optimal alternative has been identified. A successful closure of a reasoning may identify a maximal alternative, which is not judged to be worse than any other available option. A maximal alternative need not be optimal (...) in the sense of being ‘best’. Critically sound reasoning can lead us to a partial ordering yielding a maximal alternative that is not optimal. The compulsive search for an optimal alternative needlessly limits the reach of reasoning in ethics. (shrink)

Two options are ‘incommensurate’ when neither is better than the other, but they are not equally good. Typically, we will say that one option is better in some ways, and the other in others, but neither is better ‘all things considered’. It is tempting to think that incommensurability is vagueness—that it is (perhaps) indeterminate which is better—but this ‘vagueness view’ of incommensurability has not proven popular. I set out the vagueness view and its implications in more detail, and argue that (...) it can explain most of the puzzling features of incommensurability. This argument proceeds without appeal to John Broome’s ‘collapsing principle’. (shrink)

In virtue of what is something a reason for action? That is, what makes a consideration a reason to act? This is a metaphysical or meta-normative question about the grounding of reasons for action. The answer to the grounding question has been traditionally given in ‘pure’, univocal terms. This paper argues that there is good reason to understand the ground of practical normativity as a hybrid of traditional ‘pure’ views. The paper 1) surveys the three leading ‘pure’ answers to the (...) question of a normative ground, 2) examines one or two of the most difficult problems for each, proposing along the way a new objection to one, and 3) argues that a particular hybrid view about normative grounds –‘hybrid voluntarism’ – avoids each of the main problems faced by the three leading ‘pure’ views. (shrink)

Ruth Chang has defended a concept of "parity", implying that two items may be evaluatively comparable even though neither item is better than or equally good as the other. This article takes no stand on whether there actually are cases of parity. Its aim is only to make the hitherto somewhat obscure notion of parity more precise, by defining it in terms of the standard value relations. Given certain plausible assumptions, the suggested definiens is shown to state a necessary and (...) sufficient condition for parity, as this relation is envisaged by Chang. (shrink)

In his Tanner Lecture of 1979 called ‘Equality of What?’ Amartya Sen asked what metric egalitarians should use to establish the extent to which their ideal is realized in a given society. What aspect of a person’s condition should count in a fundamental way for egalitarians, and not merely as cause of or evidence of or proxy for what they regard as fundamental?

This paper argues for the existence of a fourth positive generic value relation that can hold between two items beyond ‘better than’, ‘worse than’, and ‘equally good’: namely ‘on a par’.

This essay begins by summarizing the reasons why unregulated health-care markets are inefficient. The inefficiencies stem from the asymmetries of information among providers, patients and payers, which give rise to moral hazard and adverse selection. Attempts to ameliorate these inefficiencies by means of risk-adjusted insurance and monetary incentives such as co-pays and deductibles lessen the inefficiencies at the cost of increasing inequalities. Another possibility is to rely on non-monetary incentives, including ordeals. While not a magic bullet, these are feasible methods (...) for addressing the inadequacies of market provision of health care, such as moral hazard. (shrink)

Suppose that A and B are two kinds of goods such that more of each is better than less. A is strongly superior to B if any amount of A is better than any amount of B. It is weakly superior to B if some amount of A is better than any amount of B. There are many examples of these relations in the literature, sometimes under the labels “higher goods” and “discontinuity.” The chapter gives a precise and generalized statement (...) of Strong and Weak Superiority and discusses different ways in which these relations can be relevant to the aggregation of welfare. It also proves a number of general results. One of the results gives rise to a dilemma: It can be used as an argument against the existence of value superiority or, alternatively, as an argument against the view that superiority entails a radical difference in value. (shrink)

This paper addresses how to think about the permissibility of introducing deadweight costs on candidate recipients of goods in order to attain better outcomes. The paper introduces some distinctions between different kinds of value dimensions that should be taken into account when such judgements are made and draws from the literature on comparisons across different value dimensions in order to canvas what sort of situations one might arguably face when evaluating ordeals. In light of the distinctions drawn and the possibilities (...) canvassed, the paper proceeds to outline what circumstances indicate which of the possible situations one is in. (shrink)

This article analyzes approaches to nondeterminacy that suggest that one can make justified choices when primary criteria fail to fully determine a best alternative by introducing a secondary criterion. It is shown that these approaches risk violating Basic Contraction Consistency. Some ways of adjusting two-step models in order to protect against this are addressed, and it is suggested that proponents of two-step models should adopt formal conditions which qualify what counts as a permissible secondary criterion that resemble supervaluationist conditions that (...) qualify what counts as admissible precisifications of vague terms. (shrink)

Ordeals are burdens placed on individuals that yield no benefits to others; hence they represent a dead-weight loss. Ordeals – the most common is waiting time – play a prominent role in rationing health care. The recipients most willing to bear them are those receiving the greatest benefit from scarce health-care resources. Health care is heavily subsidized; hence, moral hazard leads to excess use. Ordeals are intended to discourage expenditures yielding little benefit while simultaneously avoiding the undesired consequences of rationing (...) methods such as quotas or pricing. This analysis diagnoses the economic underpinnings of ordeals. Subsidies for nursing-home care versus home care illustrate. (shrink)

Abstract: The paper provides a general account of value relations. It takes its departure in a special type of value relation, parity, which according to Ruth Chang is a form of evaluative comparability that differs from the three standard forms of comparability: betterness, worseness and equal goodness. Recently, Joshua Gert has suggested that the notion of parity can be accounted for if value comparisons are interpreted as normative assessments of preference. While Gert's basic idea is attractive, the way he develops (...) it is flawed: His modeling of values by intervals of permissible preference strengths is inadequate. Instead, I provide an alternative modeling in terms of intersections of rationally permissible preference orderings. This yields a general taxonomy of all binary value relations. The paper concludes with some implications of this approach for rational choice. (shrink)

In this article, we provide a comprehensive analysis and a normative assessment of rationing through inconvenience as a form of rationing. By “rationing through inconvenience” in the health sphere, we refer to a nonfinancial burden that is either intended to cause or has the effect of causing patients or clinicians to choose an option for health-related consumption that is preferred by the health system for its fairness, efficiency, or other distributive desiderata beyond assisting the immediate patient. We argue that under (...) certain conditions, rationing through inconvenience may turn out to serve as a legitimate and, compared to direct rationing, even a preferable tool for rationing; we propose a research agenda to identify more precisely when that might be the case and when, alternatively, rationing through inconvenience remains ethically undesirable. After defining and illustrating rationing through inconvenience, we turn to its moral advantages and disadvantages over other rationing methods. We take it as a starting assumption that rationing, understood as scarce-resource prioritization, is inevitable and, in a society that has goals beyond optimizing health care for individual patients—such as improving societal health care, education, or overall welfare—prudent and fair. (shrink)

This article seeks to contribute to the discussion on the nature of choice in virtue theory. If several different actions are available to the virtuous agent, they are also likely to vary in their degree of virtue, at least in some situations. Yet, it is widely agreed that once an action is recognised as virtuous there is no higher level of virtue. In this paper we discuss how the virtue theorist could accommodate both these seemingly conflicting ideas. We discuss this (...) issue from a modern Aristotelian perspective, as opposed to a purely exegetic one. We propose a way of resolving what seems to be a major clash between two central features of virtue ethics. Our proposal is based on the notion of parity, a concept which recently has received considerable attention in the literature on axiology. Briefly put, two alternatives are on a par (or are ‘roughly equal’) if they are comparable, although it is not the case that one is better than the other, nor that they are equally good. The advantages of applying the concept of parity to our problem are twofold. Firstly, it sheds new light on the account of choice in virtue theory. Secondly, some of the criticisms that have been mounted against the possibility of parity can be countered by considering the notion of choice from a virtue theory perspective. (shrink)