Several attempts have been made to apply the choice-sensitive theory of distributive justice, luck egalitarianism, in the context of health and healthcare. This article presents a framework for this discussion by highlighting different normative decisions to be made in such an application, some of the objections to which luck egalitarians must provide answers and some of the practical implications associated with applying such an approach in the real world. It is argued that luck egalitarians should address distributions of health rather (...) than healthcare, endorse an integrationist theory that combines health concerns with general distributive concerns and be pluralist in their approach. It further suggests that choice-sensitive policies need not be the result of applying luck egalitarianism in this context. (shrink)

There are many uses in English of the word “ought” (see Ought). This essay concerns the normative uses and the concepts or properties denoted thereby. In particular, it concerns two nonfinal oughts commonly used in the philosophical literature: prima facie oughts and pro tanto oughts.

This paper examines what would be a fair distribution of the right to emit greenhouse gases. It distinguishes between views that treat the distribution of this right on its own (Isolationist Views) and those that treat it in conjunction with the distribution of other goods (Integrationist Views). The most widely held view treats adopts an Isolationist approach and holds that emission rights should be distributed equally. This paper provides a critique of this 'equal per capita' view, and the isolationist assumptions (...) on which it depends. It examines four arguments for this view, finding each wanting. It then presents two general challenges to the 'equal per capita' view, and, indeed, any views which treat the distribution of greenhouse gas emissions in isolation from other goods. It concludes by outlining and defending an alternative (Integrationist) approach to the distribution of rights to emit greenhouse gases. (shrink)

The idea of distributive justice presupposes a bounded world within which distributions takes place: a group of people committed to dividing, exchanging, and sharing social goods, first of all among themselves. That world, as I have already argued, is the political community, whose members distribute power to one another and avoid, if they possibly can, sharing it with anyone else. When we think about distributive justice, we think about independent cities or countries capable of arranging their own patterns of division (...) and exchange, justly or unjustly. We assume an established group and a fixed population, and so we miss the first and most important distributive question: How is that group constituted? (shrink)

The paper distinguishes between two rival views about the nature of final value (i.e. the value something has for its own sake) — intrinsicalism and conditionalism. The former view (which is the one adopted by G.E. Moore and several later writers) holds that the final value of any F supervenes solely on features intrinsic to F, while the latter view allows that the final value of F may supervene on features non-intrinsic to F. Conditionalism thus allows the final value of (...) F to vary according to the context in which F appears. Given the plausible assumption that there is an intimate tie between final values and appropriate attitudinal responses, it appears that conditionalism is the better approach for mainly the following three reasons: First, intrinsicalism is too indiscriminate, which makes it subject to what I call ‘location problems’ of final value. I illustrate this problem by discussing alleged examples of Moorean organic unities. Second, intrinsicalism evokes symptoms of ‘evaluative schizophrenia’. Third, considerations of theoretical economy tell in favour of conditionalism. Thereafter I respond to some recent challenges to conditionalism. An appendix surveys some meritorious implications that conditionalism offers for various substantial versions of such structurally different views about value as monism, pluralism, and particularism. (shrink)

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One widely accepted way of justifying universal access to health care is to argue that access to health care is necessary to ensure health, which is necessary to provide equality of opportunity. But the evidence on the social determinants of health undermines this argument.

In recent work, Norman Daniels extends the application of Rawls's principle of ‘fair equality of opportunity’ from health care to health proper. Crucial to that account is the view that health care, and now also health, is special. Daniels also claims that a rival theory of distributive justice, namely luck egalitarianism (or ‘equal opportunity for welfare’), cannot provide an adequate account of justice in health and health care. He argues that the application of that theory to health policy would result (...) in an account that is, in a sense, too narrow, for it denies treatment to imprudent patients (e.g. lung cancer patients who smoked). In a different sense, Daniels argues, luck egalitarian health policy would be too wide: it arguably tells us to treat individuals for such brute-luck conditions as shyness, stupidity, ugliness, and having the ‘wrong’ skin colour. I seek to advance three claims in response to Daniels's revised theory, and in defence of a luck egalitarian view of health policy. First, I question Daniels's assertion regarding the specialness of health. While he is right to abandon his insistence on the specialness of health care, it is doubtful that health proper can be depicted as special. Second, I try and meet Daniels's objections to luck egalitarianism. Luck egalitarian health policy escapes being too narrow for it does not in fact require denying basic care to imprudent patients. As for it being allegedly too wide, I try to show that it is not, after all, counterintuitive to rid individuals of unfortunate and disadvantageous biological traits (say, a disadvantageous skin colour). And third, I question whether Daniels's own Rawlsian account is in fact wide enough. I argue that fair equality of opportunity fails to justify some standard medical procedures that many health systems do already practice. (shrink)