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This article discusses the relation between prioritarian and egalitarian principles, whether and why we need to appeal to both kinds of principle, how prioritarians can answer various objections, especially those put forward by Michael Otsuka and Alex Voorhoeve, the moral difference between cases in which our acts could affect only one person or two or more people, veil of ignorance contractualism and utilitarianism, what prioritarians should claim about cases in which the effects of our acts are uncertain, the relative moral (...) |
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This paper argues that the Quality Adjusted Life Year or QALY is fatally flawed as a way of priority setting in health care and of dealing with the problem of scarce resources. In addition to showing why this is so the paper sets out a view of the moral constraints that govern the allocation of health resources and suggests reasons for a new attitude to the health budget. |
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I discuss Ingmar Persson’s recent argument that the Levelling Down Objection could be worse for prioritarians than for egalitarians. Persson’s argument depends upon the claim that indifference to changes in the average prioritarian value of benefits implies indifference to changes in the overall prioritarian value of a state of affairs. As I show, however, sensible conceptions of prioritarianism have no such implication. Therefore prioritarians have nothing to fear from the Levelling Down Objection. |
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We argue that there is a marked shift in the moral weight of an increment in a person's well-being when one moves from a case involving only intra-personal trade-offs to a case involving only inter-personal trads-offs. This shift, we propose, is required by the separateness of persons. We also argue that the Priority View put forward by Parfit cannot account for such a shift. We also outline two alternative views, an egalitarian view and a claims-based view, that can account for (...) |
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We are often faced with choices that involve the weighing of people's lives against each other, or the weighing of lives against other good things. These are choices both for individuals and for societies. A person who is terminally ill may have to choose between palliative care and more aggressive treatment, which will give her a longer life but at some cost in suffering. We have to choose between the convenience to ourselves of road and air travel, and the lives (...) |
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We shall focus on moral theories that are solely concerned with promoting the benefits (e.g., wellbeing) of individuals and explore the possibility of such theories ascribing some priority to benefits to those who are worse off—without this priority being absolute. Utilitarianism (which evaluates alternatives on the basis of total or average benefits) ascribes no priority to the worse off, and leximin (which evaluates alternatives by giving lexical priority to the worst off, and then the second worst off, and so on) (...) |
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In her recent, provocative essay “What Is the Point of Equality?”, Elizabeth Anderson argues against a common ideal of egalitarian justice that she calls “ luck egalitarianism” and in favor of an approach she calls “democratic equality.”1 According to the luck egalitarian, the aim of justice as equality is to eliminate so far as is possible the impact on people’s lives of bad luck that falls on them through no fault or choice of their own. In the ideal luck egalitarian (...) |
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It is widely recognized that prioritizing health care resources by their relative cost-effectiveness can result in lower priority for the treatment of disabled persons than otherwise similar non-disabled persons. I distinguish six different ways in which this discrimination against the disabled can occur. I then spell out and evaluate the following moral objections to this discrimination, most of which capture an aspect of its unethical character: it implies that disabled persons' lives are of lesser value than those of non-disabled persons; (...) |
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Equality is a key concept in our moral and political vocabulary. There is wide agreement on its instrumental value and its favourable impact on many aspects of society, but less certainty over whether it has a non-instrumental or intrinsic value that can be demonstrated. In this project, Shlomi Segall explores and defends the view that it does. He argues that the value of equality is not reducible to a concern we might have for the worse off, or to ensuring that (...) |
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How should medical services be distributed within society? Who should pay for them? Is it right that large amounts should be spent on sophisticated technology and expensive operations, or would the resources be better employed in, for instance, less costly preventive measures? These and others are the questions addreses in this book. Norman Daniels examines some of the dilemmas thrown up by conflicting demands for medical attention, and goes on to advance a theory of justice in the distribution of health (...) |
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This book, written by four internationally renowned bioethicists and first published in 2000, was the first systematic treatment of the fundamental ethical issues underlying the application of genetic technologies to human beings. Probing the implications of the remarkable advances in genetics, the authors ask how should these affect our understanding of distributive justice, equality of opportunity, the rights and obligations as parents, the meaning of disability, and the role of the concept of human nature in ethical theory and practice. The (...) |
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Derek Parfit has argued that, in contrast to prioritarianism, egalitarianism is exposed to the levelling down objection, i.e., the objection that it is absurd that a change which consists merely in the betteroff losing some of their well-being should be in one way for the better. In reply, this paper contends that there is a plausible form of egalitarianism which is equivalent to another form of prioritarianism than the Parfitian one, a relational rather than an absolute form of prioritarianism, and (...) |
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This article seeks to defend prioritarianism against a pair of challenges from Michael Otsuka and Alex Voorhoeve. Otsuka and Voorhoeve first argue that prioritarianism makes implausible recommendations in one-person cases under conditions of risk, as it fails to allow that it is reasonable to act to maximize expected utility, rather than expected weighted benefits, in such cases. I show that, in response, prioritarians can either reject Otsuka and Voorhoeve's claim, by means of appealing to a distinction between personal and impersonal (...) |
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It is common to define egalitarianism in terms of an inequality ordering, which is supposed to have some weight in overall evaluations of outcomes. Egalitarianism, thus defined, implies that levelling down makes the outcome better in respect of reducing inequality; however, the levelling down objection claims there can be nothing good about levelling down. The priority view, on the other hand, does not have this implication. This paper challenges the common view. The standard definition of egalitarianism implicitly assumes a context. (...) |
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This paper takes its departure from the Interpersonal Addition Theorem. The theorem, by John Broome, is a re-formulation of the classical result by Harsanyi. It implies that, given some seemingly mild assumptions, the overall utility of an uncertain prospect can be seen as the sum of its individual utilities. In sections 1 and 2, I discuss the theorem’s connection with utilitarianism and in particular the extent to which this theorem still leaves room for the Priority View. According to the latter, (...) |
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