To be a liberal is, among other things, to grant basic liberties some degree of priority over other aspects of justice. But why do basic liberties warrant this special treatment? For Rawls, the answer has to do with the allegedly special connection between these freedoms and the ‘two moral powers’ of reasonableness and rationality. Basic freedoms are said to be preconditions for the development and exercise of these powers and are held to warrant priority over other justice-relevant values for that (...) reason. In the first half of the article I mount an internal critique of this Rawlsian line, arguing that it is flawed in two main ways. First, it overestimates the contribution of basic freedom to moral personality. Second, it underestimates the contribution of non-liberty resources to moral personality. In the second half of the article I repair these flaws. The result is a new, intriguingly radical version of justice as fairness, one with surprising—yet plausible—implications for economic and gender justice. (shrink)

The first principle of Rawls’s conception of justice secures a set of ‘basic liberties’ equally for all citizens within the constitutional structure of society. The ‘worth’ of citizens’ liberties, however, may vary depending upon their wealth. Against Rawls, Cohen contends that an absence of money often can directly constrain citizens’ freedom and not simply its worth. This is because money often can remove legally enforced constraints on what citizens can do. Cohen’s argument – if modified to apply to citizens’ ‘moral (...) powers’ rather than ‘negative liberty’ – threatens a core feature of Rawls’s conception of justice, as it is unclear why the parties within the ‘original position’ would endorse the lexical priority of the first principle over the ‘difference principle’ if both principles similarly shape citizens’ freedom. I concede Cohen’s point regarding the relation between freedom and money but argue that it is not fatal to Rawls’s conception of justice if the ‘basic needs principle’ is understood to enjoy lexical priority over the first principle and is modified to include a right to adequate discretionary time. Nonetheless, Cohen’s argument helpfully highlights the infelicitous nature of Rawls’s terminology with respect to liberty: the basic needs principle, the first principle and the difference principle all should be understood as shaping citizens’ freedom to exercise their moral powers. (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)