The author discusses Rawls’s conception of socioeconomic justice, Democratic Equality. He contrasts Rawls’s account, which includes the difference principle constrained by the principle of fair equality of opportunity, with Natural Aristocracy, which constrains the difference principle only by the principle of careers open to talents. According to the author, many of Rawls’s own arguments support NaturalAristocracy over Democratic Equality. In particular, Natural Aristocracy appears well placed to avoid a challenge that naturally arises in consideration of Democratic Equality, with respect to (...) which formal distributive principle should deal with social and natural causes of inequality. The challenge is to cite a morally relevant distinction which supports the appropriateness of dealing with natural causes of inequality differently to those generated by social causes. In support of his proposal, the author also appeals to certain arguments in Rawls’s Political Liberalism. (shrink)

This article is about the justifiability of accepting worse cost effectiveness for orphan drugs, that is, treatments for rare diseases, in a publicly financed health care system. Recently, three arguments have been presented that may be used in favour of exceptionally advantageous economic terms for orphan drugs. These arguments share the common feature of all referring to considerations of justice or fairness: the argument of the irrelevance of group size, the argument from the principle of need, and the argument of (...) identifiability. It is argued that all of these arguments fail to support the conclusion that orphan drugs should be subsidized to a larger extent than treatments for common diseases. The argument of the irrelevance fails to distinguish between directly and indirectly relevant considerations of fairness or justice. The recent attempt to revive the moral relevance of identifiability has provided no novel reasons to think that identifiability is morally relevant in itself or due to considerations of fairness and justice. The argument from the principle of need does not fail due to any inherent flaw in the principle as such. Rather, this principle can be interpreted in different ways, and none of these interpretations support exceptionally advantageous terms economically for treating rare diseases specifically. It is concluded that we are awaiting justice based reasons for the preferential treatment of orphan drugs. (shrink)