The available resources for global health assistance are far outstripped by need. In the face of such scarcity, many people endorse a principle according to which highest priority should be given to the worst off. However, in order for this prioritarian principle to be useful for allocation decisions, policy-makers need to know what it means to be badly off. In this article, we outline a conception of disadvantage suitable for identifying the worst off for the purpose of making health resource (...) allocation decisions. According to our total advantage view: the worst off are those who have the greatest total lifetime disadvantage; advantage foregone due to premature death should be treated in the same way as other ways of being disadvantaged at a time; how badly off someone is depends on the actual outcomes that will befall her without intervention, not her prospects at a time; and all significant forms of disadvantage count for determining who is worst off, not just disadvantage relating to health. We conclude by noting two important implications of the total advantage view: first, that those who die young are among the globally worst off, and second, that the epidemiological shift in the global burden of disease from communicable to non-communicable diseases should not lead to a corresponding shift in global health spending priorities. (shrink)

I here settle a recent dispute between two rival theories in distributive ethics: Restricted Prioritarianism and the Competing Claims View. Both views mandate that the distribution of benefits and burdens between individuals should be justifiable to each affected party in a way that depends on the strength of each individual’s separately assessed claim to receive a benefit. However, they disagree about what elements constitute the strength of those individuals’ claims. According to restricted prioritarianism, the strength of a claim (...) is determined in ‘prioritarian’ fashion by both what she stands to gain and her absolute level of well-being, while, according to the competing claims view, the strength of a claim is also partly determined by her level of well-being relative to others with conflicting interests. I argue that, suitably modified, the competing claims view is more plausible than restricted prioritarianism. (shrink)

I argue that prioritarianism cannot be assessed in abstraction from an account of the measure of utility. Rather, the soundness of this view crucially depends on what counts as a greater, lesser, or equal increase in a person’s utility. In particular, prioritarianism cannot accommodate a normatively compelling measure of utility that is captured by the axioms of John von Neumann and Oskar Morgenstern’s expected utility theory. Nor can it accommodate a plausible and elegant generalization of this theory that (...) has been offered in response to challenges to von Neumann and Morgenstern. This is, I think, a theoretically interesting and unexpected source of difficulty for prioritarianism, which I explore in this article. (shrink)

Prioritarianism is a variant of utilitarianism. It differs from utilitarianism in that benefiting individuals matters more the worse off these individuals are. On this view, there are two standard ways of handling risky prospects: Ex-Post Prioritarianism adjusts for prioritizing the worse off in final outcomes and then values prospects by the expectation of the sum total of those adjusted values, whereas Ex-Ante Prioritarianism adjusts for prioritizing the worse off on each individual's expectation and then values prospects by (...) the sum total of those adjusted expectations. A standard objection to Ex-Post Prioritarianism is that it violates Ex-Ante Pareto, that is, it prescribes choices that worsen the expectations for everyone. In this article, I argue that Ex-Ante Prioritarianism suffers from much the same problem: it violates a sequential version of Ex-Ante Pareto, that is, it prescribes sequences of choices that worsen the expectations for everyone. (shrink)

In this paper we argue that the use of survey data or intuitions about single person cases as a dialectically neutral data point for favouring telic egalitarianism over prioritarianism has dim prospects for success. We take as a case study Otsuka and Voorhoeve (2009)'s now well known paper and show that it either is either argumentatively irrelevant or question-begging, depending on whether the survey data about people's judgements concerning single-person cases is interpreted as being prudential or moral in character. (...) We suggest that this problem is likely to generalise to other ways of trying to use intuitions or survey data about single-person cases, where those data or intuitions are not just treated as further direct moral intuitions about prioritarianism and telic egalitarianism. (shrink)

The article develops an internalist justification of welfare ethics based on empathy. It takes up Hume’s and Schopenhauer’s internalistic (but not consistently developed) justification approach via empathy, but tries to solve three of their problems: 1. the varying strength of empathy depending on the proximity to the object of empathy, 2. the unclear metaethical foundation, 3. the absence of a quantitative model of empathy strength. 1. As a solution to the first problem, the article proposes to limit the foundation of (...) welfare ethics to certain types of empathy. 2. In response to the second problem, an internalistic metaethical conception of the justification of moral principles is outlined, the result of which is: The moral value of the well-being of persons is identical to the expected extent of (positive and negative) empathy arising from this well-being. 3. The contribution to the solution of the third problem and focus of the article is an empirical model of the (subject’s) expected extent of empathy depending on (an object’s) well-being. According to this model, the extent of empathy is not proportional to the expected empathy, but follows a concave function and is therefore prioritarian. Accordingly, the article provides a sketch of an internalist justification of prioritarianism. (shrink)

In this paper, first the term 'prioritarianism' is defined, with some mathematical precision, on the basis of intuitive conceptions of prioritarianism, especially the idea that "benefiting people matters more the worse off these people are". (The prioritarian weighting function is monotonously ascending and concave, while its first derivation is smoothly descending and convex but positive throughout.) Furthermore, (moderate welfare) egalitarianism is characterized. In particular a new symmetry condition is defended, i.e. that egalitarianism evaluates upper and lower deviations from (...) the social middle symmetrically and equally negatively (as do e.g. variance and Gini). Finally, it is shown that this feature distinguishes egalitarianism also extensionally from prioritarianism. (shrink)

Does individual desert matter for distributive justice? Is it relevant, for purposes of justice, that the pattern of distribution of justice’s “currency” (be it well-being, resources, preference-satisfaction, capabilities, or something else) is aligned in one or another way with the pattern of individual desert? -/- This paper examines the nexus between desert and distributive justice through the lens of individual claims. The concept of claims (specifically “claims across outcomes”) is a fruitful way to flesh out the content of distributive justice (...) so as to be grounded in the separateness of persons. A claim is a relation between a person and a pair of outcomes. If someone is better off in one outcome than a second, she has a claim in favor of the first. If she is equally well off in the two outcomes, she has a null claim between the two. In turn, whether one outcome is more just than a second depends upon the pattern of claims between them. -/- In prior work, I have elaborated the concept of claims across outcomes, and have used it to provide a unified defense of the Pareto and Pigou-Dalton axioms. Adding some further, plausible, axioms, we arrive at prioritarianism. -/- Here, I consider the possibility of desert-modulated claims—whereby the strength of an individual’s claim between two outcomes is determined not only by her well-being levels in the two outcomes, and her well-being difference between them, but also by her desert. This generalization of the notion of claims suggests a new axiom of justice: Priority for the More Deserving, requiring that, as between two individuals at the same well-being level, a given increment in well-being be allocated to the more deserving one. -/- If individual desert is intrapersonally fixed, this new axiom, together with a desert-modulated version of the Pigou-Dalton principle, and the Pareto axioms, yields a desert-modulated prioritarian account of distributive justice. Trouble arises, however, if an individual’s desert level can be different in different outcomes. In this case of intrapersonally variable desert, Priority for the More Deserving can conflict with the Pareto axioms (both Pareto indifference and strong Pareto). -/- This conflict, I believe, is sufficient reason to abandon the proposal to make claim strength a function of individual desert on top of well-being levels and differences. If distributive justice is truly sensitive to each individual’s separate perspective—if the justice ranking of outcomes is built up from the totality of individual rankings—we should embrace the Pareto axioms as axioms of justice and reject Priority for the More Deserving. In short: desert-modulated prioritarianism is a nonstarter. Rawls was right to sever distributive justice from desert. (shrink)

Many welfarists wish to assign to each possible state of the world a numerical value that measures something like its moral goodness. How are we to determine this quantity? This paper proposes a contractualist approach: a legitimate measure of moral goodness is one that could be justified to each member of the population in question. How do we justify a measure of moral goodness to each individual? Each individual recognises the measure of moral goodness must be a compromise between the (...) different levels of well-being within the population. Some compromises are more reasonable than others; and some are better justifiable to a given member of the population than others. Each member recognises that the social chooser's measure of moral goodness is going to have to deviate from the well-being function of at least some of the members of the population. But we can nonetheless justify it to each of them if it doesn't deviate more than is necessary, and if the deviations from each member are given equal weighting in whatever process we use to determine it. This paper proposes that we begin with a measure of the distance from a proposed compromise to an individual's level of well-being, and then say that the moral goodness is the candidate compromise that minimizes the sum of distances from it to the individuals' levels of well-being. I describe a range of such measures of distance and show that some give utilitarianism, others different versions of prioritarianism. (shrink)

How should we choose between uncertain prospects in which different possible people might exist at different levels of wellbeing? Alex Voorhoeve and Marc Fleurbaey offer an egalitarian answer to this question. I give some reasons to reject their answer and then sketch an alternative, which I call person-affecting prioritarianism.

According to the priority view, or prioritarianism, it matters more to benefit people the worse off they are. But how exactly should the priority view be defined? This article argues for a highly general characterization which essentially involves risk, but makes no use of evaluative measurements or the expected utility axioms. A representation theorem is provided, and when further assumptions are added, common accounts of the priority view are recovered. A defense of the key idea behind the priority view, (...) the priority principle, is provided. But it is argued that the priority view fails on both ethical and conceptual grounds. (shrink)

It has been argued that Prioritarianism violates Risky Non-Antiegalitarianism, a condition stating roughly that an alternative is socially better than another if it both makes everyone better off in expectation and leads to more equality. I show that Risky Non-Antiegalitarianism is in fact compatible with Prioritarianism as ordinarily defined, but that it violates some other conditions that may be attractive to prioritarians. While I argue that the latter conditions are not core principles of Prioritarianism, the choice between (...) these conditions and Risky Non-Antiegalitarianism nonetheless constitutes an important intramural debate for prioritarians. (shrink)

We discuss two leading theories of distributive justice: egalitarianism and prioritarianism. We argue that while each has particular merits and shortcomings, egalitarian views more fully satisfy a key requirement of distributive justice: respect for both the unity of the individual and the separateness of persons.

One widely used method for allocating health care resources involves the use of cost-effectiveness analysis (CEA) to rank treatments in terms of quality-adjusted life-years (QALYs) gained. CEA has been criticized for discriminating against people with disabilities by valuing their lives less than those of non-disabled people. Avoiding discrimination seems to lead to the ’QALY trap’: we cannot value saving lives equally and still value raising quality of life. This paper reviews existing responses to the QALY trap and argues that all (...) are problematic. Instead, we argue that adopting a moderate form of prioritarianism avoids the QALY trap and disability discrimination. (shrink)

This is a paper about the methodology of normative ethics. I claim that much work in normative ethics can be interpreted as modelling, the form of inquiry familiar from science, involving idealised representations. I begin with the anti-theory debate in ethics, and note that the debate utilises the vocabulary of scientific theories without recognising the role models play in science. I characterise modelling, and show that work with these characteristics is common in ethics. This establishes the plausibility of my interpretation. (...) Taking methodological inspiration from modelling in science gives us new tools for managing idealisations, and a new perspective on pluralism. I demonstrate why this interpretation is a fruitful way of interpreting ethics, by looking at three case studies. First, I return to the anti-theory debate and argue that modelling opens up a new middle ground. Second, I argue that a modelling lens offers a new way of understanding impossibility theorems in population ethics, and their bearing on ethics as a whole. Finally, I show how viewing our work as modelling can be deployed in debates within ethics, using the debate over prioritarianism as an example. I close with further methodological suggestions for those who choose to see themselves as modellers. I discuss the role of counterexamples, our responses to moral disagreement, and the training of new ethicists. (shrink)

The Pigou-Dalton (PD) principle recommends a non-leaky, non-rank-switching transfer of goods from someone with more goods to someone with less. This Article defends the PD principle as an aspect of distributive justice—enabling the comparison of two distributions, neither completely equal, as more or less just. It shows how the PD principle flows from a particular view, adumbrated by Thomas Nagel, about the grounding of distributive justice in individuals’ “claims.” And it criticizes two competing frameworks for thinking about justice that less (...) clearly support the principle: the veil-of-ignorance framework, and Larry Temkin’s proposal that fairer distributions are those concerning which individuals have fewer “complaints.” -/- The Article also clarifies the relation between the PD principle and prioritarianism. Prioritarians will surely endorse the PD principle (with the “good” individual well-being), but they are also committed to a distinct axiom of separability: the moral value of someone’s well-being change does not depend upon her position relative to others. The PD principle neither implies separability, nor is implied by it. Although prioritarianism is very plausible, the case for the PD principle is yet more compelling than for the combination of that principle with separability. In discussing prioritarianism, we should differentiate between these two, logically independent aspects of the view. -/- . (shrink)

In this article, I firstly discuss why a prioritarian clause can rescue the utilitarian doctrine from the risk of exacerbating inequality in the distribution of resources in those cases in which utility of income does not decline at the margin. Nonetheless, when in the presence of adaptive preferences, classic prioritarianism is more likely than utilitarianism to increase the inequality of resources under all circumstances, independently of the diminishing trend of utility. Hence, I propose to shift the informational focus of (...) prioritarianism from welfare to either social income or capabilities in order to safeguard those who are worse off. Following this, I argue that we may have reasons to limit the aggregative logic of priority-amended utilitarianism through one or more sufficiency thresholds, and that we can partially defuse the negative-thesis objection that is usually levelled against sufficientarianism, provided we interpret the threshold(s) as valid only as long as everyone is led above it. (shrink)

The ex ante Pareto principle has an intuitive pull, and it has been a principle of central importance since Harsanyi’s defence of utilitarianism. The principle has been used to criticize and refine a range of positions in welfare economics, including egalitarianism and prioritarianism. But this principle faces a serious problem. I have argued elsewhere :303-323 2017) that the concept of ex ante Pareto superiority is not well defined, because its application in a choice situation concerning a fixed population can (...) depend on how the members of that population are designated. I show in this paper that in almost all cases of policy choice, there will be numerous sets of rival designators for the same fixed population. I explore two ways that we might complete the definition of ex ante Pareto superiority. I call these the ‘supervaluationist’ reading and the ‘subvaluationist’ reading. I reject the subvaluationist reading as uncharitable, and argue that the supervaluationist reading is the most promising interpretation of the ex ante Pareto principle. I end by exploring some of the implications of this principle for prioritarianism and egalitarianism. (shrink)

Well-being measurements are frequently used to support conclusions about a range of philosophically important issues. This is a problem, because we know too little about the intervals of the relevant scales. I argue that it is plausible that well-being measurements are non-linear, and that common beliefs that they are linear are not truth-tracking, so we are not justified in believing that well-being scales are linear. I then argue that this undermines common appeals to both hypothetical and actual well-being measurements; I (...) first focus on the philosophical literature on prioritarianism and then discuss Kahneman’s Peak-End Rule as a systematic bias. Finally, I discuss general implications for research on well-being, and suggest a better way of representing scales. (shrink)

In this extended book review, I summarize Adler's views and critically analyze his key arguments on the measurement of well-being and the foundations of prioritarianism.

Emissions grandfathering holds that a history of emissions strengthens an agent’s claim for future emission entitlements. Though grandfathering appears to have been influential in actual emission control frameworks, it is rarely taken seriously by philosophers. This article presents an argument for thinking this an oversight. The core of the argument is that members of countries with higher historical emissions are typically burdened with higher costs when transitioning to a given lower level of emissions. According to several appealing views in political (...) philosophy (utilitarianism, egalitarianism, prioritarianism, and sufficientarianism) they are therefore entitled to greater resources, including emission entitlements, than those in similar positions but with lower emissions. This grandfathering may play an especially important role in allocating emission entitlements among rich countries. (shrink)

This article is devoted to analysing the ethical commitments underlying research methodology on “brain drain” and leading participants in the public debate to deny the human right of emigration for skilled persons. Here, we identify five such commitments : to consequentialism, prioritarianism and nationalism, we add sedentarism and elitism. Based on this analysis, we argue that even though the emigration of the most talented would be a loss for the country of origin, this loss is not sufficient to require (...) that migrants themselves compensate it – either by tax payments (e.g. Bhagwati’s tax proposal) or by not exercising their right to emigrate. Moreover, to interpret public investment in education as the source of migrants’ further obligations to their country is to view education rather as a source of dividends than an access to opportunity that present generations owe to futures ones. (shrink)

Desire', 'preference', 'utility', '(utility-aggregating) moral desirability' are terms that build on each other in this order. The article follows this definitional structure and presents these terms and their justifications. The aim is to present welfare-ethical criteria of the common good that define 'moral desirability' as an aggregation, e.g. addition, of individual utility: utilitarianism, utility egalitarianism, leximin, prioritarianism.

The Distribution View provides a model that integrates four distributional concerns in the evaluation of risky prospects. Starting from these concerns, we can generate an ordering over a set of risky prospects, or, starting from an ordering, we can extract a characterization of the underlying distributional concerns. Separability of States and/or Persons for multiple-person risky prospects, for single-person risky prospects and for multiple-person certain prospects are discussed within the model. The Distribution View sheds light on public health policies and provides (...) a framework for the discussion of Parfit's Priority View for risky prospects. (shrink)

Matthew Adler's Measuring Social Welfare is an introduction to the social welfare function (SWF) methodology. This essay questions some ideas at the core of the SWF methodology having to do with the relation between the SWF and the measure of well-being. The facts about individual well-being do not single out a particular scale on which well-being must be measured. As with physical quantities, there are multiple scales that can be used to represent the same information about well-being; no one scale (...) is special. Like physical laws, the SWF and its ranking of distributions cannot depend on exactly which of these scales we use. Adler and other theorists in the SWF tradition have used this idea to derive highly restrictive constraints on the shape of the SWF. These constraints rule out seemingly plausible views about distributive justice and population ethics. I argue, however, that these constraints stem from a simple but instructive mistake. The SWF should not be applied to vectors of numbers such as 1 and 2, but rather to vectors of dimensioned quantities such as 1 util and 2 utils. This seemingly pedantic suggestion turns out to have far-reaching consequences. Unlike the orthodox SWF approach, treating welfare levels as dimensioned quantities lets us distinguish between real changes in well-being and mere changes in the unit of measurement. It does this without making the SWF depend on the scale on which welfare is measured, and in a way that avoids the restrictive constraints on the shape of the SWF. (shrink)

This paper develops and explores a new framework for theorizing about the measurement and aggregation of well-being. It is a qualitative variation on the framework of social welfare functionals developed by Amartya Sen. In Sen’s framework, a social or overall betterness ordering is assigned to each profile of real-valued utility functions. In the qualitative framework developed here, numerical utilities are replaced by the properties they are supposed to represent. This makes it possible to characterize the measurability and interpersonal comparability of (...) well-being directly, without the use of invariance conditions, and to distinguish between real changes in well-being and merely representational changes in the unit of measurement. The qualitative framework is shown to have important implications for a range of issues in axiology and social choice theory, including the characterization of welfarism, axiomatic derivations of utilitarianism, the meaningfulness of prioritarianism, the informational requirements of variable-population ethics, the impossibility theorems of Arrow and others, and the metaphysics of value. (shrink)

The veil of ignorance argument was used by John C. Harsanyi to defend Utilitarianism and by John Rawls to defend the absolute priority of the worst off. In a recent paper, Lara Buchak revives the veil of ignorance argument, and uses it to defend an intermediate position between Harsanyi's and Rawls' that she calls Relative Prioritarianism. None of these authors explore the implications of allowing that agent's behind the veil are averse to ambiguity. Allowing for aversion to ambiguity---which is (...) both the most commonly observed and a seemingly reasonable attitude to ambiguity---however supports a version of Egalitarianism, whose logical form is quite different from the theories defended by the aforementioned authors. Moreover, it turns out that the veil of ignorance argument neither supports standard Utilitarianism nor Prioritarianism unless we assume that rational people are insensitive to ambiguity. (shrink)

Utilitarianism, it has been said, is not sensitive to the distribution of welfare. In making risky decisions for others there are multiple sensitivities at work. I present examples of risky decision-making involving drug allocations, charitable giving, breast-cancer screening and C-sections. In each of these examples there is a different sensitivity at work that pulls away from the utilitarian prescription. Instances of saving fewer people at a greater risk to many is more complex because there are two distributional sensitivities at work (...) that pull in opposite directions from the utilitarian calculus. I discuss objections to these sensitivities and conclude with some reflections on the value of formal modelling in thinking about societal risk. (shrink)

A possible person’s conditional expected well-being is what the quality of their prospects would be if they were to come into existence. This paper examines the role that this form of expected well-being should play in distributing benefits among prospective people and in deciding who to bring into existence. It argues for a novel egalitarian view on which it is important to ensure equality in people’s life prospects, not merely between actual individuals, but also between all individuals who, given our (...) choices, have a chance of coming into existence. The paper argues that such egalitarianism for prospective people springs from equal concern for each person and has plausible implications. It further shows that it has a rationale in respect for both the unity of the individual and the separateness of persons. Finally, it defends this view against a key objection and shows it is superior to a rival view. (shrink)

A natural view in distributive ethics is that everyone's interests matter, but the interests of the relatively worse off matter more than the interests of the relatively better off. I provide a new argument for this view. The argument takes as its starting point the proposal, due to Harsanyi and Rawls, that facts about distributive ethics are discerned from individual preferences in the "original position." I draw on recent work in decision theory, along with an intuitive principle about risk-taking, to (...) derive the view. (shrink)

Carl Knight argues that lexical sufficientarianism, which holds that sufficientarian concerns should have lexical priority over other distributive goals, is ‘excessive’ in many distinct ways and that sufficientarians should either defend weighted sufficientarianism or become prioritarians. In this article, I distinguish three types of weighted sufficientarianism and propose a weighted sufficientarian view that meets the excessiveness objection and is preferable to both Knight’s proposal and prioritarianism. More specifically, I defend a multi-threshold view which gives weighted priority to benefits directly (...) above and below its thresholds, but gives benefits below the lowest threshold lexical priority over benefits above the highest threshold. (shrink)

This paper introduces a symposium on Equality versus Priority. It explains how cases involving risk are key to distinguishing these views and discusses a 'social egalitarian' critique of both 'telic egalitarians' and 'telic prioritarians'.

I defend a weak version of the Pigou-Dalton principle for chances. The principle says that it is better to increase the survival chance of a person who is more likely to die rather than a person who is less likely to die, assuming that the two people do not differ in any other morally relevant respect. The principle justifies plausible moral judgements that standard ex post views, such as prioritarianism and rank-dependent egalitarianism, cannot accommodate. However, the principle can be (...) justified by the same reasoning that has recently been used to defend the core axiom of ex post prioritarianism and egalitarianism, namely, Pigou-Dalton for well-being. The arguably biggest challenge for proponents of Pigou-Dalton for chances is that it violates State Dominance for social prospects. However, I argue that we have independent reason for rejecting State Dominance for social prospects, since it prevents a social planner from properly respecting people's preferences. (shrink)

Is the overall value of a world just the sum of values contributed by each value-bearing entity in that world? Additively separable axiologies (like total utilitarianism, prioritarianism, and critical level views) say 'yes', but non-additive axiologies (like average utilitarianism, rank-discounted utilitarianism, and variable value views) say 'no'. This distinction is practically important: additive axiologies support 'arguments from astronomical scale' which suggest (among other things) that it is overwhelmingly important for humanity to avoid premature extinction and ensure the existence of (...) a large future population, while non-additive axiologies need not. We show, however, that when there is a large enough 'background population' unaffected by our choices, a wide range of non-additive axiologies converge in their implications with some additive axiology -- for instance, average utilitarianism converges to critical-level utilitarianism and various egalitarian theories converge to prioritiarianism. We further argue that real-world background populations may be large enough to make these limit results practically significant. This means that arguments from astronomical scale, and other arguments in practical ethics that seem to presuppose additive separability, may be truth-preserving in practice whether or not we accept additive separability as a basic axiological principle. (shrink)

The most common argument against negative utilitarianism is the world destruction argument, according to which negative utilitarianism implies that if someone could kill everyone or destroy the world, it would be her duty to do so. Those making the argument often endorse some other form of consequentialism, usually traditional utilitarianism. It has been assumed that negative utilitarianism is less plausible than such other theories partly because of the world destruction argument. So, it is thought, someone who finds theories in the (...) spirit of utilitarianism attractive should not go for negative utilitarianism, but should instead pick traditional utilitarianism or some other similar theory such as prioritarianism. I argue that this is a mistake. The world destruction argument is not a reason to reject negative utilitarianism in favour of these other forms of consequentialism, because there are similar arguments against such theories that are at least as persuasive as the world destruction argument is against negative utilitarianism. (shrink)

In this article, we propose the Fair Priority Model for COVID-19 vaccine distribution, and emphasize three fundamental values we believe should be considered when distributing a COVID-19 vaccine among countries: Benefiting people and limiting harm, prioritizing the disadvantaged, and equal moral concern for all individuals. The Priority Model addresses these values by focusing on mitigating three types of harms caused by COVID-19: death and permanent organ damage, indirect health consequences, such as health care system strain and stress, as well as (...) economic destruction. It proposes proceeding in three phases: the first addresses premature death, the second long-term health issues and economic harms, and the third aims to contain viral transmission fully and restore pre-pandemic activity. -/- To those who may deem an ethical framework irrelevant because of the belief that many countries will pursue "vaccine nationalism," we argue such a framework still has broad relevance. Reasonable national partiality would permit countries to focus on vaccine distribution within their borders up until the rate of transmission is below 1, at which point there would not be sufficient vaccine-preventable harm to justify retaining a vaccine. When a government reaches the limit of national partiality, it should release vaccines for other countries. -/- We also argue against two other recent proposals. Distributing a vaccine proportional to a country's population mistakenly assumes that equality requires treating differently situated countries identically. Prioritizing countries according to the number of front-line health care workers, the proportion of the population over 65, and the number of people with comorbidities within each country may exacerbate disadvantage and end up giving the vaccine in large part to wealthy nations. (shrink)

This paper presents a new kind of problem in the ethics of distribution. The problem takes the form of several “calibration dilemmas,” in which intuitively reasonable aversion to small-stakes inequalities requires leading theories of distribution to recommend intuitively unreasonable aversion to large-stakes inequalities. We first lay out a series of such dilemmas for prioritarian theories. We then consider a widely endorsed family of egalitarian views and show that they are subject to even more forceful calibration dilemmas than prioritarian theories. Finally, (...) we show that our results challenge common utilitarian accounts of the badness of inequalities in resources. (shrink)

Lara Buchak argues for a version of rank-weighted utilitarianism that assigns greater weight to the interests of the worse off. She argues that our distributive principles should be derived from the preferences of rational individuals behind a veil of ignorance, who ought to be risk averse. I argue that Buchak’s appeal to the veil of ignorance leads to a particular way of extending rank-weighted utilitarianism to the evaluation of uncertain prospects. This method recommends choices that violate the unanimous preferences of (...) rational individuals and choices that guarantee worse distributions. These results, I suggest, undermine Buchak’s argument for rank-weighted utilitarianism. (shrink)

This articles proposes that theories and principles of distributive justice be considered substantively egalitarian iff they satisfy each of three conditions: (1) they consider the bare fact that a person is in certain circumstances to be a conclusive reason for placing another relevantly identically entitled person in the same circumstances, except where this conflicts with other similarly conclusive reasons arising from the circumstances of other persons; (2) they can be stated as 'equality of x for all persons', making no explicit (...) or implicit exclusion of persons or individuals and showing no greater concern and respect for some rather than others; and (3) they pursue equality in a dimension that is valuable to egalitarians. On this construal, prioritarianism and Dworkinian equality of resources, a view often identified as luck egalitarian, are not substantively egalitarian, but equality of opportunity, the standard form of luck egalitarianism, may be. (shrink)

The standard version of sufficientarianism maintains that providing people with enough, or as close to enough as is possible, is lexically prior to other distributive goals. This article argues that this is excessive – more than distributive justice allows – in four distinct ways. These concern the magnitude of advantage, the number of beneficiaries, responsibility and desert, and above-threshold distribution. Sufficientarians can respond by accepting that providing enough unconditionally is more than distributive justice allows, instead balancing sufficiency against other considerations.

Allocation of very scarce medical interventions such as organs and vaccines is a persistent ethical challenge. We evaluate eight simple allocation principles that can be classified into four categories: treating people equally, favouring the worst-off, maximising total benefits, and promoting and rewarding social usefulness. No single principle is sufficient to incorporate all morally relevant considerations and therefore individual principles must be combined into multiprinciple allocation systems. We evaluate three systems: the United Network for Organ Sharing points systems, quality-adjusted life-years, and (...) disability-adjusted life-years. We recommend an alternative system—the complete lives system—which prioritises younger people who have not yet lived a complete life, and also incorporates prognosis, save the most lives, lottery, and instrumental value principles. (shrink)

Public funders of health research have been widely criticized on the grounds that their allocations of funding for disease-specific research do not reflect the relative burdens imposed by different diseases. For example, the US National Institutes of Health spends a much greater fraction of its budget on HIV/aids research and a much smaller fraction on migraine research than their relative contribution to the US burden of disease would suggest. Implicit in this criticism is a normative claim: Insofar as the scientific (...) opportunities are equal, each patient merits research into their condition proportional to the burden of disease for which that condition is responsible. This claim—the proportional view—is widely accepted but has never been fully specified or defended. In this paper, I explain what is required to specify the view, attempt to do so in the most charitable way, and then critically evaluate its normative underpinnings. I conclude that a severity-weighted proportional view is defensible. I close by drawing out five key lessons of my analysis for health research priority-setting. (shrink)

The issue of justice after catastrophe is an enormous challenge to contemporary theories of distributive justice. In the past three decades, the controversy over distributive justice has centered on the ideal of equality. One of intensely debated issues concerns what is often called the “equality of what,” on which there are three primary views: welfarism, resourcism, and the capabilities approach. Another major point of dispute can be termed the “equality or another,” about which three positions debate: egalitarianism, prioritarianism, and (...) sufficientarianism. On these topics of distributive justice, authors are concerned with the current difference between the better-off and the worse-off or the present situation of the badly-off. By contrast, it is essential to take account of the past distribution of well-being as well as the present situation in order to explore questions of post-catastrophe justice. Without looking at the pre-disaster distribution of income, preference satisfaction, or basic capabilities among affected people, no present assessment of the damage caused by the disaster could be correct and no proposed remedy adequate. It is true that luck egalitarians assess the current distribution among people by referring to the decision that each individual made. Yet they pay scant attention to the situation in which each one stayed in the past. Therefore, we can legitimately say that most theorists of distributive justice, including luck egalitarians, have failed to give consideration to the past state of each person. -/- To fill this gap in the literature, the present article explores philosophical questions that arise when we take account of each person’s past and present situations in discussing distributive justice regarding public compensation and assistance to survivors and families of victims of natural and industrial disasters. In addressing these novel questions, I develop and refine various concepts, ideas, and arguments that have been presented in the study of distributive justice in normal settings. I tackle two tasks, the first of which is to explore the foundation and scope of luck egalitarianism. Despite the moral appeal it has in many cases, luck egalitarianism has attracted the so-called harshness objection. Some luck egalitarians attempt to avoid this objection in a pragmatic way by combining the luck egalitarian doctrine with the principle of basic needs satisfaction. However, they do not provide any systematic rationale for this combination. In contrast with such pragmatic responses, I seek to offer a principled argument for holding individuals responsible for their choices only when their basic needs are met, by invoking the ideas of respect for human voluntariness and rescue of human vulnerability. Based on this argument, I propose a form of responsibility-sensitive theory, which considers the pre-disaster distribution of well-being as a default position. The second task I take on is to refine sufficientarianism in the context of post-catastrophe justice. Luck egalitarianism with boundaries set by the basic needs principle seems to indicate the potential for sufficientarianism. But major proponents of this view conceive the welfarist assumption, a considerably high standard of well-being, and the controversial treatment of persons staying below the threshold, all of which seem problematic in the post-disaster situation. I try to construct a new version of sufficientarianism by replacing these current features with more robust ones. (shrink)

Discrimination, understood as differential treatment of individuals on the basis of their respective group memberships, is widely considered to be morally wrong. This moral judgment is backed in many jurisdictions with the passage of equality of opportunity legislation, which aims to ensure that racial, ethnic, religious, sexual, sexual-orientation, disability and other groups are not subjected to discrimination. This chapter explores the conceptual underpinnings of discrimination and equality of opportunity using the tools of analytical moral and political philosophy.

This chapter discusses how justice applies to public health. It begins by outlining three different metrics employed in discussions of justice: resources, capabilities, and welfare. It then discusses different accounts of justice in distribution, reviewing utilitarianism, egalitarianism, prioritarianism, and sufficientarianism, as well as desert-based theories, and applies these distributive approaches to public health examples. Next, it examines the interplay between distributive justice and individual rights, such as religious rights, property rights, and rights against discrimination, by discussing examples such as (...) mandatory treatment and screening. The chapter also examines the nexus between public health and debates concerning whose interests matter to justice (the “scope of justice”), including global justice, intergenerational justice, and environmental justice, as well as debates concerning whether justice applies to individual choices or only to institutional structures (the “site of justice”). The chapter closes with a discussion of strategies, including deliberative and aggregative democracy, for adjudicating disagreements about justice. (shrink)

It is generally recognised that the potential positive and negative impacts of geoengineering will be distributed unevenly both geographically and temporally. The question of distributive justice in geoengineering thus is one of the major ethical issues associated with geoengineering. Currently, the question of distributive justice in geoengineering is framed in terms of who gets what (potential) benefits and harms from geoengineering, i.e. it is about the distribution of the outcomes of geoengineering. In this paper, I argue that the discussions on (...) distributive justice in geoengineering should not be outcome-based. Instead, it should be risk-based. I identify two problems for framing the question of distributive justice in geoengineering in terms of the distribution of its outcomes, i.e. the ‘if and then’ syndrome and the limited applicability of distributive principles in geoengineering policy, and suggest risk is a more proper object of distribution in the case of geoengineering. Following Hayenhjelm, I argue that the object of distribution in the case of fair distribution of risk should be (i) sources of risks and (ii) precautionary measures. I shall then demonstrate how it can be applied to the question of distributive justice in geoengineering. Finally, I end this paper by exploring the possible responses to the question of distributive justice in geoengineering by three major accounts of distributive justice, i.e. egalitarianism, prioritarianism, and sufficientarianism. (shrink)

Public funders of health research have been widely criticized on the grounds that their allocations of funding for disease-specific research do not reflect the relative burdens imposed by different diseases. For example, the US National Institutes of Health spends a much greater fraction of its budget on HIV/AIDS research and a much smaller fraction on migraine research than their relative contribution to the US burden of disease would suggest. Implicit in this criticism is a normative claim: Insofar as the scientific (...) opportunities are equal, each patient merits research into their condition proportional to the burden of disease for which that condition is responsible. This claim—the proportional view—is widely accepted but has never been fully specified or defended. In this paper, I explain what is required to specify the view, attempt to do so in the most charitable way, and then critically evaluate its normative underpinnings. I conclude that a severity-weighted proportional view is defensible. I close by drawing out five key lessons of my analysis for health research priority-setting. (shrink)

The good of those who are worse off matters more to the overall good than the good of those who are better off does. But being worse off than one’s fellows is not itself bad; nor is inequality itself bad; nor do differences in well-being matter more when well-being is lower in an absolute sense. Instead, the good of the relatively worse-off weighs more heavily in the overall good than the good of the relatively better-off does, in virtue of the (...) fact that the former are relatively worse off. This paper articulates and defends the view just described. (shrink)

In this book some options concerning the greenhouse effect are assessed from a welfarist point of view: business as usual, stabilization of greenhouse gas emissions and reduction by 25% and by 60%. Up to today only economic analyses of such options are available, which monetize welfare losses. Because this is found to be wanting from a moral point of view, the present study welfarizes (among others) monetary losses on the basis of a hedonistic utilitarianism and other, justice incorporating, welfare ethics. (...) For these welfarist evaluations information about the social consequences of the four options are collected from the literature and eventually corrected; then the consequences for individual well-being are assessed based on psychological research about well-being dependent on the social situation of the individual; finally the aggregation formulas of the respective welfare ethics are applied to these data. Assessments by other types of ethics, e.g. Kantian ethic, are included. The strongest abatement option is found to be optimum with great unanimity. - In addition a cost-welfare analysis of greenhouse gas abatement is undertaken revealing efficient cost-welfare ratios for these measures and the most efficient ratio for the strongest option. - A final, more theoretical part discusses the moral obligations following from such evaluations. The notion of 'moral obligation' is explained in a way that, apart from moral goodness of the required act, reinforcement by formal or informal sanctions is another necessary condition for moral obligations. This leads to a conception of a historical morality according to which the demands of morality rise in the long run. Applying this conception to the greenhouse effect implies that presently we have the moral duty to raise the standards of greenhouse gas abatement as much as is politically feasible. (shrink)

The Complaint Model is an interpretation of Scanlon’s contractualism which holds that (1) an individual can reasonably reject a distribution of well-being when her complaint against that distribution is larger than any other person’s complaint against any other distribution. The Complaint Model further holds that (2) the size of an individual’s complaint against a distribution is a function of (2a) her absolute level of well-being under that distribution, with the size of her complaint increasing as her absolute level of well-being (...) decreases, and (2b) the size of her loss in well-being under that distribution relative to the level of well-being she could have enjoyed under the distribution most favourable to her, with the size of her complaint increasing as her loss increases. In this paper, I argue that the Complaint Model should be rejected, because the way in which it takes individuals’ losses into account leads to strongly counterintuitive results. In particular, I show that the Complaint Model may sacrifice the well-being associated with the least-well-off, secondleast-well-off, etc. positions for the sake of minimizing the largest complaint. I also argue that revisions to element (1) to allow for the aggregation of complaints must either leave the Complaint Model vulnerable to this objection or lead it to collapse into prioritarianism. The failure of the Complaint Model may lead us to search for an alternative way of taking losses into account. I conclude by arguing that the attractiveness of the Anonymous Pareto principle poses a challenge to any such alternative. (shrink)