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- Ronald M. Green (2001). Access to Healthcare: Going Beyond Fair Equality of Opportunity. American Journal of Bioethics 1 (2):22 – 23.
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Stephen Kershnar (2004) recently argues that under its most plausible interpretation, equality of opportunity is simply not something worth pursuing; at least, not for itself. In this paper I try to show that even if we accept Kershnar's characterisation of equality of opportunity in terms of weighted aggregate chances, none of his objections succeed. Opportunities, not outcomes, are the appropriate focus of EO advocates; hedonic treadmills are irrelevant to the issue; we do not need to assume general equality in some attribute to ground equality of opportunity; finally, it is possible to show that it is permissible to promote EO at some cost to other independent values.
This paper is an engagement with Equality by John Baker, Kathleen Lynch, Judy Walsh and Sara Cantillon. It identifies a dilemma for educational egalitarians, which arises within their theory of equality, arguing that sometimes there may be a conflict between advancing equality of opportunity and providing equality of respect and recognition, and equality of love care and solidarity. It argues that the latter values may have more weight in deciding what to do than traditional educational egalitarians have usually thought.
This paper deals with the policy of affirmative action as an additional means for achieving equality of opportunity in society. It assumes that in modem society-at least in principle-the superior positions are distributed according to merit, and on the basis of fair competition. I argue that formal equality of opportunity injects apparently neutral requirements, such as experience, into the selection procedure for top positions, that, in fact, act particularly against women, since they allow the past employment situation to affect the new selection. I use a statistical argument to show that without preferential treatment towards women, they will not overcome structural obstacles that prevent them from getting top positions. I also use the same argument to show that affirmative action at present contributes to equality of opportunity in the future.
According to John Rawls, "Justice is the first virtue of social institutions."1 Like Gaul, justice is tripartite. Rawls affirms an Equal Liberty Principle that guarantees equal basic or constitutional liberties for all citizens and a Difference Principle that requires inequalities in the distribution of certain social and economic benefits, the primary social goods, to be set so that the long-term holdings of primary social goods are maximized for the citizens whose holdings are least. Sandwiched between these two principles is a Fair Equality of Opportunity Principle, which has stimulated much less commentary.2 Yet this Principle is plausible, controversial, and has radical implications for the design of social policy and legislation in modern democracies. This essay assesses Fair Equality of Opportunity and offers reasons for rejecting it.
Many countries have imposed strict regulations on the genetic information to which insurers have access. Commentators have warned against the emerging body of legislation for different reasons. This paper demonstrates that, when confronted with the argument that genetic information should be available to insurers for health insurance underwriting purposes, one should avoid appeals to rights of genetic privacy and genetic ignorance. The principle of equality of opportunity may nevertheless warrant restrictions. A choice-based account of this principle implies that it is unfair to hold people responsible for the consequences of the genetic lottery, since we have no choice in selecting our genotype or the expression of it. However appealing, this view does not take us all the way to an adequate justification of inaccessibility of genetic information. A contractarian account, suggesting that health is a condition of opportunity and that healthcare is an essential good, seems more promising. I conclude that if or when predictive medical tests (such as genetic tests) are developed with significant actuarial value, individuals have less reason to accept as fair institutions that limit access to healthcare on the grounds of risk status. Given the assumption that a division of risk pools in accordance with a rough estimate of people's level of (genetic) risk will occur, fairness and justice favour universal health insurance based on solidarity.
It is often supposed that the point of equality of opportunity is to create a level playing-field. This is understood in different ways, however. A common proposal is what I call the neutralization view: that people's social circumstances should not differentially affect their life chances in any serious way. I raise problems with this view, before developing an alternative conception of equal opportunity which allows some variations in social circumstances to create differences in life prospects. The meritocratic conception which I defend is grounded in the idea of respect for persons, and provides a less demanding interpretation of fair access to qualifications; it nevertheless places constraints on the behaviour of parents, and has implications for educational provision in schools.
Where does the aspiration to retard human ageing fit in the ‘big picture’ of medical necessities and the requirements of just healthcare? Is there a duty to retard human ageing? And if so, how much should we invest in the basic science that studies the biology of ageing and could lead to interventions that modify the biological processes of human ageing? I consider two prominent accounts of equality and just healthcare – Norman Daniels's application of the principle of fair equality of opportunity and Ronald Dworkin's account of equality of resources – and conclude that, once suitably amended and revised, both actually support the conclusion that anti-ageing research is important and could lead to interventions that ought to be considered ‘medical necessities’.
The principle of fair equality of opportunity is regularly used to justify social policies, both in the philosophical literature and in public discourse. However, too often commentators fail to make explicit just what they take the principle to say. A principle of fair equality of opportunity does not say anything at all until certain variables are filled in. I want to draw attention to two variables, timing and currency. I argue that once we identify the few plausible ways we have at our disposal for filling in those variables, it will become apparent that a reasonable version of the principle will be quite narrow. Its usefulness as a justificatory basis for social policies will be limited to those policies that target the distribution of competitive opportunities among people entering majority.
Although discussions of John Rawls’ A Theory of Justice generally refer to Rawls’ two principles of justice, and although Rawls himself labels his principles “the two principles of justice”, Rawls actually sets forth three distinct principles in the following lexical order: the liberty principle, the fair equality of opportunity principle, and the difference principle. Rawls argues at some length for the priority of the liberty principle over the other two. On the other hand, Rawls offers hardly any argument at all for the priority of the fair equality of opportunity principle over the difference principle. In this article I will argue that making the fair equality of opportunity principle separate from and lexically prior to the difference principle is both intuitively unattractive and inconsistent with Rawls’ method of deriving principles of justice from the choices of rational contractors in the original position.
Many political philosophers argue that a principle of ‘fair equality of opportunity’ (FEO) ought to extend beyond national borders. I agree that there is a place for FEO in a theory of global justice. However, I think that the idea of cross-border FEO is indeterminate between three different principles. Part of my work in this paper is methodological: I identify three different principles of cross-border fair equality of opportunity and I distinguish them from each other. The other part of my work in this paper is normative: I argue that we should endorse only two of the three principles of cross-border fair equality of opportunity and that we shouldreject the third. Importantly, I think that we should reject the one version of transnational fair equality of opportunity that most advocates of such a principle appear to endorse.
Discussion of Ronald M. Green, Access to healthcare: Going beyond fair equality of opportunity
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