Health, Luck, and Justice is the first attempt to systematically apply luck egalitarianism to the just distribution of health and health care.

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 (...) individuals do not fall into poverty and destitution; instead he claims that undeserved inequalities, wherever and whenever we might find them, are bad in themselves. Assessing the strength of competing accounts, such as sufficientarianism and prioritarianism, he brings together for the first time discussions of the moral value of equality with luck- or responsibility-sensitive accounts of distributive justice. His book will interest readers in political and moral philosophy. (shrink)

Egalitarians have traditionally been suspicious of equality of opportunity, but recently there has been a sea-change in thinking about that concept. Shlomi Segall brings together these developments and offers a new account of 'radical equality of opportunity', which removes all obstacles (to one's opportunity-set) that lie outside one's control.

The article argues that discrimination is bad as such when and because it undermines equality of opportunity. It shows, first, that other accounts, such as those concerning intent, efficiency, false representation, prejudice, respect and desert cannot account for the badness of discrimination as such. The inequality of opportunity account, in contrast, captures everything that is bad about discrimination. The article then addresses some counter-examples of practices that are discriminatory without arguably entailing inequality of opportunity, where the notable case is that (...) of segregation. It is further demonstrated that the account successfully handles some of the tricky aspects associated with discrimination, such as those concerning the confinement of discrimination to salient groups, discriminatees by means of financial compensation, in the selection of life partners, and the duties of employers. (shrink)

Telic sufficientarians hold that there is something special about a certain threshold level such that benefiting people below it, or raising them above it, makes an outcome better in at least one respect. The article investigates what fundamental value might ground that view. The aim is to demonstrate that sufficientarianism, at least on this telic version, is groundless and as such indefensible. The argument is advanced in three steps: first, it is shown that sufficientarianism cannot be grounded in a personal (...) value. Neither, secondly, is it committed to the person-affecting view, the view that says that nothing can be better if there is no one for whom it is better. This, in itself, is of interest because some sufficientarians reject egalitarianism precisely for its alleged incompatibility with the person-affecting view. Sufficientarians' disavowal of the person-affecting view implies that their view, similarly to egalitarianism, must be anchored in some impersonal value. But crucially, and this is the third step of the argument, there is no apparent value that can fit that role. We must conclude, then, that telic sufficientarianism is groundless. (shrink)

Can outcome equality (say, in welfare) ever be unjust? Despite the extensive inquiry into the nature of luck egalitarianism in recent years, this question is curiously under-explored. Leading luck egalitarians pay little attention to the issue of unjust equalities, and when they do, they appear not to speak in one voice. To facilitate the inquiry into the potential injustice of equalities, the paper introduces two rival interpretations of egalitarianism: the responsibility view, which may condemn equalities as unjust (when they reflect (...) unequal levels of personal responsibility); and, the non-responsibility view, which does not. It then teases out the implications of these two views, in the hope of establishing that the latter is at least as plausible as the former. The paper thus establishes that the egalitarian ideal can be plausibly formulated in a way that condemns only (certain) inequalities but never equalities, and that this formulation is both coherent and attractive. (shrink)

This report by the WHO Consultative Group on Equity and Universal Health Coverage addresses how countries can make fair progress towards the goal of universal coverage. It explains the relevant tradeoffs between different desirable ends and offers guidance on how to make these tradeoffs.

In recent work, Norman Daniels extends the application of Rawls's principle of ‘fair equality of opportunity’ from health care to health proper. Crucial to that account is the view that health care, and now also health, is special. Daniels also claims that a rival theory of distributive justice, namely luck egalitarianism (or ‘equal opportunity for welfare’), cannot provide an adequate account of justice in health and health care. He argues that the application of that theory to health policy would result (...) in an account that is, in a sense, too narrow, for it denies treatment to imprudent patients (e.g. lung cancer patients who smoked). In a different sense, Daniels argues, luck egalitarian health policy would be too wide: it arguably tells us to treat individuals for such brute-luck conditions as shyness, stupidity, ugliness, and having the ‘wrong’ skin colour. I seek to advance three claims in response to Daniels's revised theory, and in defence of a luck egalitarian view of health policy. First, I question Daniels's assertion regarding the specialness of health. While he is right to abandon his insistence on the specialness of health care, it is doubtful that health proper can be depicted as special. Second, I try and meet Daniels's objections to luck egalitarianism. Luck egalitarian health policy escapes being too narrow for it does not in fact require denying basic care to imprudent patients. As for it being allegedly too wide, I try to show that it is not, after all, counterintuitive to rid individuals of unfortunate and disadvantageous biological traits (say, a disadvantageous skin colour). And third, I question whether Daniels's own Rawlsian account is in fact wide enough. I argue that fair equality of opportunity fails to justify some standard medical procedures that many health systems do already practice. (shrink)

:The paper seeks to defend Telic Egalitarianism by distinguishing two distinct categories into which typical objections to it fall. According to one category of objections TE isgroundless. That is, there is simply no good reason to think that inequality as such is bad. The other type of objections to TE focuses on itscounterintuitiveimplications: it is forced to condemn inequalities between ourselves and long-dead Inca peasants, or between us and worse-off aliens from other planets. The paper shows that once we unpack (...) these two types of objections to TE they become much less persuasive. (shrink)

The paper examines the view that individuals have a claim to the jobs for which they are the best qualified. It seeks to show this view to be groundless, and to offer, instead, a luck egalitarian account of justice in hiring. That account consists of three components: monism, non-meritocracy, and non-discrimination. To demonstrate the coherence of this view, two particular internal conflicts are addressed. First, luck egalitarian monism (the view that jobs are not special) may end up violating the non-discrimination (...) requirement. Second, non-discrimination, it is often suggested, cannot be defined without reference to qualifications, thus violating the non-meritocracy requirement. The paper seeks to address these, as well as other, potential objections, and show that whereas meritocratic accounts are without basis, luck egalitarianism provides a coherent and attractive account of justice in hiring. (shrink)

Stuart White and others claim that providing welfare benefits to citizens who do not, and are not willing to, work breaches the principle of reciprocity. This, they argue, justifies placing a minimum work requirement on welfare recipients. This article seeks to rebut their claim. It begins by rejecting the attempt to ground the work requirement on a civic obligation to work. The article then explores the principle of reciprocity, and argues that the practice of reciprocity depends on the particular conception (...) of distributive justice adopted. An examination of different interpretations of egalitarian justice and their corresponding patterns of reciprocity demonstrates that unconditional welfare benefits are compatible with, and sometimes even warranted by, the principle of reciprocity. Thus, imposing a work requirement on welfare recipients is by no means a mandate of reciprocity. Key Words: contractualism • unconditional basic income • reciprocity • welfare state • work. (shrink)

In a recent article, Michael Otsuka and Alex Voorhoeve argue that prioritarianism fails to account for the shift in moral significance in gains to individuals in interpersonal as compared to intrapersonal cases. In this article, I show that the priority view escapes this objection but in a way that deprives it of its anti-egalitarian stance. Despite Otsuka and Voorhoeve, prioritarianism, rightly understood, provides consistent and attractive recommendations in both single- and multi-person cases. Yet prioritarians, the article goes on to show, (...) cannot do so while availing themselves of the leveling down objection to egalitarianism. They may not do so because similarly to egalitarianism, prioritarianism also must reject the principle of personal good. That is, egalitarians and prioritarians may sometime recommend certain actions and outcomes even when these are better for no one. Prioritarians may survive the Otsuka–Voorhoeve critique, but to do so they must abandon their anti-egalitarian stance. (shrink)

Utilitarians are said to be indifferent between interpersonal and intrapersonal transfers. In doing so, they fail to register the separateness of persons. This ‘separateness of persons’ objection has been traditionally used against utilitarianism, but more recently against prioritarianism. In this paper, I examine how yet another distributive view, namely sufficientarianism, fares in this respect. Sufficientarians famously believe that while inequality as such does not matter, what does matter is that all individuals meet some adequate threshold. It is often taken for (...) granted that sufficientarianism does not violate the separateness of persons. In this paper, I seek to show that that is not the case. The main challenge, however, proves to be formulating an accurate understanding of what the separateness of persons precisely means. I offer several interpretations and argue that sufficientarianism, surprisingly, violates them all. Sufficientarianism, just like utilitarianism does not respect the separateness of persons. (shrink)

Luck egalitarians typically hold that it is bad for some to be worse off than others through no fault or choice of their own. In this paper I want to address two complaints against standard luck egalitarianism that do not question responsibility-sensitivity. The first objection says that equality itself lacks inherent non-instrumental value, and so the luckist component ought to be attached to a different pattern, say prioritarianism. The second objection also endorses luckism but worries that luck egalitarianism as conventionally (...) formulated is committed in fact to neutralizing not just brute luck but also option luck. And this would mean, among other things, compensating unsuccessful gamblers, which is something many egalitarians find counterintuitive. My aim is to show that there is a way for luck egalitarianism to meet both criticisms; that it can maintain its egalitarian credentials while avoiding the counterintuitive consequences of compensating unsuccessful gamblers. To do so, I propose, we ought to understand luck egalitarianism as resting on the disvalue of being arbitrarily worse off compared to others. In addition, I suggest, the badness of luck egalitarian inequality – that of arbitrary disadvantage – has both an inter-personal and an intra-personal dimension. (shrink)

Individuals come into the world with talents that differ greatly in their marketability. These talents command a wide variety of rents; from millions of dollars per film for a movie star, to just a few thousands of dollars per annum for a fast-food joint worker. How should we distribute income fairly given these disparities? That is the topic of Kristi Olson’s excellent new book, The Solidarity Solution: Principles for a Fair Income Distribution. 1 1 The question is not new, but (...) Olson’s treatment is among the most comprehensive and well-argued one can find. The manuscript is well researched, scholarly, thorough, packed full of arguments and low on fluff. It is well worth the time of anyone interested in fairness in the sphere of work and income. (shrink)

It has been claimed that modern long-standing scientific theories are fertile, in the sense of having been progressively successfully modified to meet new experimental observations or theoretical developments in related areas, and that these modifications arise naturally from each preceding version of the theory. McMullin has advanced this form of fertility as a vindication of scientific realism, since if the theories did not approximate the real, the observation would be inexplicable. In response Nolan has denied the existence of fertility in (...) this sense as an independent virtue. The present paper argues that the rebuttal is flawed. Introduction McMullin's P-fertility Fertility Explained Away as Novel Prediction Conclusion CiteULike Connotea Del.icio.us What's this? (shrink)

The article assesses recent attempts to deflect two persistent objections to Positive Egalitarianism (PE), the view that equality adds to the goodness of a state of affairs. The first says that PE entails bringing into existence individuals who are equal to each other in leading horrible lives, such that they are worthnotliving. I assess three strategies for deflecting this objection: offering a restricted version of PE; biting the bullet; and pressing alevelling outcounter-objection. The second objection points out that for any (...) world A containing many individuals all leading very satisfying lives, and in perfect equality, PE prefers a much larger, perfectly equal population Z with much lower (yet positive) well-being. I review two main strategies for avoiding this Repellent Conclusion: a Capped Model and making egalitarianism sensitive to welfare levels. Both solutions, I show, are worse than the problems they are meant to solve. (shrink)

In addition to empirical adequacy and compatibility with other current theories, scientific theories are commonly judged on three criteria â simplicity, elegance, and fertility. Fertility has received comparatively little attention in the philosophical literature. A definition of a certain sort of fertility, called P-fertility, proposed by Ernan McMullin, is that it consists in the capacity of a theory to be successfully modified over time to explain new experimental data or theoretical insights. McMullin made the major claim that he has a (...) novel and perhaps the sole argument for Scientific Realism. His argument involves two strands (i) theories must be considered diachronically and it is an historical fact that long standing successful scientific theories are P-fertile, and (ii) the correct explanation of this fact is that these theories reflect the realities of a mind-independent world. A rebuttal of McMullinâs position given in the literature is considered and rejected. His argument therefore requires further consideration. The plausible first strand of McMullinâs argument is accepted for the purposes of discussion, and thus the observation requires explanation, either along McMullinâs own lines or otherwise. The concept of diachronicity and the implications of accepting a diachronic view of scientific theories are considered. The identity of theory across time can be understood both from a Realist and an Anti-realist perspective via the concept of significant claims in the successive versions of the long standing successful theories. This defuses a possible objection to McMullinâs argument, namely that by assuming diachronicity he begs the question against the Anti-realist. Explanations of the conjunction of success and P-fertility are examined from the perspective of Scientific Realism and the major current Anti-realist stances â Entity Realism, Structural Realism, Instrumentalism, and Internal Realism. 3 To justify the second strand of McMullinâs argument, a notion of the approximate truth or of the verisimilitude of theories is required. Inter alia it is argued that a distinction must be made between the approximate truth of a scientific theory and that of a simple assertion or a simple narrative. The concepts of the approximate truth of scientific theories and their verisimilitude are explored and some serious difficulties are identified. First, it is difficult to accommodate differences in respect as well as in degree in delineating the nature of an approximately true theory. Second, it is difficult to give a satisfactory account of the metric used to assess the verisimilitude of theories. It is argued that in any case no version of these concepts can adequately support the second strand of McMullinâs thesis. This is because, at best, approximate truth and verisimilitude can only support a pragmatic claim â the improved empirical adequacy of successive versions of the long standing theory. In contrast, McMullinâs thesis requires that successor versions generally are better theories. Third, there is an intractable theory dependent weighting problem posed by the open ended nature of scientific theories in contrast with the closed narratives describing idealized models. The role of the approximate truth of scientific theories is explored, within the frameworks of Realism and Anti-realism, with regard to the possible responses to the existence of two highly successful, well corroborated, but incompatible theories â general relativity and quantum mechanics. It is suggested that Scientific Realism itself, not only McMullinâs argument for Scientific Realism, requires the notion of approximate truth or verisimilitude of theories. Putnamâs Internal Realism is considered, and, if as I suggest, no adequate account of the concepts of the approximate truth or verisimilitude of scientific theories can be given, Internal Realism (which need not draw on these concepts because of its denial that there is a unique correct description of the world) is more plausible than the full blooded Scientific Realism advocated by McMullin, despite granting the claim of the historical observation of the conjunction between long standing successful theories and their P-fertility. (shrink)

Derek Parfit held that in evaluating the future, we should ignore the difference between necessary persons and merely possible persons. In this article, I look at one of the most prominent alternatives to Parfit's view, namely Michael Otsuka and Larry Temkin ‘shortfall complaints’ view. In that view, we aggregate future persons’ well-being and deduct intrapersonal shortfall complaints, giving extra weight to the complaints of necessary persons. I offer here a third view. I reject Parfit's no difference view in that I (...) register a difference between necessary and possible persons. But I also reject the Shortfall View and replace its intra-personal complaints with an inter-personal complaints mechanism. I argue that the value of a population is its aggregate prioritarian value minus the egalitarian complaints that necessary persons hold. I show that the egalitarian view has all the explanatory power of the Shortfall view in easy cases, while significantly improving on it in three sorts of tough cases. (shrink)

La cobertura universal de salud está en el centro de la acción actual para fortalecer los sistemas de salud y mejorar el nivel y la distribución de la salud y los servicios de salud. Este documento es el informe fi nal del Grupo Consultivo de la OMS sobre la Equidad y Cobertura Universal de Salud. Aquí se abordan los temas clave de la justicia (fairness) y la equidad que surgen en el camino hacia la cobertura universal de salud. Por lo (...) tanto, el informe es pertinente para cada agente que infl uye en ese camino y en particular para los gobiernos, ya que se encargan de supervisar y guiar el progreso hacia la cobertura universal de salud. (shrink)

Alfred North Whitehead's first book as a professor of philosophy at Harvard University, Science and the Modern World, is not only a historical treatment of the rise and fall of scientific materialism. It also marks his turn to metaphysics in search of an alternative cosmological scheme that would replace matter in motion with organic process as that which is generic in Nature. Among the metaphysical innovations introduced in this book are the somewhat enigmatic “eternal objects.” The publication of the first (...) and second volumes of Whitehead's Harvard Lectures on the philosophical presuppositions (HL1) and general metaphysical problems (HL2) of science provides students of his corpus with an opportunity to catch the thinker in the act of creating his concepts. In searching through student notes for glimpses of what Whitehead really meant, I have kept in mind his admonition that “no thinker thinks twice” (PR 29). Whitehead never ceased philosophizing, and surely he intended for us to continue thinking with but beyond the letter of his ideas. In this spirit and in light of HL1 and HL2, this article seeks to elucidate the role of eternal objects as a category of existence in Whitehead's Philosophy of Organism, with the goal not simply of textual exegesis, but of showing how the meaning of the fifth category of existence (as he refers to eternal objects in PR) is exemplified in the gradual ingression of the idea in Whitehead's imagination. My aim is to sustain the effort at constructive thought he began, making his speculative hypothesis as explicit as possible so as to better prepare it for critical improvement (PR xiv). (shrink)

The social and ecological crises of the twenty-first century represent a failure of the techno-industrial way of living and knowing. It has become apparent that we need both a new mythos and a new science. In this essay, I draw attention to the important epistemological and cosmological implications of enactivism, a still emerging paradigm within the life sciences. Guided by the insights of the enactive paradigm, I offer a new story of human origins and destiny in an attempt to contribute (...) to a more livable future for our species and the rest of the community of life on Earth. (shrink)

This report from the WHO Consultative Group on Equity and Universal Health Coverage offers advice on how to make progress fairly towards universal health coverage.

This study examines high school students’ responses to a public policy discussion on the topic of Internet privacy. Specifically, students discussed the question of whether search engines and social media sites should be permitted to monitor, track, and share users’ personal data or whether such practices violate personal privacy. We observed discussions of the topic in four high school classrooms in 2015–2016, prior to the presidential election in 2016. We first explain why the topic failed to work as a controversial (...) public issue with high schoolers. We then explain their responses to the issue. We found (1) students displayed a surprising trust in Facebook and Google; (2) students framed the issue of Internet Privacy as a conflict in values and a set of trade-offs; and (3) students tended to put more weight on personal responsibility than implications for democracy in their assessment of the (acknowledged) erosion of privacy as a result of social media and Internet search engines. We conclude with implications for social studies education and teacher education. (shrink)

Some egalitarians argue against public services that are free for all, on the grounds that free access appears to primarily benefit the middle classes. I advocate, instead, the inclusion of the middle classes in public services, arguing that only truly universal intake of public services prevents the inegalitarian effects of economic segregation. Such universal participation in public services is achieved, partly, through subsidies for, and regulation of, privately produced services.