Developments in Non-Invasive Prenatal Testing (NIPT) and cell-free fetal DNA analysis raise the possibility that antenatal services may soon be able to support couples in non-invasively testing for, and diagnosing, an unprecedented range of genetic disorders and traits coded within their unborn child’s genome. Inevitably, this has prompted debate within the bioethics literature about what screening options should be offered to couples for the purpose of reproductive choice. In relation to this problem, the European Society of Human Genetics (ESHG) and (...) American Society of Human Genetics (ASHG) tentatively recommend that any expansion of this type of screening, as facilitated by NIPT, should be limited to serious congenital and childhood disorders. In support of this recommendation, the ESHG and ASHG cite considerations of distribution justice. Notably, however, an account of justice in the organization and provision of this type of screening which might substantiate this recommendation has yet to be developed. This paper attempts to redress this oversight through an investigation of Norman Daniels’ theory of Just health: meeting health needs fairly. In line with this aim, the paper examines what special moral importance (for Just health) screening for the purpose of reproductive choice might have where concerning serious congenital and childhood disorders in particular. The paper concludes that screening for reproductive choice where concerning serious congenital and childhood disorders may be important for providing women with fair opportunity to protect their health (by either having or not having an affected child). (shrink)

While libertarians affirm personal responsibility as a central moral and political value, libertarian theorists write relatively little about the theory and practice of this value. Focusing on the work of F. A. Hayek and David Schmidtz, this article identifies the core of a libertarian approach to personal responsibility and demonstrates the ways in which this approach entails a radical revision of the ethics and American politics of personal responsibility. Then, I highlight several central implications of this analysis in the American (...) political and economic status quo. First, this analysis makes a mockery of so-called libertarian/conservative ‘fusionism’, such that libertarian personal responsibility cannot partner with meritocratic conservative thought to provide a plural grounding for rejecting progressive or redistributive economic policy. Next, preferred libertarian policies threaten the status, esteem and social bases of self-respect of citizens who are worse-off through little or no fault of their own. Finally, these policies undermine the ethics of personal responsibility that Americans from across the ideological spectrum value and many conservatives and libertarians celebrate. In the American status quo, those who value personal responsibility must reserve a central place for policies that mitigate opportunity and distributive inequalities. (shrink)

After reviewing the compelling case for separability (`social welfare is a separable function of individual utilities'), an argument is advanced for utilitarianism (defined as `social welfare is the unweighted sum of individual utilities'). Basically, a compelling individualism-type axiom leads us to (social welfare as an) unweighted sum (of individual utilities), given separability.

Is well-being the kind of thing that can be summed across individuals? This paper takes a measurement-theoretic approach to answering this question. To make sense of adding well-being, we would need to identify some natural "concatenation" operation on the bearers of well-being that satisfies the axioms of extensive measurement and can therefore be represented by the arithmetic operation of addition. I explore various proposals along these lines, involving the concatenation of segments within lives over time, of entire lives led alongside (...) one another or in sequence, and of evaluatively basic propositions via conjunction. All of these proposals turn out to carry highly controversial commitments about the good. I do not claim that these commitments are unacceptable. But they suggest that we cannot simply take for granted, as many philosophers do, that there is any such thing as the sum of well-being. (shrink)

Pluralist egalitarians think that luck and relational egalitarianism each articulates a component in a pluralist account of egalitarian justice. However, this ecumenical view appears problematic in the light of Elizabeth Anderson's claim that the divide arises because two incompatible views of justification are in play, which in turn generates derivative disagreements – e.g. about the proper currency of egalitarian justice. In support of pluralist egalitarianism I argue that two of Anderson's derivative disagreements are not rooted in the disagreement over justification (...) she identifies, and that the disagreement over justification cuts across standard disagreements between luck and relational egalitarian justice. (shrink)

Ronald Dworkin's theory of equality of resources makes extensive use of markets. I show that all these markets rely on one specific neoclassical conception of the ideal market in full equilibrium, as analyzed by Debreu. This market must be understood as operating under circumstances of certainty, and this is incompatible with several components of Dworkin's account. In particular, it does not allow one to hold people responsible for their option luck, and it implies a high social safety net rather than (...) insurance schemes for addressing brute luck. I conclude by outlining an interpretation of equality of resources that takes the ideal market seriously. (shrink)

The traditional doctrine on federalism claims that economic inequalities are morally justified as long as they result from the legitimate exercise of federal subunit self-government. This paper discusses that claim and examines the philosophical grounds of federal economic decentralization in order to lay the basis for a federal theory of distributive justice. I explore the analogy between federal organizations and the international order claiming that moral conditions of political legitimacy generate some requirements for distribution. But also, I criticize the idea (...) of fraternity as a demanding and fragile political virtue. I try to show that fraternity gives us stronger reasons to reduce economic inequality in territorial federal states than in multicultural federal states. (shrink)

Rare diseases pose a particular priority setting problem. The UK gives rare diseases special priority in healthcare priority setting. Effectively, the National Health Service is willing to pay much more to gain a quality-adjusted life-year related to a very rare disease than one related to a more common condition. But should rare diseases receive priority in the allocation of scarce healthcare resources? This article develops and evaluates four arguments in favour of such a priority. These pertain to public values, luck (...) egalitarian distributive justice the epistemic difficulties of obtaining knowledge about rare diseases and the incentives created by a higher willingness to pay. The first is at odds with our knowledge regarding popular opinion. The three other arguments may provide a reason to fund rare diseases generously. However, they are either overinclusive because they would also justify funding for many non-rare diseases or underinclusive in the sense of justifying priority for only some rare diseases. The arguments thus fail to provide a justification that tracks rareness as such. There are no data in this work. (shrink)

Extensive measurement is the standard measurement-theoretic approach for constructing a ratio scale. It involves the comparison of objects that can be concatenated in an additively representable way. This paper studies the implications of extensively measurable welfare for social choice theory. We do this in two frameworks: an Arrovian framework with a fixed population and no interpersonal comparisons, and a generalized framework with variable populations and full interpersonal comparability. In each framework we use extensive measurement to introduce novel domain restrictions, independence (...) conditions, and constraints on social evaluation. We prove a welfarism theorem for these domains and characterize the social welfare functions that satisfy the axioms of extensive measurement at both the individual and social levels. The main results are simple axiomatizations of strong dictatorship in the Arrovian framework and classical utilitarianism in the generalized framework. (shrink)

Despite the prominence of thresholds and limits in theories of distributive justice, there is no general account of their role within such theories. This has allowed an ongoing lack of clarity and misunderstanding around threshold views in distributive justice. In this thesis, I develop an account of the conceptual structure of such views. Such an account helps understand and characterize threshold views, can subsume what may seem to be different debates about such views under one conceptual header, and can be (...) used to further examine and develop patterns of justice that draw on thresholds. In light of this account, I propose a novel characterization of sufficientarianism which sheds new light on the distinctiveness of sufficientarianism as a distributive principle and on the common objections to sufficientarianism. Moreover, I examine and defend limitarianism, which is the view that people should not have more than a certain amount of wealth. In particular, I argue in favour of limitarianism as a midlevel principle for guiding institutional design and individual actions and, furthermore, as a specification of what a just allocation of wealth requires under epistemic constraints. (shrink)

Over the last 30 years the Indian philosopher-economist Amartya Sen has developed an original normative approach to the evaluation of individual and social well-being. The foundational concern of this ‘capability approach’ is the real freedom of individuals to achieve the kind of lives they have reason to value. This freedom is analysed in terms of an individual’s ‘capability’ to achieve combinations of such intrinsically valuable ‘beings and doings’ (‘functionings’) as being sufficiently nourished and freely expressing one’s political views. In this (...) account, ‘development’ is conceived as the expansion of individuals’ capability, and thus as a concept that goes beyond the economic growth of third world countries. My thesis is a philosophical examination of Sen’s capability approach. In the first part (chapters 1-3) I present and defend my interpretation of Sen’s work. (shrink)

Arrow's Independence of Irrelevant Alternatives (IIA) has been under criticism for decades for not taking account of preference intensities. Computer-simulation results by Aki Lehtinen concerning strategic voting under various voting rules show that this intensity argument does not need to rest on mere intuition. Voters may express intensities by voting strategically, and that this has beneficial aggregate-level consequences: utilitarian efficiency is higher if voters engage in strategic behaviour than if they always vote sincerely. Strategic voting is thus unambiguously beneficial under (...) a utilitarian evaluation of outcomes. What has been considered the main argument for IIA turns out to be one against it. This paper assesses the implications of these results for interpretations of Arrow's theorem and the Gibbard-Satterthwaite theorem in a discussion on the methodological and philosophical arguments concerning preference intensities and IIA. (shrink)