Several liberal philosophers and penal theorists have argued that the state has a reason to prohibit acts that harm individuals. But what is harm? According to one specification of harm, a person P is harmed by an act (or an event) a iff, as a result of a, P is made worse off in terms of well-being. One central question here involves the baseline against which we assess whether someone is ‘worse off’. In other words, when a person (...) is harmed he is worse off, certainly—but what is worse off a variation from? A central part of the paper critically discusses different answers to this question based on versions of what we can call: the temporal baseline, the baseline from mankind and the counterfactual baseline. Essentially, it will be argued that the counterfactual baseline leaves us with a better understanding of harming than the other baselines discussed. The final part of the paper will describe some of the implications of our investigation for the application and evaluation of the view that harm matters in the justification of which type of acts should be criminalized by the state. The overall conclusion of the paper is that adherents of a view like the harm principle face a dilemma. Either they can accept the counterfactual baseline but then, they can do without the harm principle. Or they can reject the counterfactual baseline—but then they will have to formulate an alternative baseline which, as will be shown in the paper, is no easy task. (shrink)

There is a growing body of literature which suggests that decisions about healthcare priority setting should take into account the extent to which patients are worse off. However, such decisions are often based on how badly off patients are with respect to the condition targeted by the treatment whose priority is under consideration (condition‐specific severity). In this paper I argue that giving priority to the worse off in terms of condition‐specific severity does not reflect the morally relevant sense (...) of being worse off. I conclude that an account of giving priority to the worse off relevant for healthcare priority setting should take into account how badly off patients are when all of their conditions are considered (holistic severity). (shrink)

This chapter examines whether an individual’s being worse off than others should be a relevant consideration in the allocation of limited medical resources. It reviews arguments pressed by proponents of different theories of justice about whether being worse off than others makes special demands on health care resource prioritization. Even if there is good reason to restrict the concern for the worse off to those with worse health in the prioritization and allocation of health care resources, (...) additional issues remain. One is how to determine who has worse health, and whether the worse off are those with the worse overall health or those with the most serious medical condition now in need of treatment. Another issue is whether only individuals’ present health, or instead their lifetime health, including past and expected future health, is relevant. (shrink)

Does disability make a person worse off? I argue that the best answer is yes AND no, because we can be worse off in two conceptually distinct ways. Disabilities usually make us worse off in one way (typified by facing hassles) but not in the other (typified by facing loneliness). Acknowledging two conceptually distinct ways to be worse off has fundamental implications for philosophical theories of well-being. (This paper won the APA’s Routledge, Taylor & Francis Prize (...) in 2017.). (shrink)

According to luck egalitarianism it is bad or unjust if someone is worse off than another through no fault or choice of her own. This article argues that there is a tension in standard luck egalitarian theory between justifying absolute and comparative welfare levels. If a person responsibly acts in a way that brings her welfare level below that of others, this is justified according to the theory. However, even if we can say that the person's new welfare level (...) is justified in absolute terms, it is less clear that her now being worse off than others, is justified. The reason is that while she has in one sense chosen her welfare level, she has not chosen to be worse off than others. Her relative standing, something with which egalitarians ought to be concerned, is determined by her choices in conjunction with the choices of all others. But no individual controls the choices of all others. Hence, for any one individual it is the case that her relative standing is beyond her control. Some responses to this problem are available. It is doubtful, however, that these are entirely successful. (shrink)

Luck egalitarians need to address the question of cost-responsibility: If an individual is responsible for being worse off than others, then what benefits, if any, is that individual uniquely cost-responsible for? By applying luck egalitarianism to justice in health I discuss different answers to this question inspired by two different interpretations of luck egalitarianism, namely ‘standard luck egalitarianism’ and ‘all luck egalitarianism’, respectively. Even though I argue that the latter is more plausible than the former, I ultimately suggest and (...) defend a third interpretation of luck egalitarianism, which I label ‘universal luck egalitarianism’. Finally, I adjust my findings to a (all things considered) more plausible currency, namely welfare. (shrink)

It is a common view that benefits to the worse off should be given priority when health benefits are distributed. This paper addresses how to understand who is worse off in this context when individuals are differently well off at different times. The paper argues that the view that this judgment about who is worse off should be based solely on how well off individuals are when their complete lives are considered (i.e. 'the complete lives view') is (...) implausible in this context. Instead, it is argued that a pluralistic stance toward this issue should be accepted. This pluralistic stance recognizes that also the view that only focuses on how well off individuals are now and in the future (i.e. 'the forward-looking view') is relevant. The argument is based on appeals to intuitive judgments concerning who is worse off in different cases and reference to various underlying reasons why priority to benefits to the worse off is justified. (shrink)

In this article, I argue that it makes a moral difference whether an individual is worse off than she could have been. Here, I part company with consequentialists such as Parfit and side with contractualists such as Scanlon. But, unlike some contractualists, I reject the view that all that matters is whether a principle can be justified to each particular individual, where such a justification is attentive to her interests, complaints and other claims. The anonymous goodness of a distribution (...) also matters. My attempt to reconcile contractualist and consequentialist approaches proceeds via a serious of reflections on cases. (shrink)

: When reflecting on arguments in the debate about genetic technologies, decision makers must try to be empathetic to those who are worse off. Disparities in health and health care in the U.S. pale when global facts are considered. Although U.S. citizens ought to be concerned about the worse off in the U.S., such concern ultimately must be balanced against the urgent imperative to address the plight of those in poor countries. It is a matter of fairness that (...) care and concern be directed to those who are truly worse off in global terms. (shrink)

A powerful argument against the counterfactual comparative account of harm is that it cannot distinguish harming from failing to benefit. In reply to this problem, I suggest a new account of harm. The account is a counterfactual comparative one, but it counts as harms only those events that make a person occupy his level of well-being at the world at which the event occurs. This account distinguishes harming from failing to benefit in a way that accommodates our intuitions about the (...) standard problem cases. In laying the groundwork for this account, I also demonstrate that rival accounts of harm are able to distinguish harming from failing to benefit only if, and because, they also appeal to the distinction between making upshots happen and allowing upshots to happen. One important implication of my discussion is that preserving the moral asymmetry between harming and failing to benefit requires a commitment to the existence of a metaphysical and moral distinction between making and allowing. (shrink)

In Norway, priority for health interventions is assigned on the basis of three official criteria: health benefit, resources, and severity. Responses to the COVID-19 pandemic have mainly happened through intersectoral public health efforts such as lockdowns, quarantines, information campaigns, social distancing and, more recently, vaccine distribution. The aim of this article is to evaluate potential priority setting criteria for public health interventions. We argue in favour of the following three criteria for public health priority setting: benefit, resources and improving the (...) well-being of the worse off. We argue that benefits and priority to the worse off may reasonably be understood in terms of individual well-being, rather than only health, for public health priority setting. We argue that lessons from the COVID-19 pandemic support our conclusions. Keywords: COVID-19, Prioritarianism, Priority Setting, Public Health, Severity. (shrink)

Egalitarian theories of justice hold that equality should be promoted. Typically, perfect equality will not be achievable, and it will be necessary to determine which of various unequal distributions is the most equal. All plausible conceptions of equality hold that, where perfect equality does not obtain, (1) any benefit (no matter how small) to a worst-off person that leaves him/her still a worst-off person has priority (with respect to equality promotion) over any benefit (no matter how large) to a best-off (...) person, and (2) any benefit to a worse-off person (even if not a worst-off person) has priority over a benefit of the same size to a better off person (even if not a best-off person). Beyond that there is much disagreement. (shrink)

We argue that there is a marked shift in the moral weight of an increment in a person's well-being when one moves from a case involving only intra-personal trade-offs to a case involving only inter-personal trads-offs. This shift, we propose, is required by the separateness of persons. We also argue that the Priority View put forward by Parfit cannot account for such a shift. We also outline two alternative views, an egalitarian view and a claims-based view, that can (...) account for this shift. (shrink)

In this issue of The Journal of Clinical Ethics, Emily Bell and Eric Racine are guest editors of a special section focusing on the use of deep brain stimulation (DBS) to treat Parkinson’s disease. In “Deep Brain Stimulation, Ethics, and Society,” Bell and Racine report that DBS already has been used to treat more than 50,000 patients. The ethical issues raised in this special section are important not only in regard to Parkinson’s disease and DBS, but in many areas of (...) medicine.The articles discuss sound, state-of-the-art ethical approaches. This introduction to the issue presents approaches that are adjunctive and intended to increase careproviders’ options, that should increase careproviders’ ability to individualize the care that they provide to their patients. (shrink)

Because harm is an important notion in ethics, it’s worth investigating what it amounts to. The counterfactual comparative account of harm, commonly thought to be the most promising account of harm, analyzes harm by comparing what actually happened with what would have happened in some counterfactual situation. But it faces the preemption problem, a problem so serious that it has driven some to suggest we abandon the counterfactual comparative account and maybe even abandon the notion of harm altogether. This paper (...) defends a version of the counterfactual comparative account that solves the preemption problem, a version called the “worse than nothing account.” It says that you harm someone just in case you leave them worse off than if you’d done nothing at all. (shrink)

Harm is one of the central concepts of ethics so it would be good to offer an account of it. Many accounts appeal to a baseline: they say that you harm someone if you leave them worse off than in the baseline case. In this paper, I draw some lessons regarding what counts as an appropriate baseline and explore what these general lessons reveal about the nature of harm. In the process of so doing, I argue that a certain (...) rarely-discussed account of harm -- the worse than nothing account of harm -- does a particularly good job at identifying a baseline. This account says you harm someone if you leave them worse off than if you had done nothing to them. (shrink)

In this article we argue that the social value of health research should be conceptualized as a function of both the expected benefits of the research and the priority that the beneficiaries deserve. People deserve greater priority the worse off they are. This conception of social value can be applied for at least two important purposes: in health research priority setting when research funders, policy-makers, or researchers decide between alternative research projects; and in evaluating the ethics of proposed research (...) proposals when research ethics committees assess whether the social value of the research is sufficient to justify the risks and burdens to research participants and others. In assessing how far a proposed research project will advance the interests of people who are more disadvantaged, research priority setters and RECs should examine the diseases that the research targets and the type of research. Just as certain diseases impose a greater burden on people who are more disadvantaged, so certain types of intervention and forms of research are more likely to benefit people who are more disadvantaged. We outline which populations are likely to be representative of the global worst off and identify what types of health research, and which disease categories, are priorities for these populations. (shrink)

In response to criticism following news of the mistreatment of Iraqis at the US prison in Abu Ghraib, some media personalities and politicians suggested that the treatment of these prisoners ‘‘would have been even worse’’ had former Iraqi President Saddam Hussein still been in power. It was hypothesized that the contemplation of this argument has undesirable consequences because counterfactual thinking can elicit both contrastive and assimilative effects. In the reported study, participants considered how the prisoners at Abu Ghraib would (...) have been worse off under Saddam. The results revealed that generating downward counterfactuals made participants feel better about Abu Ghraib (thereby evidencing contrast), and also lowered ethical standards regarding how the US should treat prisoners of war in the future (thereby evidencing assimilation). (shrink)

This paper offers a novel account of how complaints of unfairness arise in risky distributive cases. According to a recently proposed view in distributive ethics, the Competing Claims View, an individual has a claim to a benefit when her well-being is at stake, and the strength of this claim is determined by the expected gain to the individual’s well-being, along with how worse off the individual is compared to others. If an individual is at a lower level of well-being (...) than another, their claim to a given benefit is stronger. On this view, the strength of individuals’ claims are a function of their comparative well-being levels. In this paper, I instead argue that competing claims obtain only when a particular relationship obtains between the fates of individuals: that one individual’s gain is at the expense of another. This is a particular complaint that obtains when the fates of individuals are tied together in such a way that inequality that is to the detriment of the person who is worse off is guaranteed to obtain. I demonstrate that this complaint arises only when individuals are exposed to a particular type of risk that allows some to gain only if others lose. As such, I propose that complaints of unfairness occur less frequently than we might think if we take the Competing Claims View to be true. A purely comparative view is unable to account for this unique complaint of unfairness. I argue that this complaint is not only independently plausible, but can serve as a foundation for a more general account of competing claims complaints. (shrink)

In this chapter, Fourie identifies and systematizes the impairments associated with having privilege and evaluates their implications for theories of relational equality and distributive justice. Having certain social privileges, for example, being a man in a patriarchal society, can also be damaging; in other words, there are “impairments of privilege.” Fourie delineates six kinds of impairments—epistemic, evaluative, emotional, health-related, affiliative, and moral. She then goes on to assess the implications of the impairments of privilege for two theories in political philosophy. (...) Relational egalitarianism, she argues, has the theoretical resources to identify and address the problems associated with these impairments, whereas distributive egalitarianism does not. Furthermore, she argues that assessing the impairments of privilege through relational egalitarianism helps to characterize a society of equals: we must address the causes of functional impairments, express respect for the worse off by not normalizing the experiences of the privileged, and minimize competitive positionality. (shrink)

Clinical research is increasingly ‘offshored’ to developing countries, a practice that has generated considerable controversy. It has recently been argued that the prevailing ethical norms governing such research are deeply puzzling. On the one hand, sponsors are not required to offshore trials, even when participants in developing countries would benefit considerably from these trials. On the other hand, if sponsors do offshore, they are required not to exploit participants, even when the latter would benefit from and consent to exploitation. How, (...) it is asked, can it be worse to exploit the global poor than to neglect them when exploitation is voluntary and makes them better off? The present article seeks to respond to this challenge. I argue that mutually beneficial and voluntary exploitation can be worse than neglect when — as is typically true of exploitative international research — it takes advantage of unjust background conditions. This is because, in such cases, exploitation overlaps with another, less familiar wrong: complicity in injustice. Recognising complicity as a distinct wrong should make us judge exchanges arising from background injustice more harshly than we typically do, in research and elsewhere. (shrink)

We shall focus on moral theories that are solely concerned with promoting the benefits (e.g., wellbeing) of individuals and explore the possibility of such theories ascribing some priority to benefits to those who are worse off—without this priority being absolute. Utilitarianism (which evaluates alternatives on the basis of total or average benefits) ascribes no priority to the worse off, and leximin (which evaluates alternatives by giving lexical priority to the worst off, and then the second worst off, and (...) so on) ascribes absolute priority to the worse off (i.e., favors even a very small benefit to a worse off person over very large benefits to large numbers of better off people). Neither extreme view, we assume, is plausible. (shrink)

Patients in the vegetative state are wholly unaware of themselves, or their surroundings. However, a minority of patients diagnosed as vegetative are actually aware. What is the well-being of these patients? How are their lives going, for them? It has been argued that on a reasonable conception of well-being, these patients are faring so poorly that it may be in their best interests not to continue existing. I argue against this claim. Standard conceptions of well-being do not clearly support the (...) conclusion that these patients would be better off having life-sustaining treatment withdrawn, and in fact, it may be possible for these patients to retain a passable level of well-being. I suggest that further research into the subjective experiences of these patients will allow us to better promote their well-being. (shrink)

This chapter contains sections titled: Does Feminism Discriminate against Men? Are Men Worse off than Women? Taking the Second Sexism Seriously Conclusion.

What is the relation between monetary policy and inequalities in income and wealth? This question has received insufficient attention, especially in light of the unconventional policies introduced since the 2008 financial crisis. The article analyzes three ways in which the concern central banks show for inequalities in their official statements remains incomplete and underdeveloped. First, central banks tend to care about inequality for instrumental reasons only. When they do assign intrinsic value to containing inequalities, they shy away from trade-offs (...) with the standard objectives of monetary policy that such a position entails. Second, central banks play down the causal impact monetary policy has on inequalities. When they do acknowledge it, they defend their actions by claiming that it is an unintended side effect, that it is temporary, and/or that any alternative policy would fare even worse. The article appeals to the doctrine of double effect to criticize these arguments. Third, even if one accepts that inequalities should be contained and that today’s monetary policies exacerbate them, is it both desirable and feasible to make containing inequalities part of the mandate of central banks? The article analyzes and rejects three attempts on the part of central banks to answer this question negatively. (shrink)

The COVID-19 pandemic has generated an imbalance between the clinical needs of the population and the effective availability of advanced life support (ALS) resources. Triage protocols have thus become necessary. Triage decisions in situations of scarce resources were not extraordinary in the pre-COVID-19 era; these protocols abounded in the context of organ transplantation. However, this prior experience was not considered during the COVID-19 outbreak in Spain. Lacking national guidance or public coordination, each hospital has been forced to put forth independent (...) and autonomous triage protocols, most of which were, nonetheless, based on common ethical principles and clinical criteria. However, controversial, non-clinical criteria have also been defended by Spanish scientific societies and public institutions, including setting an age cut-off value for unilaterally withholding ALS, using ‘social utility’ criteria, prioritising healthcare professionals or using ‘first come, first served’ policies. This paper describes the most common triage criteria used in the Spanish context during the COVID-19 epidemic. We will highlight our missed opportunities by comparing these criteria to those used in organ transplantation protocols. The problems posed by subjective, non-clinical criteria will also be discussed. We hope that this critical review might be of use to countries at earlier stages of the epidemic while we learn from our mistakes. (shrink)

ABSTRACTThe present study assessed the extent to which culture impacts the emotion-induced memory trade-off effect. This trade-off effect occurs because emotional items are better remembered than neutral ones, but this advantage comes at the expense of memory for backgrounds such that neutral backgrounds are remembered worse when they occurred with an emotional item than with a neutral one. Cultures differ in their prioritisation of focal object versus contextual background information, with Westerners focusing more on objects and Easterners focusing more (...) on backgrounds. Americans, a Western culture, and Turks, an Eastern-influenced culture, incidentally encoded positive, negative, and neutral items placed against neutral backgrounds, and then completed a surprise memory test with the items and backgrounds tested separately. Results revealed a reduced trade-off for Turks compared to Americans. Although both groups exhibited an emotional enhancement in item memory, Turks did not show a decrement in memory... (shrink)

Some people are worse off than others. Does this fact give rise to moral concern? Egalitarianism claims that it does, for a wide array of reasons. It is one of the most important and hotly debated problems in moral and political philosophy, occupying a central place in the work of John Rawls, Thomas Nagel, G. A. Cohen and Derek Parfit. It also plays an important role in practical contexts such as the allocation of health care resources, the design of (...) education and tax systems, and the pursuit of global justice. Egalitarianism is a superb introduction to the problem of contemporary egalitarian theories. It explains how rival theories of egalitarianism evaluate distributions of people’s well-being, and carefully assesses the theoretical structure of each theory. It also examines how egalitarian theories are applied to the distribution of health and health care, thus bringing a deceptively complex philosophical debate into clear focus. Beginning with a brief introduction to basic terminology, Iwao Hirose examines the following topics: Rawlsian egalitarianism luck egalitarianism telic egalitarianism prioritarianism sufficientarianism equality and time equality in health and health care. Including chapter summaries, annotated further reading and a glossary, this is an ideal starting point for anyone studying distributive justice for the first time, and will also be of interest to more advanced students and researchers in philosophy, economics, political theory, public policy, and public health. (shrink)

For the last thirty years or so, there has been a search underway for a theory that can accommodate our intuitions in regard to moral duties to future generations. The object of this search has proved surprisingly elusive. The classical moral theories in the literature all have perplexing implications in this area. Classical Utilitarianism, for instance, implies that it could be better to expand a population even if everyone in the resulting population would be much worse off than in (...) the original. The main problem has been to find an adequate population theory, that is, a theory about the moral value of states of affairs where the number of people, the quality of their lives, and their identities may vary. Since, arguably, any reasonable moral theory has to take these aspects of possible states of affairs into account when determining the normative status of actions, the study of population theory is of general import for moral theory. A number of theories have been proposed in the literature that purport to avoid counterintuitive implications such as the one mentioned above. The suggestions are diverse: introducing novel ways of aggregating welfare into a measure of value, revising the notion of a life worth living, questioning the way we can compare and measure welfare, counting people’s welfare differently depending on the temporal location or the modal features of their lives, and challenging the logic of axiological and normative concepts. We investigate the concepts and assumptions involved in these theories as well as their implications for population theory. In our discussion, we propose a number of intuitively appealing and logically weak adequacy conditions for an acceptable population theory. Finally, we consider whether it is possible to find a theory that satisfies all of these conditions. We prove that no such theory exists. (shrink)

Politics, Philosophy & Economics, Volume 21, Issue 2, Page 122-164, May 2022. I argue that the consensus view that one must never level down to equality gives rise to a dilemma. This dilemma is best understood by examining two parallel cases of leveling down: one drawn from the economic domain, the other from the political. In the economic case, both egalitarians and non-egalitarians have resisted the idea of leveling down wages to equality. With no incentives for some people to work (...) hard social productivity will likely decline, further lowering people's wages and thus leaving everybody all-things-considered worse off as a result—hence “never level down.” On the other hand, however, the argument against leveling down does not appear to pass muster in the political sphere: denying political equality in the form of “one person, one vote”, for example, by giving a higher share of voting power to people with, say, more education seems straightforwardly objectionable, even if such a voting scheme would improve the outcomes of all people, including those who are ultimately left with fewer votes. Thus, a fundamental tension arises: we can either endorse the widely-affirmed “never-level-down” thesis, which says that sacrificing people's well-being exclusively for the sake of promoting equality can never be the right thing to do, or we can endorse the principle of “one person, one vote.” But we cannot do both. I defend this dilemma against a view I call the compatibility view: roughly, that because OPOV is strictly necessary to advance some weighty, non-egalitarian interest people have, accepting OPOV as a principle of justice is compatible with one's rejection of leveling down. (shrink)

Positional goods are goods whose relative amount determines their absolute value. Many goods appear to have positional aspects. For example, one’s relative standing in the distribution of education and wealth may determine one’s absolute condition with respect to goods like employment opportunities, self-respect, and social inclusion. Positional goods feature in recent arguments from T.M. Scanlon, Brian Barry, and Harry Brighouse and Adam Swift that assert that we should favor egalitarian distributions of positional goods even if we reject equality as a (...) fundamental principle of distributive justice. With respect to positional goods, worsening the better off is required to better the worse off. Thus, we have reason to “level down” goods such as education and wealth in order to benefit those worse off with respect to the value of those goods. I argue that the allegedly positional aspects of the goods in question are not actually positional. Moreover, leveling down these goods risks self-defeat: it may produce a net decrease in the value of the shares of individuals with less of such goods. If so, leveling down measures would fail on their own terms. (shrink)

While morality prohibits us from creating miserable children, it does not require us to create happy children. I offer an actualist explanation of this apparent asymmetry. Assume that for every possible world W, there is a distinct set of permissibility facts determined by the welfare of those who exist in W. Moral actualism says that actual-world permissibility facts should determine one's choice between worlds. But if one doesn't know which world is actual, one must aim for subjective rightness and maximize (...) expected actual-world permissibility. So, because one should expect actual people to be worse off than they could have been if one creates a miserable child, creating a miserable child is subjectively impermissible. And because one should expect actual people to be at least as well off as they could have been if one fails to create a happy child, failing to create a happy child is subjectively permissible. (shrink)

Principles of need are constantly referred to in health care priority setting. The common denominator for any principle of need is that it will ascribe some kind of special normative weight to people being worse off. However, this common ground does not answer the question how a plausible principle of need should relate to the aggregation of benefits across individuals. Principles of need are sometimes stated as being incompatible with aggregation and sometimes characterized as accepting aggregation in much the (...) same way as utilitarians do. In this paper we argue that if one wants to take principles of need seriously both of these positions have unreasonable implications. We then characterize and defend a principle of need consisting of sufficientarian elements as well as prioritarian which avoids these unreasonable implications. (shrink)

In this paper, I consider the problem of omission for the counterfactual comparative account of harm. A given event harms a person, on this account, when it makes her worse off than she would have been if it had not occurred. The problem arises because cases in which one person merely fails to benefit another intuitively seem harmless. The account, however, seems to imply that when one person fails to benefit another, the first thereby harms the second, since the (...) second person would have been better off if the first had benefited her. I argue that the cases of failing to benefit at issue are in fact cases of harming. They are cases of preventive harm. I also argue that we can explain away the intuition that no harm occurs in these cases, and that the relevant implication of the counterfactual comparative account is consistent with a variety of plausible views about the moral significance of harm. (shrink)

A natural way of viewing compensation is to see it as the restoration of a good or level of well-being which someone would have enjoyed if he had not been adversely affected by the act of another. This view underlies Nozick’s assertion that “something fully compensates … person X for Y’s action A if X is no worse off receiving it, Y having done A, than X would have been without receiving it if Y had not done A”; and (...) it has been held by many others as well. Because the notion that compensation is the restoration of a good which a person would have had but for the act of another is so pervasive, I shall refer to it as the official view of compensation. One noteworthy feature of the official view is the ease with which it allows compensation to be justified in particular cases. If compensation is just the restoration of a good which one would have had if the ordinary course of things had not been disrupted, then to provide a prima facie justification of it, one need only argue that the natural course of things should not have been disrupted in the first place. (shrink)

I propose an analysis of harm in terms of causation: harm is when a subject is caused to be worse off. The pay-off from this lies in the details. In particular, importing influential recent work from the causation literature yields a contrastive-counterfactual account. This enables us to incorporate harm's multiple senses into a unified scheme, and to provide that scheme with theoretical ballast. It also enables us to respond effectively to previous criticisms of counterfactual accounts, as well as to (...) sharpen criticisms of rival views. (shrink)

When thinking about population level healthcare priority setting decisions, such as those made by the National Institute for Health and Care Excellence, good medical ethics requires attention to three main principles of health justice: (1) cost-effectiveness, an aspect of beneficence, (2) non-discrimination, and (3) priority to the worse off in terms of both current severity of illness and lifetime health. Applying these principles requires consideration of the identified patients who benefit from decisions and the unidentified patients who bear the (...) opportunity costs. (shrink)

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)

Reading these essays has shown me a great deal, both about the substantive issues I have dealt with and about how to do philosophy. On the former front, they show that I have missed some points and overstated others, and sometimes just been unable to penetrate the fog. On the latter front, they show how hard it is to write philosophy that works--and this is the point that stands out for me as I reflect on these rich and varied essays. (...) Philosophical books and articles routinely fail to achieve their manifest goal of persuading their intended audiences of their main points. Does this make philosophy any worse off than other writing endeavors? Most published novels are failures of one sort or another, and the press has reported a recent study (whose methodology I wonder about) that concludes that the median number of readers of any paper published in a psychology journal is zero. But it seems to me that philosophy displays a particularly feckless record, with such a huge gap between authorial pretense and effect achieved that it is perhaps more comic than pathetic. In one weak moment I found myself thinking that perhaps some of our French colleagues have the right idea: deliberate obscurantism and the striking of stylized poses--since the goal of persuading by clear, precise analysis and argument is so manifestly beyond us. But that worldly weariness passed, I'm happy to say, and my cock-eyed American optimism returned. My ambition continues to be to change people's minds, and not just to win people over to my way of doing philosophy, as Bo Dahlbom suggests. But I admit that it is harder than I had thought. It's hard enough to get a good idea, but sometimes it's even harder, apparently, to get others to see what the idea is, and why it's good. (shrink)

RATIONAL ALTRUISM. A PRUDENTIAL THEORY OF RATIONALITY AND ALTRUISM - STRUCTURE: "Rational altruism" is the attempt to develop and rationally justify moral principles - with a very strong emphasis on this justification. The concept of justification is developed in a metaethical part (ch. 2); it requires recourse to prudential decisions and to information about our decision-making procedures. The actual normative ethics (Ch. 6 and especially 7) is therefore still based on a prudential desirability theory (Ch. 4 and Sections 5.5-5.6) and (...) this in turn on an empirical action theory (Ch. 3 and Sections 5.1-5.4). - METAETHICS (Ch. 2): In the metaethical part of the book, conditions of adequacy for cogent moral justifications are first developed and justified, which demand, among other things, an information-stable motivation through cogent moral justifications (internalist moral justification). After an examination of various approaches to justification in ethics with regard to this adequacy condition and the negative outcome of this examination, an alternative solution strategy is presented. Among other things, the rationality requirements of profane rational reasoning approaches in ethics are to be systematically reinforced by a prudential desirability theory that aims at information-stable evaluations. - EMPIRICAL THEORY OF ACTION (Chapter 3 and Sections 5.1-5.4): The empirical theory of action developed here therefore provides a detailed analysis of the regularities and leeway of our decisions, especially the influence of information on decision-making paths. - PRUDENTIAL DESIRABILITY THEORY (Chapter 4 and Sections 5.5-5.6): In the prudential desirability theory, the 'individual desirability' of events, especially actions, is then defined in such a way that, of the various evaluation possibilities, the one that is stable in terms of information is always chosen. This procedure far exceeds the rationality requirements of rational decision theory, for example. - NORMATIVE ETHICS (chap. 6 and especially 7): Finally, in the actual normative ethics, a prioritarian standard for the moral evaluation of actions, norms and entire social orders is developed, called "Utilex". Utilex is based on compassion and, like compassion, is partial to the worse off, the poor and unfortunate, but without neglecting the interests of the better off. (shrink)

Prioritarianism is an ethical theory that gives extra weight to the well-being of the worse off. In contrast, dominant policy-evaluation methodologies, such as benefit-cost analysis, cost-effectiveness analysis, and utilitarianism, ignore or downplay issues of fair distribution. Based on a research group founded by the editors, this important book is the first to show how prioritarianism can be used to assess governmental policies and evaluate societal conditions. This book uses prioritarianism as a methodology to evaluate governmental policy across a variety (...) of policy domains: taxation, health policy, risk regulation, education, climate policy, and the COVID-19 pandemic. It is also the first to demonstrate how prioritarianism improves on GDP as an indicator of a society's progress over time. Edited by two senior figures in the field with contributions from some of the world's leading economists, this volume bridges the gap from the theory of prioritarianism to its practical application. (shrink)

This paper argues that we can benefit or harm people by creating them, but only in the sense that we can create things that are good or bad for them. What we cannot do is to confer comparative benefits and harms to people by creating them or failing to create them. You are not better off (or worse off) created than you would have been had you not been created, for nothing has value for you if you do not (...) exist, not even neutral value. (shrink)

Philosophical discussions of prioritarianism, the view that we ought to give priority to those who are worse off, have hitherto been almost exclusively focused on cases involving a fixed population. The aim of this paper is to extend the discussion of prioritarianism to encompass also variable populations. I argue that prioritarianism, in its simplest formulation, is not tenable in this area. However, I also propose several revised formulations that, so I argue, show more promise.

When discussing exploitation, we often say things like this, “sweatshop laborers have terrible working conditions and are paid almost nothing, but they are better off with that labor than with no labor.” Similarly, in describing the Non-Identity Problem, Derek Parfit points out: we cannot say that the individuals born in future generations are worse off because of our destructive environmental policies because the particular people living in those future generations wouldn’t even exist if it were not for these destructive (...) policies. How can we explain these cases, exploitation and environmental destruction, as ones of wrongdoing when the victims in both cases are no worse off than they would have otherwise been? This paper investigates the link between these two moral puzzles and ultimately uses one to solve the other: an exploitation solution to the Non-Identity Problem. (shrink)

We tell a story where an agent who chooses in such a way as to make the greatest possible profit on each of an infinite series of transactions ends up worse off than an agent who chooses in such a way as to make the least possible profit on each transaction. That is, contrary to what one might suppose, it is not necessarily rational always to choose the option that yields the greatest possible profit on each transaction.

This article sets out the moral failure of single-tier basic healthcare. Single-tier basic healthcare has been advocated on the grounds that the provision of healthcare should be divorced from ability to pay and unequal access to basic healthcare is morally intolerable. However, single-tier basic healthcare encounters a host of catastrophic moral failings. Given the fact of human pluralism it is impossible to objectively define “basic” healthcare. Attempts to provide single-tier healthcare therefore become political processes in which interest groups compete for (...) control of scarce resources with the most privileged possessing an inherent advantage. The focus on outputs in arguments for single-tier provision neglects the question of justice between individuals when some people provide resources for others without reciprocal benefits. The principle that only healthcare that can be provided to everyone should be provided at all leads to a leveling-down problem in which advocates of single-tier provision must prefer a situation where some individuals are made worse-off without any individual being made better-off compared to plausible multi-tier alternatives. Contemporary single-tier systems require the exclusion of noncitizens, meaning that their universalism is a myth. In the light of these pathologies, it is judged that multi-tier healthcare is morally required. (shrink)

Derek Parfit has argued that egalitarianism is exposed to a levelling down objection because it implies, implausibly, that a change, which consists only in the better-off sinking to the level of the worse-off, is in one respect better, though it is better for nobody. He claims that, in contrast, the prioritarian view that benefits to the worse-off have greater moral weight escapes this objection. This article contends, first, that prioritarianism is equally affected by the levelling down objection as (...) is egalitarianism, but that this objection lacks force. Secondly, prioritarianism is less plausible than egalitarianism because it implies that lowering the level of equality by diffusing a quantity of welfare equally over as many recipients as possible is for the better all things considered, and that the outcome of such welfare diffusion would still be better in one respect, even if the quantity of welfare was radically reduced. (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)

In a series of excellent, recent papers, Deborah Hellman expounds the intuitively appealing idea that we have a duty not to compound injustice. Roughly, one compounds injustice when facts that obtain as a result of prior injustice form part of one’s reason for imposing further disadvantages on the victims of this prior injustice. This article identifies several complexities and problems motivating various amendments to Hellman’s formulation of the duty not to compound injustice. Critically, it argues that the intuitions she and (...) others have sought to explain in terms of the duty not to compound injustice are better explained by the duty not to cause additional harm to people who are already unjustly worse off – perhaps in conjunction with a duty not to implicate ourselves in injustice. (shrink)