Priority and Prioritarianism

I offer a new style of argument that supports either utilitarianism or instances of the expected equally distributed equivalent version of prioritarianism (EEDE). The central idea is that the value the welfarist assigns to a state of the world should not lie unnecessarily far from the utilities of the individuals who exist at that state. I describe various ways we might measure distance from a candidate value to the individuals' utilities, characterize a family of such measures, and explain which versions (...) of welfarism follow when we use them. For some, it's utilitarianism; for others, it's different instances of EEDE. (shrink)

In societies where rewards attached to positions of advantage generate excessive inequalities, the generally endorsed principle of fair equality of opportunity for such positions does not apply. There are no claims to equal opportunities for positions that are banned by justice. I argue that the various considerations supportting the principle of fair equality of opportunity in just societies do not vidicate it in unjust ones. This entails that widely shared beliefs about, for instance, reasons to discourage some forms of parental (...) partiality or to wellcome social mobility are miguided insofar as current societies are in fact unjust. I also breach the question of what distributive justice requires in such societies; even in unjust circumstances there might be claims grounded in principles of need or of luck egalitarian equal opportunities, whose validity does not depend on schedules of rewards. (shrink)

According to prioritarianism, benefiting a person is more morally important, the worse off this person is. This view seems plausible: good as it is to give a large benefit to a person, it seems better to give a slightly smaller benefit to someone else who is substantially worse off. Nonetheless, I argue that it is difficult for prioritarianism to avoid giving implausibly extreme priority to the extremely worse off. It is difficult for the view to avoid the counterintuitive implication that (...) it is better to give a tiny benefit to one badly off person than to give a very large benefit to another badly off person, if the first person is sufficiently worse off than the second. I present a version of prioritarianism that avoids this implication, but it is unclear whether it can be given a plausible rationale. (shrink)

Prioritarianism is claimed to fare badly in variable-population comparisons. This is so, I argue, because it is understood as Absolute Prioritarianism, as invoking an increasing, strictly concave function of absolute welfare. That misunderstands Parfit’s Priority View by considering the absolute welfare rather than the welfare gains and losses. Therefore, it implies a super-repugnant conclusion and the desirability of welfare diffusion by creating people. However, both implications are implausible – at least if we reject that people can be better off by (...) coming into existence. I present an alternative – Comparative Prioritarianism – which is concerned only with individual gains and losses. I argue that this avoids the implausible implications, it can be supplemented with further principles that solve the problems of population ethics, and it prevents cyclical orderings if we adopt a set-wise approach to comparing outcomes. Therefore, Comparative Prioritarianism is better suited to capture the core intuition of the Priority View. (shrink)

A wide range of governmental policies characteristic of the modern state seek to reduce individuals’ fatality risks—risks that arise from air and water pollution, pathogens, food ingredients and contaminants, motor vehicles, infrastructure, radiation, workplace accidents, alcohol and recreational drugs, firearms, consumer products, tobacco, natural disasters, and other sources. This book provides a rigorous treatment of the ethics of fatality risk regulation. It does so through the lens of welfare-consequentialism—specifically, lifetime welfarism, with a focus on utilitarianism and prioritarianism. The ethical ranking (...) of possible worlds depends on the patterns of lifetime well-being in the worlds. Premature death is ethically significant just so insofar as it changes the lifetime well-being of the person who dies and perhaps others. At the level of policy choice, the book deploys the social-welfare-function (SWF) framework—the most systematic decision-procedure for implementing lifetime welfarism. The book demonstrates how the SWF methodology can be brought to bear in assessing risk-regulation policies. Each individual faces a policy-specific lottery over lifetime well-being, as determined by their risk profile (probability of surviving the current year and future years) and attribute profile (the attributes the individual will have in the current year and future years if alive rather than dead). In short, a policy corresponds to an array of individual risk and attribute profiles, which can then be assigned a utilitarian or prioritarian value. The SWF methodology as thus applied to risk regulation differs quite substantially from cost-benefit analysis (CBA), which is currently the dominant policy-assessment methodology in governmental practice. (shrink)

This article develops a fairness-based criticism of the UK’s policy of promoting free admissions at major museums. With a focus on geographic inequalities and per-capita museums spending, I argue that free admissions can be a surprisingly bad way of promoting cultural opportunities for disadvantaged groups. My criticism emphasises the fact that free admissions consume resources without necessarily providing targeted benefits to disadvantaged groups and addressing background inequalities. Given that museums vary in their location, visitor profile, and operating costs, this critique (...) does not apply to all museums. It applies to the largest and most popular museums in the most advantaged areas, which can expect to keep drawing significant numbers while charging. If we are aiming to prioritise the interests of less advantaged groups, we should be in favour of charging at London’s major museums, to finance “levelling up” across regions, and more direct access-promoting measures in targeted outreach, collaboration, and programming. (shrink)

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

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

Some philosophers and segments of the public think age is relevant to healthcare priority-setting. One argument for this is based in equity: “Old” patients have had either more of a relevant good than “young” patients or enough of that good and so have weaker claims to treatment. This article first notes that some discussions of age-based priority that focus in this way on old and young patients exhibit an ambiguity between two claims: that patients classified as old should have a (...) low priority, and that patients classified as young should have high priority. The author next argues, drawing on a problem raised by Christine Overall, that equity cannot justify giving “old” patients low priority, since there is wide variety in the total lifetime experiences of older people, partly influenced by gender, race, class, and disability injustice. Finally, the author suggests that there might be a limited role for age-based prioritization in the context of infant and childhood death, since those who die in childhood are always and uncontroversially among the worst-off. (shrink)

The COVID-19 pandemic has helped to clarify the fair and equitable allocation of scarce medical resources, both within and among countries. The ethical allocation of such resources entails a three-step process: (1) elucidating the fundamental ethical values for allocation, (2) using these values to delineate priority tiers for scarce resources, and (3) implementing the prioritisation to faithfully realise the fundamental values. Myriad reports and assessments have elucidated five core substantive values for ethical allocation: maximising benefits and minimising harms, mitigating unfair (...) disadvantage, equal moral concern, reciprocity, and instrumental value. These values are universal. None of the values are sufficient alone, and their relative weight and application will vary by context. In addition, there are procedural principles such as transparency, engagement, and evidence-responsiveness. Prioritising instrumental value and minimising harms during the COVID-19 pandemic led to widespread agreement on priority tiers to include health-care workers, first responders, people living in congregate housing, and people with an increased risk of death, such as older adults and individuals with medical conditions. However, the pandemic also revealed problems with the implementation of these values and priority tiers, such as allocation on the basis of population rather than COVID-19 burden, and passive allocation that exacerbated disparities by requiring recipients to spend time booking and travelling to appointments. This ethical framework should be the starting point for the allocation of scarce medical resources in future pandemics and other public health conditions. For instance, allocation of the new malaria vaccine among sub-Saharan African countries should be based not on reciprocity to countries that participated in research, but on maximally reducing serious illness and deaths, especially among infants and children. (shrink)

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

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

In this essay I argue that even though egalitarianism and prioritarianism are different theories of social welfare, they can use the same social welfare measures. I present six different arguments for this thesis. The first argument is that conceptual connections between egalitarianism and prioritarianism ensure that any measure that works for either theory works for both. The second argument is that conditions necessary and sufficient to identify egalitarian and prioritarian measures, respectively, are equivalent. The third argument is that both egalitarianism (...) and prioritarianism can use two standard measures, typically proposed for only one theory. The fourth to sixth arguments contend that four properties that have been proposed as distinctive of either egalitarian or prioritarian measures cannot distinguish between them. I conclude that any egalitarian measure is also a prioritarian measure, and vice versa. (shrink)

Aiming at the allocation of scarce medical resources, Immanuel and other scholars have put forward a set of influential ethical values and guiding principles. It assigns the priority of resource allocation to those whose lives can be saved and maximized, those who can bring the greatest instrumental value, and those who are the worse off. For other members of society, random selection under the same conditions is adopted. Following the Rawlsian "lexical order, lexicographical" rule, this priority arrangement requires that the (...) "utilitarian principle" should be placed before the "equality principle", and the "instrumental difference principle", the "integrity difference principle" and the "fair opportunity principle" in turn acts on specific distribution agents. Although the framework and its priority rules have obvious drawbacks when faced with Medical Resources Squeeze and other dilemmas, with the help of an understanding of its internal structure, it can effectively respond to the four core issues in the allocation of scarce medical resources. (shrink)

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

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

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

The U.S. FDA has issued emergency use authorizations for monoclonal antibodies for non-hospitalized patients with mild or moderate COVID-19 disease and for individuals exposed to COVID-19 as post-exposure prophylaxis. One EUA for an oral antiviral drug, molnupiravir, has also been recommended by FDA’s Antimicrobial Drugs Advisory Committee, and others appear likely in the near future. Due to increased demand because of the Delta variant, the federal government resumed control over the supply and asked states to ration doses. As future variants (...) with increased infectivity and/or severity emerge, further rationing may be required. We identify relevant ethical principles and priority groups for access to therapies based on an integrated approach to population health and medical factors. Using priority categories to allocate scarce therapies effectively operationalizes important ethical values. This strategy is preferable to the current approach of categorical rules based on vaccination, immunocompromise status, or older age, or the ad hoc consideration of clinical risk factors. (shrink)

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

A half-century of Rawls interpreters have overemphasized economic equality in A Theory of Justice, slighting liberty—the central value of liberalism—in the process. From luck-egalitarian readings of Rawls to more recent claims that Rawls was a “reticent socialist,” these interpretations have obscured Rawls’s identity as a philosopher of freedom. They have also obscured the perhaps surprising fact that Rawlsian liberties (basic and non-basic) restrain and even undermine that same economic equality. As I will show in this article, such undermining occurs in (...) three areas: first, in the lexical priority of the basic liberties; second, in the (underappreciated) role played by free and competitive markets in Rawls’s theory; and third, in the structure and functioning of Rawls’s preferred economic institutions, viz., liberal socialism and property-owning democracy. (shrink)

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

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

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

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

Proposals for allocating scarce lifesaving resources in the face of the Covid-19 pandemic have aligned in some ways and conflicted in others. This paper attempts a kind of priority setting in addressing these conflicts. In the first part, we identify points on which we do not believe that reasonable people should differ—even if they do. These are (i) the inadequacy of traditional clinical ethics to address priority-setting in a pandemic; (ii) the relevance of saving lives; (iii) the flaws of first-come, (...) first-served allocation; (iv) the relevance of post-episode survival; (v) the difference between age and other factors that affect life-expectancy; and (vi) the need to avoid quality-of-life judgments. In the second part, we lay out some positions on which reasonable people can and do differ. These include (i) conflicts between maximizing benefits and priority to the worst off; (ii) role-based priority; and (iii) whether patients’ existing lifesaving resources should be subject to redistribution. (shrink)

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

This chapter argues that rather than viewing transparency as a right, we should regard it as a finite resource whose allocation involves tradeoffs. It then argues that those tradeoffs should be resolved by using a multi-principle approach to distributive justice. The relevant principles include maximizing welfare, maximizing autonomy, and giving priority to the worst off. Finally, it examines some of the implications for law of recognizing the tradeoffs presented by transparency proposals.

Many assume that theories of distributive justice must obviously take people’s lifetimes, and only their lifetimes, as the relevant period across which we distribute. Although the question of the temporal subject has risen in prominence, it is still relatively underdeveloped, particularly in the sphere of health and healthcare. This paper defends a particular view, “momentary sufficientarianism,” as being an important element of healthcare justice. At the heart of the argument is a commitment to pluralism about justice, where theorizing about just (...) principles demands paying attention to the role particular goods play in our lives. This means that different approaches to the temporal subject—as well as other relevant issues—may be appropriate for different goods, including different goods within healthcare. In particular, the paper discusses two central goods targeted by healthcare: life-saving and pain relief. The view is offered as complementary to, rather than competitive with, lifetime approaches. As such, the paper finishes by considering how a pluralist approach, which engages both with people’s lives as a whole and with their states at particular moments, can reconcile the potentially competing claims in healthcare that emerge from these two perspectives. (shrink)

The phenomenon of corruption is a cancer that affects our country and that it is necessary to eradicate; This dilutes the opportunities for economic and social development, privileging the single conjunction of particular interests, political actors in non-legal agreements for their own benefit, which lead to acts of corruption. Recent studies indicate that the level of corruption present in a political system is directly related to the type of institutional structure that defines it (Boehm and Lambsdorff, 2009), as well as (...) the ineffectiveness of the control organisms (Casar, 2015; Cárdenas, 2010, Rojas, 2010, Carbonell, 2009, Restrepo, 2004), which requires citizen action to combat corruption (Sandoval, 2010, Villanueva, 2006). This work, focuses our attention on the federal public administration, presenting as a proposal to empower the citizen action in the fight against corruption and in the National Anticorruption System; the figure of Whistleblowers or generator of citizen alert, based on two fundamental principles: i) recognizing the citizen's obligation to report acts of corruption and ii) the granting by the authority of witness protection. These two actions will result in two important results: i) Consolidate the citizen's complaint to inform society about acts of corruption and ii) and the exercise of freedom of information so that society is able to be informed about acts of corruption. These actions will allow promoting and consolidating a culture of reporting acts of corruption that may constitute a crime as a fundamental pillar in the National Anticorruption System in Mexico. (shrink)

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

Our Viewpoint argues that expanding access to less effective or more toxic treatments is supported not only by utilitarian ethical reasoning but also by two other ethical frameworks: those that emphasise equality and those that emphasise giving priority to the patients who are worst off. The inadequate resources available for global health reflect not only natural constraints but also unwise social and political choices. However, pitting efforts to reduce inequality and better fund global health against efforts to put available resources (...) to their best use mistakes complementary objectives for conflicting ones. (shrink)

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

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

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

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

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

We consider an ethical dilemma in global health: is it ethically acceptable to provide some patients cheaper treatments that are less effective or more toxic than the treatments other patients receive? We argue that it is ethical to consider local resource constraints when deciding what interventions to provide. The provision of cheaper, less effective health care is frequently the most effective way of promoting health and realizing the ethical values of utility, equality, and priority to the worst off.

Shlomi Segall’s Why Inequality Matters contains many novel ideas. It should engage researchers with an interest in debates between luck egalitarians and two of their principal opponents, prioritarians and sufficientarians. While, as I shall argue below, not all of its arguments succeed, it also makes contributions which deserve to profoundly influence debates on distributive justice. I proceed as follows. In Section 1, I summarize the book’s central points; in Section 2, I evaluate some of its arguments.

This chapter explores two questions in detail: How should we determine the threshold for costs that individuals are asked to bear through insurance premiums or care-related out-of-pocket costs, including user fees and copayments? and What is an adequate relationship between costs and benefits? This chapter argues that preventing impoverishment is a morally more urgent priority than protecting households against income fluctuations, and that many health insurance plans may not adequately protect individuals from health care costs that threaten to drop their (...) financial status below a decent minimum. A design that places greater emphasis on preventing impoverishment and finances the achievement of that goal by reducing unnecessary subsidies to better-off households would better accord with a sufficientarian approach to health care. -/- . (shrink)

We reply to critics of the World Health Organisation's Report "Making Fair Choices on the Path to Universal Health Coverage". We clarify and defend the report's key moral commitments. We also explain its role in guiding policy in the face of both financial and political constraints on making fair choices.

Risky prospects represent policies that impose different types of risks on multiple people. I present an example from food safety. A utilitarian following Harsanyi's Aggregation Theorem ranks such prospects according to their mean expected utility or the expectation of the social utility. Such a ranking is not sensitive to any of four types of distributional concerns. I develop a model that lets the policy analyst rank prospects relative to the distributional concerns that she considers fitting in the context at hand. (...) I name this model ‘the Distribution View’ posing an alternative to Parfit's Priority View for risky prospects. (shrink)

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

Greg Bognar has recently offered a prioritarian justification for ‘fair innings’ distributive principles that would ration access to healthcare on the basis of patients' age. In this article, I agree that Bognar's principle is among the strongest arguments for age-based rationing. However, I argue that this position is incomplete because of the possibility of ‘time-relative' egalitarian principles that could complement the kind of lifetime egalitarianism that Bognar adopts. After outlining Bognar's position, and explaining the attraction of time-relative egalitarianism, I suggest (...) various ways in which these two kinds of principle could interact. Since various options have very different implications for age-based rationing, proponents of such a rationing scheme must take a position on time-relative egalitarianism to complement a lifetime prioritarian view like Bognar's. (shrink)

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

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

Policy-makers must sometimes choose between an alternative which has somewhat lower expected value for each person, but which will substantially improve the outcomes of the worst off, or an alternative which has somewhat higher expected value for each person, but which will leave those who end up worst off substantially less well off. The popular ex ante Pareto principle requires the choice of the alternative with higher expected utility for each. We argue that ex ante Pareto ought to be rejected (...) because it conflicts with the requirement that, when possible, one ought to decide as one would with full information. We apply our argument in an analysis of US policy on screening for breast cancer. -/- . (shrink)

Discrimination might be considered unjust on account of the comparative disadvantage it imposes, the absolute disadvantage it imposes, the disrespect it shows, or the prejudice it shows. This article argues that each of these accounts overlooks some cases of unjust discrimination. In response to this state of affairs we might combine two or more of these accounts. A promising approach combines the comparative disadvantage and absolute disadvantage accounts.

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

Michael Otsuka, Alex Voorhoeve and Marc Fleurbaey have challenged the priority view in favour of a theory based on competing claims. The present paper shows how their argument can be used to recast the priority view. All desert claims in distributive justice are comparative. The stronger a party’s claims to a given benefit, the greater is the value of her receiving it. Ceteris paribus, the worse-off have stronger claims on welfare, and benefits to them matter more. This can account for (...) intuitions that at first appear egalitarian, as the analysis of an example of Larry Temkin’s shows. The priority view, properly understood, is desert-adjusted utilitarianism under the assumption that no other claims pertain. (shrink)