Healthy Nails versus Long Lives: An Analysis of a Dutch Priority Setting Proposal

How should governments balance saving people from very large individual disease burdens (such as an early death) against saving them from middling burdens (such as erectile dysfunction) and minor burdens (such as nail fungus)? This chapter considers this question through an analysis of a priority-setting proposal in the Netherlands, on which avoiding a multitude of middling burdens takes priority over saving one person from early death, but no number of very small burdens can take priority over avoiding one death. It argues that there is some, albeit imperfect, evidence of substantial public support for such a policy. Furthermore, it provides a principled rationale for it in terms of respect for the person who faces the largest burden

Why inequality matters: luck egalitarianism, its meaning and value.

I review Shlomi Segall's book 'Why Inequality Matters'. I argue that it conclusively establishes that alongside egalitarians, prioritarians and sufficientarians must sometimes regard a prospect as better (in at least one respect) when it is not better (in terms of well-being) for anyone. Sufficientarians and prioritarians must therefore relinquish a treasured anti-egalitarian argument. It also makes a powerful case that among these three views, egalitarians are in the best position to explain such departures from what is in each person’s prudential interest. For egalitarians can point to the natural idea that it is unfair when, due to pure chance, some fare much better than others. By contrast, it remains unclear what value, if any, sufficientarians or prioritarians can appeal to in order to justify their departures from what best promotes people’s well-being

Why Health-Related Inequalities Matter and Which Ones Do

I outline and defend two egalitarian theories, which yield distinctive and, I argue, complementary answers to why health-related inequalities matter: a brute luck egalitarian view, according to which inequalities due to unchosen, differential luck are bad because unfair, and a social egalitarian view, according to which inequalities are bad when and because they undermine people’s status as equal citizens. These views identify different objects of egalitarian concern: the brute luck egalitarian view directs attention to health-related well-being, while social egalitarianism focuses on health-related capabilities that are central to a person’s status as a citizen. I argue that both views are correct and should jointly guide priority-setting in health

Balancing small against large burdens

Common principles for resource allocation in health care can prioritize the alleviation of small health burdens over lifesaving treatment. I argue that there is some evidence that these principles are at odds with a sizable share of public opinion, which holds that saving a life should take priority over any number of cures for minor ailments. I propose two possible explanations for this opinion, one debunking and one vindicatory. I also outline how well-designed surveys and moral inquiry could help decide between them. Finally, I consider how priority-setting principles could be adjusted if the view that saving a life always trumps alleviating small burdens were vindicated

Transitivity, the Sorites Paradox, and Similarity-Based Decision-Making

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Similarity and the trustworthiness of distributive judgements

When people must either save a greater number of people from a smaller harm or a smaller number from a greater harm, do their choices reflect a reasonable moral outlook? We pursue this question with the help of an experiment. In our experiment, two-fifths of subjects employ a similarity heuristic. When alternatives appear dissimilar in terms of the number saved but similar in terms of the magnitude of harm prevented, this heuristic mandates saving the greater number. In our experiment, this leads to choices that are inconsistent with all standard theories of justice. We argue that this demonstrates the untrustworthiness of distributive judgments in cases that elicit similarity-based choice

The pleasures of tranquillity

Epicurus posited that the best life involves the greatest pleasures. He also held that it involves attaining tranquillity. Many commentators, including Ken Binmore, have expressed scepticism that these two claims are compatible. For, they argue, Epicurus’ tranquil life is so austere that it is hard to see how it could be maximally pleasurable. Here, I offer an Epicurean account of the pleasures of tranquillity. I also consider different ways of valuing lives from a hedonistic point of view. Benthamite hedonists value lives by the sum of pleasures minus the sum of pains, weighted by intensity and duration. Meanwhile, Binmore proposes that Epicurus valued lives by their worst episode. In contrast, I outline an Epicurean argument for why the best life is one in which a person attains tranquillity and tastes its pleasures until death

May a Government Mandate More Comprehensive Health Insurance than Citizens Want for Themselves?

I critically examine a common liberal egalitarian view about the justification for, and proper content of, mandatory health insurance. This view holds that a mandate is justified because it is the best way to ensure that those in poor health gain health insurance on equitable terms. It also holds that a government should mandate what a representative prudent individual would purchase for themselves if they were placed in fair conditions of choice. I argue that this common justification for a mandate is incomplete. A further reason for mandated insurance is that it helps secure social egalitarian public goods that would be underprovided if insurance were optional. I also argue that rather than mandating what a representative individual would choose for themselves, we should design the mandatory package by appealing to a pluralistic egalitarian view, which cares about improving people’s well-being, reducing unfair inequality, and maintaining egalitarian social relations

Book review: Shlomi Segall, why inequality matters: luck egalitarianism, its meaning and value, Cambridge University Press, 2016, 256 + x pp., $99.00 (hbk), ISBN 9781107129818.

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