Egalitarian justice and expected value

According to all-luck egalitarianism, the differential distributive effects of both brute luck, which defines the outcome of risks which are not deliberately taken, and option luck, which defines the outcome of deliberate gambles, are unjust. Exactly how to correct the effects of option luck is, however, a complex issue. This article argues that (a) option luck should be neutralized not just by correcting luck among gamblers, but among the community as a whole, because it would be unfair for gamblers as a group to be disadvantaged relative to non-gamblers by bad option luck; (b) individuals should receive the warranted expected results of their gambles, except insofar as individuals blamelessly lacked the ability to ascertain which expectations were warranted; and (c) where societal resources are insufficient to deliver expected results to gamblers, gamblers should receive a lesser distributive share which is in proportion to the expected results. Where all-luck egalitarianism is understood in this way, it allows risk-takers to impose externalities on non-risk-takers, which seems counterintuitive. This may, however, be an advantage as it provides a luck egalitarian rationale for assisting ‘negligent victims’

The impact of a physician-staffed helicopter on outcome in patients admitted to a stroke unit: a prospective observational study

Patient characteristics, patients admitted to the stroke unit and diagnosed with stroke. GEMS: ground emergency medical services; HEMS: helicopter emergency medical services; IQR: interquartile range; AMI: acute myocardial infarction. Co-morbidity was defined as having at least one of the following conditions: diabetes, atrial fibrillation, hypertension, previous myocardial infarction, previous stroke. (DOCX 20 kb

Unequally egalitarian? Defending the credentials of social egalitarianism

In his new book, Luck Egalitarianism, Kasper Lippert-Rasmussen responds to challenges raised by social egalitarians against luck egalitarianism. Social egalitarianism is the view according to which a just society is one where people relate to each other as equals, while the basic premise of luck egalitarianism is that it is unfair if people are worse-off than others through no fault or choice of their own. Lippert-Rasmussen argues that the most important objections to luck egalitarianism made by social egalitarians can either be largely accommodated by luck egalitarians or lack the argumentative force that its proponents believe them to have. While Lippert-Rasmussen does offer a version of luck egalitarianism that seems to avoid some of the main lines of criticism, he mischaracterizes parts of both the form and the content of the disagreement, and thus ultimately misses the mark. In this paper, we provide a substantive, a methodological and a political defense of social egalitarianism by elaborating on this mischaracterization. More work must be done, we argue, if social egalitarianism is to be dismissed and its concerns genuinely incorporated in the luck egalitarian framework. Until this is done, the supposed theoretical superiority of luck egalitarianism remains contested

Organ Support Therapy in the Intensive Care Unit and Return to Work in Out-of-Hospital Cardiac Arrest Survivors:a Nationwide Cohort Study

AIM: With increased survival after out-of-hospital cardiac arrest (OHCA), impact of the post-resuscitation course has become important. Among 30-day OHCA survivors, we investigated associations between organ support therapy in the Intensive Care Unit (ICU) and return to work.METHODS: This Danish nationwide cohort-study included 30-day-OHCA-survivors who were employed prior to arrest. We linked OHCA data to information on in-hospital care and return to work. For patients admitted to an ICU and based on renal replacement therapy (RRT), cardiovascular support and mechanical ventilation, we assessed the prognostic value of organ support therapies in multivariable Cox regression models.RESULTS: Of 1,087 30-day survivors, 212 (19.5%) were treated in an ICU with 0-1 types of organ support, 494 (45.4%) with support of two organs, 26 (2.4%) with support of three organs and 355 (32.7%) were not admitted to an ICU. Return to work increased with decreasing number of organs supported, from 53.8% (95% CI: 49.5-70.1%) in patients treated with both RRT, cardiovascular support and mechanical ventilation to 88.5% (95% CI: 85.1-91.8%) in non-ICU-patients. In 732 ICU-patients, ICU-patients with support of 3 organs had significantly lower adjusted hazard ratios (HR) of returning to work (0.50 [95% CI: 0.30-0.85] compared to ICU-patients with support of 0-1 organ. The corresponding HR was 0.48 [95% CI: 0.30-0.78] for RRT alone.CONCLUSIONS: In 30-day survivors of OHCA, number of organ support therapies and in particular need of RRT were associated with reduced rate of return to work, although more than half of these latter patients still returned to work.</p

Home care providers to the rescue:a novel first-responder programme

To describe the implementation of a novel first-responder programme in which home care providers equipped with automated external defibrillators (AEDs) were dispatched in parallel with existing emergency medical services in the event of a suspected out-of-hospital cardiac arrest (OHCA).We evaluated a one-year prospective study that trained home care providers in performing cardiopulmonary resuscitation (CPR) and using an AED in cases of suspected OHCA. Data were collected from cardiac arrest case files, case files from each provider dispatch and a survey among dispatched providers. The study was conducted in a rural district in Denmark.Home care providers were dispatched to 28 of the 60 OHCAs that occurred in the study period. In ten cases the providers arrived before the ambulance service and subsequently performed CPR. AED analysis was executed in three cases and shock was delivered in one case. For 26 of the 28 cases, the cardiac arrest occurred in a private home. Ninety-five per cent of the providers who had been dispatched to a cardiac arrest reported feeling prepared for managing the initial resuscitation, including use of AED.Home care providers are suited to act as first-responders in predominantly rural and residential districts. Future follow-up will allow further evaluation of home care provider arrivals and patient survival

Facts, Principles, and (Real) Politics

Should our factual understanding of the world influence our normative theorising about it? G.A. Cohen has argued that our ultimate normative principles should not be constrained by facts. Many others have defended or are committed to various versions or subsets of that claim. In this paper I dispute those positions by arguing that, in order to resist the conclusion that ultimate normative principles rest on facts about possibility or conceivability, one has to embrace an unsatisfactory account of how principles generate normative political judgments. So political theorists have to choose between principles ostensibly unbiased by our current understanding of human motivation and political reality, or principles capable of reliably generating political judgments. I conclude with wider methodological observations in defence of the latter option, and so of a return to political philosophy’s traditional blend of normative and descriptive elements

Justifying constraints

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