Alex Voorhoeve

EQUALITY OF OPPORTUNITY AND OPPORTUNITY DOMINANCE

All conceptions of equal opportunity draw on some distinction between morally justified and unjustified inequalities. We discuss how this distinction varies across a range of philosophical positions. We find that these positions often advance equality of opportunity in tandem with distributive principles based on merit, desert, consequentialist criteria or individuals’ responsibility for outcomes. The result of this amalgam of principles is a festering controversy that unnecessarily diminishes the widespread acceptability of opportunity concerns. We therefore propose to restore the conceptual separation of opportunity principles concerning unjustified inequalities from distributive principles concerning justifiable inequalities. On this view, equal opportunity implies that that morally irrelevant factors should engender no differences in individuals’ attainment, while remaining silent on inequalities due to morally relevant factors. We examine this idea by introducing the principle of ‘opportunity dominance’ and explore in a simple application to what extent this principle may help us arbitrate between opposing distributive principles. We also compare this principle to the selection rules developed by John Roemer and Dirk Van de Gaer.

How Should We Aggregate Competing Claims

Many believe that we ought to save a large number from being permanently bedridden rather than save one from death. Many also believe that we ought to save one from death rather than a multitude from a very minor harm, no matter how large this multitude. I argue that a principle I call Aggregate Relevant Claims satisfactorily explains these judgments. I offer a rationale for this principle and defend it against objections.

VAULTING INTUITION: TEMKIN'S CRITIQUE OF TRANSITIVITY

How to rank distributions of benefits and harms? In this book, Larry Temkin addresses this question in detail. Its core claims are two. First, the goodness of a distribution is sometimes ‘essentially comparative’ – it sometimes depends on which alternative distribution(s) it is compared to. Second, there are many cases in which our intuitions are at odds with the transitivity of ‘all things considered better than’ and these cases give us reason to doubt that this relation is transitive. (Transitivity holds that if some alternative a3 is better than a2, and a2 is better than a1, then a3 is better than a1.)

Egalitarianism and the Separateness of Persons

The difference between the unity of the individual and the separateness of persons requires that there be a shift in the moral weight that we accord to changes in utility when we move from making intrapersonal trade-offs to making interpersonal trade-offs. We examine which forms of egalitarianism can, and which cannot, account for this shift. We argue that a form of egalitarianism which is concerned only with the extent of outcome inequality cannot account for this shift. We also argue that a view which is concerned with both outcome inequality and with the unfairness of inequality in individuals’ expected utilities can account for this shift. Finally, we limn an alternative view, on which such inequalities are not intrinsically bad, but nonetheless determine the strength of individuals’ competing claims. We argue that this ‘Competing Claims View’ can also account for the shift.

Universal health coverage, priority setting, and the human right to health

As health policy-makers around the world seek to make progress towards universal health coverage they must navigate between two important ethical imperatives: to set national spending priorities fairly and efficiently; and to safeguard the right to health. These imperatives can conflict, leading some to conclude that rights-based approaches present a disruptive influence on health policy, hindering states’ efforts to set priorities fairly and efficiently. Here, we challenge this perception. We argue first that these points of tension stem largely from inadequate interpretations of the aims of priority setting as well as the right to health. We then discuss various ways in which the right to health complements traditional concerns of priority setting and vice versa. Finally, we set out a three-step process by which policy-makers may navigate the ethical and legal considerations at play.

Priority or Equality for Possible People

Suppose that you must make choices that may influence the well-being and the identities of the people who will exist, though not the number of people who will exist. How ought you to choose? This article answers this question. It argues that the currency of distributive ethics in such cases is a combination of an individual’s final well-being and her expected well-being conditional on her existence. It also argues that this currency should be distributed in an egalitarian, rather than a prioritarian, manner.

Matthew D. Adler: Well-being and fair distribution: beyond cost-benefit analysis

In this extraordinarily thorough and thoughtful work, Matthew Adler proves himself a grandmaster of the moral evaluation of public policy. The core idea of the book is that large-scale public policies should be designed to maximize the expectation of a continuous prioritarian social welfare function (SWF). In other words, they should maximizetheexpectationofthesum-totaloftransformedindividualutilities,wherethe transformation gives greater weight to increases in utility the worse off an individual is in absolute terms. [Formally, a continuous prioritarian SWF holds that outcome x is at least as good as outcome y iff, for every utility function u(.) in the set of utility functions U that represent individual well-being, N=1 g(ui (x)) ≥ N i=1 g(ui (y)),

Response to our critics

Health Economics, Policy and Law / FirstView Article / January 2015, pp 1 9 DOI: 10.1017/S1744133114000590, Published online: 30 January 2015 Link to this article: http://journals.cambridge.org/abstract_S1744133114000590 How to cite this article: Alex Voorhoeve, Trygve Ottersen and Ole Fritjof Norheim Response to our critics. Health Economics, Policy and Law, Available on CJO 2015 doi:10.1017/S1744133114000590 Request Permissions : Click here

Reply to Crisp

We are grateful for, but unconvinced by, Roger Crisps defence of the Priority View against our critique. In this reply, we show that Crisp fails to grapple with, much less defeat, the central claim of our critique. We also show that an example that Crisp offers in support of the Priority View in fact lends support to our critique of that view.

Inequalities in HIV Care: Chances Versus Outcomes

Here and elsewhere in the article, Johansson and Norheim are explicit about their focus on inequality in outcomes, viz. on “inequality in the age of death.” However, the bulk of their analysis focuses on inequality in expected life years, that is, on chances. In this note, we argue that in three of their dilemmas, outcome-egalitarians will draw conclusions which differ dramatically from theirs. We believe this conclusion is important, because we take outcome-egalitarian concerns to be justified.