Alex Voorhoeve

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.

We use probability-matching variations on Ellsberg’s single-urn experiment to assess three questions: (1) How sensitive are ambiguity attitudes to changes from a gain to a loss frame? (2) How sensitive are ambiguity attitudes to making ambiguity easier to recognize? (3) What is the relation between subjects’ consistency of choice and the ambiguity attitudes their choices display? Contrary to most other studies, we find that a switch from a gain to a loss frame does not lead to a switch from ambiguity aversion to ambiguity neutrality and/or ambiguity seeking. We also find that making ambiguity easier to recognize has little effect. Finally, we find that while ambiguity aversion does not depend on consistency, other attitudes do: consistent choosers are much more likely to be ambiguity neutral, while ambiguity seeking is much more frequent among highly inconsistent choosers.

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.

If a potential person would have a good life if he were to come into existence, can we coherently regard his coming into existence as better for him than his never coming into existence? And can we regard the situation in which he never comes into existence as worse for him? In this paper, we argue that both questions should be answered affirmatively. We also explain where prominent arguments to differing conclusions go wrong. Finally, we explore the relevance of our answers to issues in population ethics.

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.

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 article examines the role that this form of expected well-being should play in distributing benefits among prospective people and in deciding whom 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 article argues that such egalitarianism for prospective people springs from equal concern for each prospective 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.

This paper explores whether people are more likely to recognize inconsistency in others’ judgments than in their own, and if so, why. It reports two pre-registered online experiments with samples representative of the UK population (N = 814 and N = 1,623). In Study 1, people are more likely to recognize inconsistency in others’ moral (and non-moral) judgments than in their own. Study 2 replicates this finding and tests three explanations: (i) motivated reasoning, (ii) selective cognitive effort, and (iii) limited insight into others’ reasoning. Ad (i), because people’s susceptibility to motivated reasoning is said to diminish when people must account for their judgments, the presence of motivated reasoning was examined by manipulating social accountability. No effect was found. Ad (ii), while people spent significantly more time (a proxy for cognitive effort) on reviewing others’ consistency than their own, this explained only a fraction of the greater rate at which inconsistencies in others’ reasoning were recognized. Ad (iii), using low confidence in consistency evaluations as a proxy for limited insight, the study did not find support for the limited insight hypothesis. The finding that people are better at recognizing inconsistency in others’ moral judgments aligns with the idea that moral consistency reasoning is a social device that operates best when we interact with others, but more research is needed to uncover the psychological mechanisms behind this effect.

In the spring of 2009, a novel strain of the H1N1 influenza virus, containing a never before witnessed combination of gene segments from human influenza, two forms of swine influenza, and avian influenza, 1 was declared a global pandemic. The UK Government had to decide whether to undertake, at a cost of £1.2 billion (USD 1.9 billion at the time, equivalent to 1 percent of that year’s health budget), an extensive set of preparatory measures, including the purchase of both antiviral medication and a novel vaccine in quantities sufficient to cover the entire UK population, or whether instead to take substantially less costly measures, which would involve having only a limited supply of these medicines and vaccines at hand.2 The possible.

Epicurus argued that the good life is the pleasurable life. He also argued that “death is nothing to us”. These claims appear in tension. For, if pleasure is good, then it seems that death is bad when it deprives us of deeply enjoyable time alive. Here, I offer an Epicurean view of pleasure and the complete life which dissolves this tension. This view is, I contend, more appealing than critics of Epicureanism have allowed, in part because it assigns higher value to pleasures that we produce by exercising our rational capacities and by establishing control over our lives.

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 judgements in cases that elicit similarity-based choice.

The COVID-19 crisis and the policy responses to it have impacted many different areas of common concern including public health and the economy. This raises difficult questions about how to balance these concerns in making policy decisions. In this chapter, we review a number of tools that welfare economics offers for conceptualizing and studying such trade-offs. We argue that social welfare analysis is the most useful method for doing so. We show how concerns for the distributive and other effects of a policy on individual wellbeing can be evaluated using a Social Welfare Function (SWF) and survey some of the main features of such functions. As an illustration, we then use this approach to model and evaluate the implications for social welfare of the adoption of pandemic policies that vary in terms of the stringency of the controls that they impose on individual behaviour. Our model reveals how such evaluations not only are determined by empirical facts but may also depend on key judgments about the relative importance of the different determinants of individual wellbeing (health, income, longevity, and so on) and about the extent to which special concern should be given to the worse-off. In doing so, it illustrates how critical transparent modelling of these concerns is in developing responses to pandemics of this kind.

Epicurus argued that the good life is the pleasurable life. He also argued that “death is nothing to us”. These claims appear in tension. For, if pleasure is good, then it seems that death is bad when it deprives us of deeply enjoyable time alive. Here, I offer an Epicurean view of pleasure and the complete life which dissolves this tension. This view is, I contend, more appealing than critics of Epicureanism have allowed, in part because it assigns higher value to pleasures that we produce by exercising our rational capacities and by establishing control over our lives.

If a potential person would have a good life if he were to come into existence, can we coherently regard his coming into existence as better for him than his never coming into existence? And can we regard the situation in which he never comes into existence as worse for him? In this paper, we argue that both questions should be answered affirmatively. We also explain where prominent arguments to differing conclusions go wrong. Finally, we explore the relevance of our answers to issues in population ethics.

In response to our critics, we clarify and defend key ideas in the report Open and Inclusive: Fair Processes for Financing Universal Health Coverage. First, we argue that procedural fairness has greater value than Dan Hausman allows. Second, we argue that the Report aligns with John Kinuthia’s view that a knowledgeable public and a capable civil society, alongside good facilitation, are important for effective public deliberation. Moreover, we agree with Kinuthia that the Report’s framework for procedural fairness applies not merely within the health sector, but also to the wider budget process. Third, we argue that while Dheepa Rajan and Benjamin Rouffy-Ly are right that robust processes for equal participation are often central to a fair process, sometimes improvements in other aspects of procedural fairness, such as transparency, can take priority over strengthening participation. Fourth, while we welcome Sara Bennett and Maria Merritt’s fascinating use of the Report’s principles of procedural fairness to assess the U.S. President’s Emergency Plan for AIDS Relief, we argue that their application of the Report’s principle of equality to development partners’ decision-making requires further justification.

We summarize key messages from the World Bank report Open and Inclusive: Fair Processes for Financing Universal Health Coverage. A central lesson of the Report is that in decision-making on the path to UHC, procedural fairness matters alongside substantive fairness. Decision systems should be assessed using a complete conception of procedural fairness that embodies core commitments to impartial and equal consideration of interests and perspectives. These commitments demand that comprehensive information is gathered and disclosed and that justifications for policies are publicly debated; that participation in decision-making is enabled; and that these characteristics of the decision system are institutionalised rather than up to the good will of decision-makers. Procedural fairness can improve equity in outcomes, raise legitimacy and trust, and can help make reforms last. While improving procedural fairness can be costly and there are barriers to achieving it, the range of instruments that countries at varying levels of income and institutional capacity have used with some success shows that, in many contexts, advances in procedural fairness in health financing are possible and worthwhile.

Stuart Rachels and Larry Temkin have offered a purported counterexample to the acyclicity of the relationship “all things considered better than”. This example invokes our intuitive preferences over pairs of alternatives involving a single person’s painful experiences of varying intensity and duration. These preferences, Rachels and Temkin claim, are confidently held, entirely reasonable, and cyclical. They conclude that we should drop acyclicity as a requirement of rationality. I argue that, together with the findings of recent research on the way people evaluate episodes of pain, the use of a heuristic known as similarity-based decision-making explains why our intuitive preferences may violate acyclicity in this example. I argue that this explanation should lead us to regard these preferences with suspicion, because it indicates that they may be the result of one or more biases. I conclude that Rachels’ and Temkin’s example does not provide sufficient grounds for rejecting acyclicity.

In October 2021, the Inclusive Framework of the Organisation for Economic Co-operation and Development (OECD) adopted a new international tax deal, which has been hailed as a major step towards a fair and effective global corporate tax system. In this article, we question this verdict. We analyse this deal on the basis of three complementary fairness principles: preventing free riding by multinational corporations (MNCs), respect for and promotion of the fiscal autonomy of countries, and the limitation of distributive and relational inequalities. We argue that the tax deal is unlikely to lead to a substantial improvement in fairness. We do, however, welcome the deal’s recognition of the need to tax multinational corporations as unitary entities subject to a global minimum effective tax rate. We argue that this recognition creates opportunities for fairer reforms that should be pursued through a more inclusive global decision-making process.

The political and philosophical problems John Rawls set out to solve arise out of the identity and conflicts of interests between citizens. There is identity of interests because social cooperation makes possible for everyone a life that is much better than one outside of society. There is a conflict of interests because people all prefer a larger to a smaller share of the benefits of social cooperation, and people have ideological differences. The problem a theory of justice has to solve is how, in the face of these conflicts, effective social cooperation can come about on terms that are justifiable to all.