Alex Voorhoeve

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.

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.

The publication of the first Report of the International Panel on Social Progress is a significant intellectual event, both because of its hugely ambitious aim – of uniting the world's leading researchers from social sciences and the humanities to develop research-based, multi-disciplinary, non-partisan, action-guiding solutions to the central challenges of our time – and because it represents the completion of a mammoth effort in the service of this aim by a diverse set of 269 authors. In its attempt to synthesize and render accessible to social actors a broad range of the latest social scientific knowledge, as well as in its confidence that knowledge can empower those actors to make progress, it recalls D'Alembert and Diderot's famous Encyclopédie. Indeed, one can say that the Report is a quintessential Enlightenment project. For example, in his famous Outlines of a Historical View of the Progress of the Human Mind, Condorcet asserts the possibility of an accumulation of empirical and theoretical knowledge and the concomitant expansion in our capacities to alleviate social and natural evils. And Condorcet and many of his contemporaries were motivated to propose political institutions that would enable such an indefinite increase in knowledge so as to bring about the attendant improvement to people's lives.

A persistent argument against the transitivity assumption of rational choice theory postulates a repeatable action that generates a significant benefit at the expense of a negligible cost. No matter how many times the action has been taken, it therefore seems reasonable for a decision-maker to take the action one more time. However, matters are so fixed that the costs of taking the action some large number of times outweigh the benefits. In taking the action some large number of times on the grounds that the benefits outweigh the costs every time, the decision-maker therefore reveals intransitive preferences, since once she has taken it this large number of times, she would prefer to return to the situation in which she had never taken the action at all. We defend transitivity against two versions of this argument: one in which it is assumed that taking the action one more time never has any perceptible cost, and one in which it is assumed that the cost of taking the action, though (sometimes) perceptible, is so small as to be outweighed at every step by the significant benefit. We argue that the description of the choice situation in the first version involves a contradiction. We also argue that the reasoning used in the second version is a form of similarity-based decision-making. We argue that when the consequences of using similarity-based decision-making are brought to light, rational decision-makers revise their preferences. We also discuss one method that might be used in performing this revision.

Philosophy of Science is a mid-level text for students with some grounding in philosophy. It introduces the questions that drive enquiry in the philosophy of science, and aims to educate readers in the main positions, problems and arguments in the field today. Alex Rosenberg is certainly well qualified to write such an introduction. His works cover a large area of the philosophy of natural and social sciences. In addition, the author of the argument that the ‘queen of the social sciences’, economics, is not a science at all, can be counted on to show how the philosophy of science can be relevant to the understanding of the status of scientific knowledge and can provide a critical assessment of practitioners’ view of their field.

Decision-makers face severe uncertainty when they are not in a position to assign precise probabilities to all of the relevant possible outcomes of their actions. Such situations are common—novel medical treatments and policies addressing climate change are two examples. Many decision-makers respond to such uncertainty in a cautious manner and are willing to incur a cost to avoid it. There are good reasons for taking such an uncertainty-averse attitude to be permissible. However, little work has been done to incorporate it into an egalitarian theory of distributive justice. We aim to remedy this lack. We put forward a novel, uncertainty-averse egalitarian view. We analyse when the aims of reducing inequality and limiting the burdens of severe uncertainty are congruent and when they conflict, and highlight practical implications of the proposed view. We also demonstrate that if uncertainty aversion is permissible, then utilitarians must relinquish a favourite argument against egalitarianism.

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.

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.

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.

Progress towards Universal Health Coverage (UHC) requires making difficult trade-offs. In this journal, Dr. Margaret Chan, the WHO Director-General, has endorsed the principles for making such decisions put forward by the WHO Consultative Group on Equity and UHC. These principles include maximizing population health, priority for the worse off, and shielding people from health-related financial risks. But how should one apply these principles in particular cases and how should one adjudicate between them when their demands conflict? This paper by some members of the Consultative Group and a diverse group of health policy professionals addresses these questions. It considers three stylized versions of actual policy dilemmas. Each of these cases pertains to one of the three principal dimensions of progress towards UHC: which services to cover first, which populations to prioritize for coverage, and how to move from out-of-pocket expenditures to pre-payment with pooling of funds. Our cases are simplified to highlight common trade-offs. While we make specific recommendations, our primary aim is to demonstrate both the form and substance of the reasoning involved in striking a fair balance between competing interests on the road to UHC.

In 'Rethinking the Good', Larry Temkin makes two core claims. First, the goodness of a distribution is sometimes ‘essentially comparative’ – it sometimes depends on which alternative distribution(s) it is compared to. Second, such cases threaten the transitivity of ‘all things considered better than’. I argue that the goodness of a distribution may indeed depend on what other distributions are feasible. But contrary to Temkin, I also argue that transitivity holds even when the goodness of a distribution depends on the feasible set of which it is a member.

Stuart Rachels and Larry Temkin have offered a purported counter-example 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

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.

I argue that Scanlon's Value of Choice View does not offer a plausible account of substantive responsibility. I offer a new account, which I call the Potential Value of Opportunities View. On this view, when a person is in a position to freely and capably make an informed choice, we assess her situation not by the outcome she achieves but by the potential value of her opportunities. This value depends on the value of the various things that she can achieve through her choices, as well as on how disposed she is to choose her better options and avoid her worse options. This view explains the priority we give to preventing harm that a person cannot avoid by choosing appropriately over harm that a person can so avoid by the fact that the second person has a valuable opportunity that the first does not have. It explains the importance of protecting people against choosing badly by the value of being placed in circumstances in which one is disposed to choose well, and the disvalue of being exposed to the danger of coming to harm by choosing badly.

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. -/- .

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.

When one faces competing claims of varying strength on public resources for health, which claims count? This paper proposes the following answer. One should count, or aggregate, a person’s claim just in case one could sympathize with her desire to prioritize her own claim over the strongest competing claim. It argues that this principle yields appealing case judgments and has a plausible grounding in both sympathetic identification with each person, taken separately, and respect for the person for whom most is at stake. It also defends this principle against several heretofore unanswered objections.

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 paper 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.