Jonathan Wolff

The regulation of drugs presents a challenge for liberalism: how can punishing a person for an action that harms only himself or herself be justified? For public policy a related difficulty is to justify the differential treatment of drugs and alcohol. Philosophical arguments suggest that current regulations are unjustified, and that some currently illegal drugs should be treated no more harshly than alcohol. However, such arguments make little or no impact in public policy discussions. This generates a further problem: to understand the different perspectives of philosophical reasoning and public policy so that philosophical arguments can have a greater role in public policy debates.

Theorists of global justice confront an apparent dilemma. If citizens in the developed world have duties of (socio-economic) justice to those elsewhere on the globe, then it is supposed that the duties must be very extensive indeed, requiring the same concern to be shown for everyone on earth. Those who deny that global obligations are as extensive as domestic obligations seem therefore to have to concede that any obligations beyond borders must be based on charity, rather than justice. The assumption on which this dilemma is based is that 'justice is uniform'. In this paper I argue that such an assumption should be rejected in favour of the view that justice is relative to norms of cooperation. Consequently it is possible to develop a view of 'justice but not the same justice': the ‘layers of justice’ view

What contribution can political philosophers make to policy questions, such as the best configuration of the welfare state? On one view, political philosophers set out abstract theories of justice that can guide policy makers in their attempt to transform existing institutions. Yet it rarely seems the case that such a model is used in practice, and it therefore becomes unclear how political philosophy can contribute to policy debates. Following a suggestion from Margaret MacDonald, I consider the view that political philosophers can contribute by drawing attention to relatively neglected values. I develop this view to add the possibility that political philosophers can try to correct a situation in which a particular value, though important, can come to be too highly emphasised. I illustrate the account by considering the rise of the value of ‘responsibility’ in the welfare state, and ultimately the damage that has been done to society to disadvantaged groups by the over-insistence on the importance of responsibility

Poverty is often defined as lacking the financial resources to meet a set of basic needs. Here, I consider four questions. First, how is the relevant level of basic needs to be determined? Second, given that the possibility of satisfying basic needs is not solely determined by possession of financial resources, is poverty better understood or measured at least in part in non-financial terms? Third, what, if anything, is owed to people in poverty and by whom? And finally, what social policies should be favoured in attempting to deal with poverty? The key message is that overcoming poverty is more than meeting needs for food and shelter, but also includes meeting the human need for a social life and fitting in with what is commonly expected in society (overcoming relative poverty). Out of respect for all, governments have a duty to adopt policies to bring people out of poverty.

This paper sets out a framework in which we can distinguish between four types of redistributive attention to the disadvantaged: compensation; personal enhancement; targeted resource enhancement; and status enhancement. It is argued that in certain cases many of us will have strong intuitions in favour or against one or more strategies for addressing disadvantage, and it is further argued that in such cases it is likely that our reactions are based on assumptions about the human good. Hence the two issues — addressing disadvantage and the human good — shed light on one another [1]

Health-related Quality of Life measures have recently been attacked from two directions, both of which criticize the preference-based method of evaluating health states they typically incorporate. One attack, based on work by Daniel Kahneman and others, argues that ‘experience’ is a better basis for evaluation. The other, inspired by Amartya Sen, argues that ‘capability’ should be the guiding concept. In addition, opinion differs as to whether health evaluation measures are best derived from consultations with the general public, with patients, or with health professionals. And there is disagreement about whether these opinions should be solicited individually and aggregated, or derived instead from a process of collective deliberation. These distinctions yield a wide variety of possible approaches, with potentially differing policy implications. We consider some areas of disagreement between some of these approaches. We show that many of the perspectives seem to capture something important, such that it may be a mistake to reject any of them. Instead we suggest that some of the existing ‘instruments’ designed to measure HR QoLs may in fact successfully already combine these attributes, and with further refinement such instruments may be able to provide a reasonable reconciliation between the perspectives

The paper starts with brief biographical details of John Rawls’s life, and indications regarding the significance of his proposal. The most relevant part of the article is dedicated to the discussion of the concept of democracy as it is included in Rawls’s theory of Justice. Rawls tries to find a solution to the incompatibility of two different motivations for democracy: the instrumental and the intrinsic defence. It followsfrom Rawls’s proposal that the two defences need not necessarily to be incompatible. Participation in public decision procedures helps citizens to improve their capacities. According to the author of the paper, the main criticisms of Rawls come not so much from doubts about the validity of these arguments, but from questioning the realism of his proposals

A number of schemes have been attempted, both in public health and more generally within social programmes, to pay individuals to behave in ways that are presumed to be good for them or to have other beneficial effects. Such schemes are normally regarded as providing a financial incentive for individuals in order to outweigh contrary motivation. Such schemes have been attacked on the basis that they can ‘crowd out’ intrinsic motivation, as well as on the grounds that they are in some sense ‘corrupt’. In response, they have been defended on the grounds that they can ‘crowd in’ improved motivation. I will argue that these debates have tended to overlook the difficulties individuals can have when attempting to behave against peer group norms. In some cases, financial payments can allow individuals to defend their actions on the grounds that ‘I am only doing it for the money’ in circumstances when it would be difficult to defend their action on their real motivations. Examples of paying children to read books, and paying women to give up smoking in pregnancy, will be discussed

The human right to health has been established in international law since 1976. However, philosophers have often regarded human rights doctrine as a marginal contribution to political philosophy, or have attempted to distinguish ‘human rights proper’ from ‘aspirations’, with the human right to health often considered as falling into the latter category. Here the human right to health is defended as an attractive approach to global health, and responses are offered to a series of criticisms concerning its demandingness.

Utilitarianism has a curious history. Its most celebrated founders—Jeremy Bentham and John Stuart Mill—were radical progressives, straddling the worlds of academic philosophy, political science, economic theory and practical affairs. They made innumerable recommendations for legal, social, political and economic reform, often (especially in Bentham’s case) described in fine detail. Some of these recommendations were followed, sooner or later, and many of their radical ideas have become close to articles of faith of western liberalism. Furthermore many of these recommendations were made expressly to improve the condition of the deprived, or of oppressed groups. Yet the moral theory which inspired this reforming zeal is, at least officially, utilitarianism, and when we teach this theory to our students we feel it our duty to point out the horrors that could be justified by any theory which assesses the moral quality of actions in terms of the maximization of good consequences over bad. No consequence is so bad that it cannot, in principle, be outweighed by a large aggregation of smaller goods. Hence there are circumstances in which utilitarianism can require slavery, the punishment of the innocent, and redistribution of resources from the poor to the rich, or from the disabled and the sick to the able bodied and healthy. Indeed, in the right circumstances, it can justify pretty much anything you can think of. For all their intelligence and imagination neither Bentham nor Mill seemed to recognise or discuss these catastrophic possibilities.

Cost-effectiveness analysis suggests that a society should allocate its health care budget in order to achieve the greatest total health for its budget. However, in ‘rescue’ cases, where an individual’s life is in immediate peril, reasoning in terms of cost-effectiveness can appear inhumane. Hence considerations of cost-effectiveness and of rescue appear to be in tension. However, by attending to the division of labour in medical decision making it is possible to see how cost-effectiveness analysis and rescue-style reasoning are commonly combined in an ethically acceptable fashion.

Hierarchy is a difficulty for theories of equality, and especially those that define equality in relational or social terms. In ideal egalitarian circumstances it seems that hierarchies should not exist. However, a liberal egalitarian defence of some types of hierarchies is common. Hierarchies of esteem have no further consequences than praise or admiration for valued individual features. Hierarchies of status, with differential reward, can, it is often argued, also be justified when they serve a justified social purpose and meet conditions of genuine equality of opportunity. However, group hierarchies remain problematic, and evidence suggests that they are pervasive in human societies above a subsistence level of production. It has also been argued that group hierarchies are impossible to eliminate, and enormous cost is associated with attempting, and failing, to remove them. However, the perspective of ‘real-world’ political philosophy suggests measures to mitigate group hierarchy, starting with those that are either the easiest to address, the most damaging, or the most consequential.

:Advocates of social equality need to develop an account of the society they favor. I have argued elsewhere that social equality should be conceived negatively: in terms of opposition to asymmetric and alienating relations such as hierarchy, domination and social exclusion, rather than in terms of a positive model of equality. This essay looks in detail at social exclusion, or rather “differential social inclusion,” and especially at the mechanisms that create exclusion and bind excluded groups together, and the consequent effects these mechanisms have on the reinforcement of inequality of opportunity and failure of social solidarity. Possible policies, such as improved social mobility, assertive self-affirmation, validation of subcultures, integration, and the creation of a large public sector are considered as possible responses to differential social inclusion in order to move closer to the idea of a society of equals.