Stephen Wall

In his late work, Rawls makes strong claims about the status of political liberty. These claims, if accepted, would have significant implications for the content of "justice as fairness." I discuss the nature of these claims, clarifying Rawls's fair value guarantee of the political liberties and critically discussing the arguments that he and others have given for assigning special importance to the political liberties. I conclude that justice as fairness, properly understood, is not a deeply democratic conception of justice.

Over the past twenty years, the debate between neutrality and perfectionism has been at the center of political philosophy. Now Perfectionism and Neutrality: Essays in Liberal Theory brings together classic papers and new ideas on both sides of the discussion. Editors George Klosko and Steven Wall provide a substantive introduction to the history and theories of perfectionism and neutrality, expertly contextualizing the essays and making the collection accessible to everyone interested in the interaction between morals and the state.

Many writers claim that democratic government rests on a principled commitment to the ideal of political equality. The ideal of political equality holds that political institutions ought to be arranged so that they distribute political standing equally to all citizens. I reject this common view. I argue that the ideal of political equality, under its most plausible characterizations, lacks independent justificatory force. By casting doubt on the ideal of political equality, I provide indirect support for the claim that democratic government is only instrumentally justified

Most donated organs in the United States come from brain dead donors, while a small percentage come from patients who die in “controlled,” or expected, circumstances, typically after the family or surrogate makes a decision to withdraw life support. The number of organs available for transplant could be substantially if donations were permitted in “uncontrolled” circumstances–that is, from people who die unexpectedly, often outside the hospital. According to projections from the Institute of Medicine, establishing programs permitting “uncontrolled donation after circulatory determination of death,” or uDCDD, throughout the United States has the potential to provide 22,000 more donation opportunities annually. In contrast, U.S. controlled donation after circulatory determination of death, or cDCDD, cases have increased progressively over the past decade from 87 to 848 donors, but currently account for only 10.6 percent of all deceased donors. Following the IOM recommendations, several projects exploring the feasibility of uDCDD were funded by the federal government, including a grant from the Health Resources and Services Administration that supported a pilot project in New York City in which the authors of this article participated.A key feature of our protocol, and indeed of many uDCDD protocols, is the initiation of preservation methods such as chest compressions and extracorporeal membrane oxygenation shortly after death in order to perfuse and preserve the donor's organs. Critics of uDCDD argue that the means of determining death deviates from generally ascribed principles. They assert that reinstituting circulation in order to preserve organs has the effect of “undoing” the prior determination of death. The result is that cDCDD is widely accepted and practiced routinely even though it only marginally increases the number of organs available for transplantation, and uDCDD is widely considered unacceptable despite being ethically embraced and proven to significantly increase organ donation opportunities in other countries. This article explores the evolution of this counterintuitive state of affairs and calls for a policy that, in line with the IOM report, allows for both cDCDD and uDCDD protocols.