Kasper Lippert-Rasmussen

Alternative allocations of a fixed bundle of healthcare resources often involve significantly different indirect, non-health effects. The question arises whether these effects must figure in accounts of the conditions under which a distribution of healthcare resources is morally justifiable. In this article we defend a Scanlonian, affirmative answer to this question: healthcare resource managers should sometimes select an allocation which has worse direct, health-related effects but better indirect, nonhealth effects; they should do this when the interests served by such a policy are more urgent than the healthcare interests better served by an alternative allocation. We note that there is a prima facie case for the claim that such benefits (and costs) are relevant—i.e. they are real benefits, and in other contexts our decisions can permissibly be guided by them. We then proceed to rebut three lines of argument that might be thought to defeat this prima facie case: they appeal to fairness, the Kantian Formula of Humanity as an End in Itself, and the equal moral worth of persons, respectively

Kasper Lippert-Rasmussen tackles all the major questions concerning luck egalitarianism, providing deep, penetrating and original discussion of recent academic discourses on distributive justice as well as responses to some of the main objections in the literature. It offers a new answer to the “Why equality?” and “Equality of what?” questions, and provides a robust luck egalitarian response to the recent criticisms of luck egalitarianism by social relations egalitarians. This systematic, theoretical introduction illustrates the broader picture of distributive justice and enables the reader to understand the core intuitions underlying, or conflicting with, luck egalitarianism.

G. A. Cohen’s critique of standard liberal interpretations of the difference principle has been very influential. According to Cohen, justice is not realized simply because the state’s tax policies and other distributive tools maximize the position of the worst off. Rather – possibly in addition to, but not to the exclusion of, certain state policies – justice requires talented people to improve the position of the worst off through their actions in their daily lives. Specifically, it prohibits talented people from insisting on inequality-causing incentives. To this extent, Cohen’s view of distributive justice is anti-statist. On standard liberal interpretations, human rights are such that, logically, they can be violated only by states, not private individuals. An individual who tortures someone commits a moral wrong but does not violate the victim’s human rights. For this reason, the crime is less problematic than it would have been had a police officer done it on behalf of the state. To this extent the standard liberal understanding of human rights is statist. This parallel between liberal understandings of distributive justice and human rights raises two questions: Is the statist understanding of human rights vulnerable to Cohenian criticisms parallel to those that he canvasses against the statist understanding of distributive justice? If so, should we welcome an anti-statist understanding of human rights, or should we see it as a problem with Cohen’s critique of a statist focus in distributive justice that it commits us to an implausible anti-statist view of human rights?

Internalism – here the view that moral judgments entail motivation – is often taken to support non-cognitivism about morality. However, Michael Smith has defended a variety of it in combination with a cognitivist account of morality. Despite the eminence of Smith’s contribution, his case in favour of internalism is flawed. I distinguish several internalist positions and argue that Smith’s version, unlike standard ones, expresses a view about, not the nature of the state one is in when one makes a moral judgment, but the norms of practical rationality. I then defend the externalist appeal to the possibility of amoralism. Such an appeal need not beg the question against internalism and can in any case be backed up by independent considerations. Moreover, neither of Smith’s two main arguments in favour of internalism – the reliable connection argument and the appeal to rationalism about moral requirements – are sound. Having shored up the case for externalism and dismissed Smith’s case against it, I end the essay with a suggestion as to why many philosophers have been attracted to internalism even though the theory turns out to be ill-founded.

Many organizations, companies, and so on are committed to certain representational aims as regards the composition of their workforce. One motivation for such aims is the assumption that numerical underrepresentation of groups manifests discrimination against them. In this article, I articulate representational aims in a way that best captures this rationale. My main claim is that the achievement of such representational aims is reducible to the elimination of the effects of wrongful discrimination on individuals and that this very important concern is, in principle, compatible with the representation of various groups diverging widely from their share of the overall population. The discussion also shows that we should ensure that a preoccupation with groups' numbers in relation to the population as a whole does not lead us away from our real aim, for example because we are blinded to the effects of discrimination against numerically overrepresented groups, or overlook the innocently different ambitions of some numerically underrepresented groups. In relation to the latter point, I appeal to the fact that many luck egalitarians think justice should be ambition sensitive. Also, the time-relative account of representational aims expounded shows that, and how, representational aims should accommodate the changing composition of populations over time.

Next SectionFive arguments are presented in favour of the proposal that people who opt in as organ donors should receive a tax break. These arguments appeal to welfare, autonomy, fairness, distributive justice and self-ownership, respectively. Eight worries about the proposal are considered in this paper. These objections focus upon no-effect and counter-productiveness, the Titmuss concern about social meaning, exploitation of the poor, commodification, inequality and unequal status, the notion that there are better alternatives, unacceptable expense, and concerns about the veto of relatives. The paper argues that none of the objections to the proposal is very telling

Agent-relative restrictions prohibit minimizing violations: that is, they require us not to minimize the total number of their violations by violating them ourselves. Frances Kamm has explained this prohibition in terms of the moral worth of persons, which, in turn, she explains in terms of persons’ high moral status as inviolable beings. I press the following criticism of this account: even if minimizing violations are permissible, we need not have a lower moral status provided other determinants thereof boost it. Thus, Kamm’s account is incomplete at best. And when, to address this incompleteness, it is insisted that our moral worth derives from specific moral statuses, the inviolability account comes to seem deficient because it begs the question against those who are not initially persuaded that minimizing violations are impermissible.

If biotechnology can be used to "upgrade" humans physically and mentally, should it be done? And if so, to what extent? How will biotechnology affect societal cohesion, and can the development be controlled? Or is this a Pandora's box that should remain closed? These are just a few of the many questions that arise as a result of the increasing ability of technology to change biology and, eventually, transform human living conditions. This development has created a new horizon of a posthuman future that will influence contemporary life and politics in a number of ways. The book gathers researchers within the fields of biotechnology, medicine, ethics, politics, and aesthetics. Among the contributors are Francis Fukuyama, Julian Savulescu, Maxwell Mehlman, Lone Frank and Chris Hables Gray.

Adherents of particularism draw rather strong implications of this view. However, particularism has never been stated in a canonical way. We locate the core of particularism as a claim about how different reasons combine to generate the Tightness or wrongness of an action. Using the notion of an ordering of alternatives containing separable factors, we show that particularism can be stated more generally as the denial that there exist separable factors.With this definition in place, we show that, once subjected to a number of clarifications, particularism largely does have the implications often associated with it. However, we find the various arguments that have been given in support of particularism to be very poor. We conclude that particularists do have a point when they claim that some form of generalism cannot simply be taken for granted. But no particular reasons in favour of being a particularist have been offered.

According to US law, insurance companies can lawfully differentiate individual health insurance premiums on the basis of non-genetic medical information, but not on the basis of genetic information. The article reviews the case for such genetic exceptionalism. First, I critically assess some standard justifications. Next, I scrutinize an argument appealing to the view that genetically based premium differentiation expresses that persons do not all merit equal concern and respect. In the final section, I argue that even if genetic exceptionalism is unjustified, there is a forceful luck egalitarian argument against basing premiums on genetic risks, to wit, that this tends to make some individuals worse off than others as a result of the bad brute luck involved in having a genetically determined, above-average risk of developing health problems

A standard formulation of luck-egalitarianism says that ‘it is [in itself] bad – unjust and unfair – for some to be worse off than others [through no fault or choice of their own]’, where ‘fault or choice’ means substantive responsibility-generating fault or choice. This formulation is ambiguous: one ambiguity concerns the possible existence of a gap between what is true of each worse-off individual and what is true of the group of worse-off individuals, fault or choice-wise, the other concerns the notion of fault. I show that certain ways of resolving these ambiguities lead to counterintuitive results; and that the most plausible way of resolving them leads to a theory of distributive justice in which responsibility plays a role significantly different from that in standard luck-egalitarian thinking. My main conclusion here is that luck-egalitarianism is best formulated as the view that it is [in itself] bad – unjust and unfair – for an individual to be worse off than others if, and only if, her being worse off does not fit the degree to which she is at fault in a not purely prudential sense.

PhD, Institute of Public Health, Unit of Medical Philosophy and Clinical Theory, University of Copenhagen, Øster Farimagsgade 5, P.O. Box 2099 1014 Copenhagen. Tel: +45 30 32 33 63; Email: s.lauridsen{at}pubhealth.ku.dk ' + u + '@ ' + d + ' '/ /- ->Citizens’ consent to political decisions is often regarded as a necessary condition of political legitimacy. Consequently, legitimate allocation of healthcare has seemed almost unattainable in contemporary pluralistic societies. The problem is that citizens do not agree on any single principle governing priorities among groups of patients. The Accountability for Reasonableness framework suggests an ingenious solution to this problem of moral disagreement. Rather than advocating any substantive distributive principle, its advocates propose a feasible set of conditions, which, if met by decision makers at the institutional level, provide, so it is promised, legitimate decisions. While we agree that A4R represents an important contribution to the priority-setting debate, we challenge the framework in two respects. First, we argue that A4R, and more specifically the relevance condition of A4R, does not enable healthcare institutions to generally distinguish between relevant and irrelevant reasons for priority-setting. Second, we criticize Daniels’ and Sabin's argument that A4R and deliberative democracy constitute necessary and sufficient conditions of a feasible procedure for setting legitimate limits within healthcare. CiteULike Connotea Del.icio.us What's this?

In recent work, T.M. Scanlon has unsuccessfully challenged the doctrine of double effect (DDE). First, comparing actions reflecting faulty moral deliberations and involving merely foreseen harm with actions reflecting less faulty moral deliberations involving intended harm suggests that proponents of DDE do not confuse the critical and the deliberative uses of moral principles. Second, Scanlon submits that it is odd to say to a deliberating agent that the permissibility of the actions she ponders depends on the intention with which she will act. I argue that this can be explained without appeal to the claim that intentions are irrelevant to permissibility.

Fundamentally, intentions do not matter to the permissibility of actions, according to Thomas Scanlon (among others). Yet, discriminatory intentions seem essential to certain kinds of direct discrimination in hiring and firing, and appear to be something by virtue of which, in part at least, these kinds of discrimination are morally impermissible. Scanlon's account of the wrongness of discrimination attempts to accommodate this appearance through the notion of the expressive meaning of discriminatory acts and a certain view about how permissibility relates to the meaning of actions. This paper explores the scope, strengths and weaknesses of this account. Specifically, it challenges the view that discrimination reflecting hierarchical value judgments necessarily involves a wrong that renders such discrimination more objectionable than other forms

With regard to intrinsically morally relevant factors it is natural to suppose that if a variation in a given factor makes a moral difference anywhere, then it makes the same moral difference everywhere (henceforth: the constancy assumption). Jonathan Dancy (and other moral particularists) reject the constancy assumption. Partly on the basis thereof, they infer that ethical decisions should be made “case by case, without the comforting support of moral principles”. In this article, I challenge Dancy's defence and use of a denial of the constancy assumption on three points. First, Dancy's appeal to moral intuitions do not justify denying a significant version of the constancy assumption. Second, if we reject the constancy assumption, surprisingly, it may in one crucial respect be very hard to defend moral particularism as commonly articulated. Third, rejecting the constancy assumption does not motivate seeing moral reasoning as essentially a case‐by‐case matter.

In this critical review, I address two themes from Shelly Kagan’s path-breaking The Geometry of Desert. First I explain the so-called “bell motion” of desert mountains—a notion reflecting that, ceteris paribus, as people get more virtuous it becomes more important not to give them too little of whatever they deserve than not to give them too much. Having argued that Kagan’s defense of it is unsatisfactory, I offer two objections to the existence of the bell motion. Second, I take up an unrelated issue—the relation between comparative and non-comparative desert. I argue that, given a certain disaggregationist view of comparative desert, it is possible that comparative desert is not satisfied, even if non-comparative desert is perfectly so. Unlike my objections to the bell motion, this possibility adds further complexity to an already complex Kaganian account of desert.