Kasper Lippert-Rasmussen

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?