Alex Voorhoeve

Limited Aggregation rests on two compelling ideas. First, we should save one person from an early death rather than any number of well-off people from very minor harms. Second, we should save many people from a considerable harm that is less bad than death rather than one person from death. However, it has proved difficult to formulate a satisfactory Limited Aggregative view. We propose a novel account, Population-Relative Egalitarianism with Thresholds (PRET), that avoids key problems faced by its rivals. PRET gives priority to improving the condition of those who are worse off than others and special priority to those facing deprivation. Crucially, it also holds that, as the number of well-off people increases, the importance of reducing deprivation grows. As a result, no matter how large the well-off population, eliminating one person’s severe deprivation always takes priority over providing marginal benefits to the well off.

Limited Aggregation rests on two compelling ideas. First, we should save one person from an early death rather than any number of well-off people from very minor harms. Second, we should save many people from a considerable harm that is less bad than death rather than one person from death. However, it has proved difficult to formulate a satisfactory Limited Aggregative view. We propose a novel account, Population-Relative Egalitarianism with Thresholds (PRET), that avoids key problems faced by its rivals. PRET gives priority to improving the condition of those who are worse off than others and special priority to those facing deprivation. Crucially, it also holds that, as the number of well-off people increases, the importance of reducing deprivation grows. As a result, no matter how large the well-off population, eliminating one person’s severe deprivation always takes priority over providing marginal benefits to the well off.

A possible person's conditional expected well-being is what the quality of their prospects would be if they were to come into existence. This article examines the role that this form of expected well-being should play in distributing benefits among prospective people and in deciding whom to bring into existence. It argues for a novel egalitarian view on which it is important to ensure equality in people's life prospects, not merely between actual individuals, but also between all individuals who, given our choices, have a chance of coming into existence. The article argues that such egalitarianism for prospective people springs from equal concern for each prospective person and has plausible implications. It further shows that it has a rationale in respect for both the unity of the individual and the separateness of persons. Finally, it defends this view against a key objection and shows it is superior to a rival view.

This paper explores whether people are more likely to recognize inconsistency in others’ judgments than in their own, and if so, why. It reports two pre-registered online experiments with samples representative of the UK population (N = 814 and N = 1,623). In Study 1, people are more likely to recognize inconsistency in others’ moral (and non-moral) judgments than in their own. Study 2 replicates this finding and tests three explanations: (i) motivated reasoning, (ii) selective cognitive effort, and (iii) limited insight into others’ reasoning. Ad (i), because people’s susceptibility to motivated reasoning is said to diminish when people must account for their judgments, the presence of motivated reasoning was examined by manipulating social accountability. No effect was found. Ad (ii), while people spent significantly more time (a proxy for cognitive effort) on reviewing others’ consistency than their own, this explained only a fraction of the greater rate at which inconsistencies in others’ reasoning were recognized. Ad (iii), using low confidence in consistency evaluations as a proxy for limited insight, the study did not find support for the limited insight hypothesis. The finding that people are better at recognizing inconsistency in others’ moral judgments aligns with the idea that moral consistency reasoning is a social device that operates best when we interact with others, but more research is needed to uncover the psychological mechanisms behind this effect.

If a potential person would have a good life if he were to come into existence, can we coherently regard his coming into existence as better for him than his never coming into existence? And can we regard the situation in which he never comes into existence as worse for him? In this paper, we argue that both questions should be answered affirmatively. We also explain where prominent arguments to differing conclusions go wrong. Finally, we explore the relevance of our answers to issues in population ethics.

We examine the ethics of enrolling individuals in research that poses net health risks by appealing to their altruism. We argue that it is permissible to enroll individuals who are motivated by altruism when (i) they autonomously consent; and (ii) the net health risks are outweighed by the combination of (ii-a) the extent to which participation furthers their considered aims and thereby contributes to their wellbeing and agency and (ii-b) the study’s social value. Further, it is permissible to enroll altruistic individuals who cannot consent when: (I) their surrogate consents and they assent, ideally because it furthers their aims; and (II) the net health risks are outweighed by the extent to which participation contributes to their wellbeing and agency. This account leads us to suggest a revision of consent forms to include more information about studies’ social value and a reduction of barriers to the enrollment of participants who cannot consent.

Suppose one can fully alleviate either the very large individual health burdens of a first group or instead the significantly lesser burdens of a second group that is at least as numerous. In such cases, the most commonly applied principles for priority setting in health have two characteristics. First, when both groups are equally large, they prioritize alleviating the plight of the more severely burdened. Second, when both groups differ in size, these common principles are unlimited in their aggregation: one very large burden can be outweighed not merely by a large number of middling burdens, but also by a sufficiently large number of very minor burdens. While priority for the significantly more severely burdened when group sizes are equal is uncontroversial, many thinkers have challenged unlimited aggregation. There is, however, little evidence on the public’s views. Here, we examine the responses to priority setting dilemmas of a representative sample of the UK population (n = 389). We find that an overwhelming majority of respondents’ views do not align with commonly used priority setting principles. A substantial share (forty-four per cent) of respondents do not always prioritize by severity when group sizes are equal. Moreover, among those who do prioritize by severity, most reject unlimited aggregation. A test for the influence of the assumed status quo did not yield a robust effect. Overall, our findings suggest that public support for commonly employed priority-setting principles cannot be assumed, and that unorthodox principles that place limits on the ability of very small burdens to outweigh very large ones may be more popular.

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.

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.

The Complaint Model is an interpretation of Scanlon’s contractualism which holds that (1) an individual can reasonably reject a distribution of well-being when her complaint against that distribution is larger than any other person’s complaint against any other distribution. The Complaint Model further holds that (2) the size of an individual’s complaint against a distribution is a function of (2a) her absolute level of well-being under that distribution, with the size of her complaint increasing as her absolute level of well-being decreases, and (2b) the size of her loss in well-being under that distribution relative to the level of well-being she could have enjoyed under the distribution most favourable to her, with the size of her complaint increasing as her loss increases. In this paper, I argue that the Complaint Model should be rejected, because the way in which it takes individuals’ losses into account leads to strongly counterintuitive results. In particular, I show that the Complaint Model may sacrifice the well-being associated with the least-well-off, secondleast- well-off, etc. positions for the sake of minimizing the largest complaint. I also argue that revisions to element (1) to allow for the aggregation of complaints must either leave the Complaint Model vulnerable to this objection or lead it to collapse into prioritarianism. The failure of the Complaint Model may lead us to search for an alternative way of taking losses into account. I conclude by arguing that the attractiveness of the Anonymous Pareto principle poses a challenge to any such alternative.

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.

Philippe van Parijs (2003) has argued that an egalitarian ethos cannot be part of a post- Political Liberalism Rawlsian view of justice, because the demands of political justice are confined to principles for institutions of the basic structure alone. This paper argues, by contrast, that certain principles for individual conduct—including a principle requiring relatively advantaged individuals to sometimes make their economic choices with the aim of maximising the prospects of the least advantaged—are an integral part of a Rawlsian political conception of justice. It concludes that incentive payments will have a clearly limited role in a Rawlsian theory of justice.

Preferences are often thought to be relevant for well-being: respecting preferences, or satisfying them, contributes in some way to making people's lives go well for them. A crucial assumption that accompanies this conviction is that there is a normative standard that allows us to discriminate between preferences that do, and those that do not, contribute to well-being. The papers collected in this volume, written by moral philosophers and philosophers of economics, explore a number of central issues concerning the formulation of such a normative standard. They examine what a defensible account of how preferences should be formed for them to contribute to well-being should look like; whether preferences are subject to requirements of rationality and what reasons we have to prefer certain things over others; and what the significance is, if any, of preferences that are arational or not conducive to well-being.