Johannes Kniess

This article assesses the normative case for using citizens' assemblies—small deliberative forums of randomly selected citizens—in health policymaking. Although they are increasingly popular, their normative justification remains underexplored. We reconstruct three possible rationales: Norman Daniels's ‘Accountability for Reasonableness’ (A4R) framework; an epistemic argument emphasising the value of outsider perspectives for making more just decisions; and a deliberative democratic argument focused on promoting legitimacy in the bureaucracy. We argue that A4R offers only weak and contingent support for citizens' assemblies. The epistemic argument highlights the value of lay perspectives in identifying epistemic blind spots but lacks clarity on when it outperforms expert knowledge. The deliberative democratic rationale is more compelling in potentially generating some kinds of legitimacy but applies only in a limited range of scenarios. We therefore conclude that the normative case for using citizens' assemblies is not as strong as their popularity in policymaking would lead us to believe.

In my article, I argued that the differential treatment entailed by a generational tobacco ban does constitute a wrongful form of unequal treatment.1 I based this argument primarily on various interpretations of relational egalitarianism and the ideal of a society of equals. Alternatively, the argument could also be framed around the value of consistency in policy-making and the law: the principle of treating like cases alike. Put in these terms, my argument is that differential treatment under the generational ban is not inconsistent once we consider the rationale and context of the policy. In their commentaries, Boretti, Saunders, and Hart and Lignou raise insightful objections, pointing out potential inconsistencies that my article did not fully address. I am grateful for these interventions and acknowledge their importance in a comprehensive evaluation of tobacco-free generation proposals. In this brief response, I sketch my replies. Boretti questions the consistency of a generational tobacco ban in light of the growing liberalisation of other previously criminalised drugs, suggesting that ‘a more balanced public health strategy could involve uniform restrictions on harmful substances’.2 While it is true that drug policies are trending towards liberalisation, consistency in regulation should be assessed based on the …

The idea of a ‘tobacco-free generation’ promises to make smoking a thing of the past by making cigarettes unavailable to birth cohorts in the future. If implemented, such a generational ban would lead to a society in which some individuals are allowed the freedom to smoke while others are not. This paper examines the ethical significance of this fact through the lens of ‘relational egalitarianism’, an approach to social justice that emphasises equal and respectful social relationships. It explores various dimensions in which a society can fail to live up to the idea of equal status, such as the denial of moral agency, discrimination, stigmatisation, the unequal recognition of interests and violations of political equality. While acknowledging the complexity of practical and ethical challenges, the paper maintains that the generational ban need not violate egalitarian commitments.

Liberal neutrality compels governments to respect individual preferences. Yet health-promotion campaigns, such as modern tobacco control policies, often seek to cultivate a preference for a healthy lifestyle. Liberal theorists have attempted to justify these policies by appealing to the concept of ‘means paternalism’, whereby these policies align with existing preferences. In contrast, this article argues that shaping preferences can be not only permissible but also morally required. Governments can preserve neutrality while influencing preferences by promoting generic goods valued in diverse societies and considering the preference-formation of future generations. This argument provides a stronger rationale for tobacco control policies.

Investment protection clauses, and the investor-state dispute settlement (ISDS) mechanisms they enable, have become a common feature of international agreements on trade and investment. Intended to promote foreign investment, these protections may also discourage governments from regulating in the public interest. This raises challenging normative questions about the rights of investors and distributive justice. In this paper, I argue that a global investment regime that disadvantages developing countries and socially disadvantaged groups is prima facie unfair. This conclusion must be defended against the claim that investors have certain independent moral rights to have their property protected, regardless of the distributive consequences. Granting the premise that such investor rights exist, I argue that these cannot plausibly ground a general rule against public interest regulation that undermines the value of property. I conclude that even if foreign investors have rights that must be safeguarded, the current investment regime must be reformed.

This year marks the centenary of John Rawls's birth and the fiftieth anniversary of the publication of A Theory of Justice. The influence of Rawls's landmark book on the general fields of moral and political philosophy is undisputed and well-documented. It has also left a significant imprint on debates surrounding health policy, health care, and health inequalities. This article traces the changing ways in which Rawls's theory influenced debates about justice in health over the last five decades. Just as Rawls's ideas have shaped debates about health, however, these debates can help us critically appraise the theory and its limitations. In that spirit, the article sketches three areas where a focus on health reveals challenges to the Rawlsian framework: the issue of priority setting among competing goods, the theory's egalitarian commitments, and its focus on the distribution of goods.

Doctors, nurses and midwifes from developing countries migrate to affluent countries in large numbers, often leaving behind severely understaffed healthcare systems. One way to limit this ‘brain drain’ is to restrict the freedom of movement of healthcare workers. Yet this seems to give rise to a conflict of human rights: on the one hand rights to freedom of movement, on the other hand rights to health. By motivating its own account of human rights, this paper argues that the conflict is not as acute as it seems, since rights to freedom of movement are in fact more limited than often acknowledged. Weak restrictions of the freedom to leave and strong restrictions of the freedom to enter are in principle compatible with the rights of healthcare workers. Hence, policies that involve restrictions of both kinds can be justified in order to secure the human right to health.

Many liberal theories are committed to the promotion of population health, and the principle of non-interference in individual life plans. Public health interventions often bring out a tension between these two values. In this paper, I examine this tension by assessing the justifiability of liberty-restricting policies in the field of obesity prevention. As I want to show, a ‘soft’ form of paternalism, which interferes with people's choices to safeguard their true interests, goes some way in justifying such policies, but it leaves unaddressed the problem of limiting the liberty of those whose true interest is in pursuing an unhealthy lifestyle. I argue that in this latter case, the key to reconcile the promotion of population health with the respect for individual liberty is distributive justice: when we cannot help those who care about their health without doing the same for those who do not, fairness will often require us to do so.

How should we think, from the point of view of distributive justice, about inequalities in health and longevity? Norman Daniels’s influential account derives a social duty to reduce health inequalities from Rawls’s principle of fair equality of opportunity. This paper criticises Daniels’s approach and offers an alternative. To the extent that the basic structure of society shapes people’s opportunities to be healthy, we ought to think of ‘the social bases of health’ directly as a Rawlsian primary social good. The paper attempts to clarify the correct principle for its distribution, and its relationship to other goods that give rise to considerations of justice.

ABSTRACT Jeremy Bentham is often thought to have set the groundwork for the modern ‘animal liberation’ movement, but in fact he wrote little on the subject. A full examination of his work reveals a less radical position than that commonly attributed to him. Bentham was the first Western philosopher to grant animals equal consideration from within a comprehensive, non-religious moral theory, and he was a staunch defender of animal welfare laws. But he also approved of killing and using animals, as long as pointless cruelty could be avoided. The nuances of his position are best brought out by comparing it to that of Peter Singer, who draws considerably more radical practical conclusions. This is not primarily explained by competing formulations of utilitarianism, however, but by different empirical background assumptions about the lives of animals.

When is it fair that some people are less healthy than others due to their own individual choices and preferences? In this paper, I explore two alternative answers. The first is a luck-egalitarian account that holds people responsible for choices that society could have reasonably expected them to avoid. I argue that this account is indeterminate and go on to sketch an alternative proposal based on Rawls’s idea of a “social division of responsibility.” This latter approach connects the notion of responsibility for health to the social conditions under which health-related behaviour is developed.