Relational Equality beyond Non-Domination

Non-domination is not the only demand of relational equality. This chapter rejects two important attempts to make sense of demands for other kinds of egalitarian relations, based on the goods of community, friendship, trust, and self-respect. The first is a pluralist, free-standing approach, according to which social equality goes beyond, and sometimes conflicts with, social justice. This approach either leads to egalitarian perfectionism, which should worry liberals, or fails to yield a mandate to shape society according to its demands. The second approach extends distributive theories of equality by incorporating fair shares of the various goods at stake in egalitarian relations. The chapter shows how resulting variants of relation-sensitive distributivism either fail to capture what is distinctive about relational goods, or to yield recognizably egalitarian demands. This result confirms the case for the liberal approach, while underscoring the need to extend it to matters of social status and self-respect.

Principles of health equity

This chapter shows how informal normative concerns about health equity raised by decision makers can be translated into formal health equity objectives that are amenable to quantitative analysis using distributional cost-effectiveness analysis (DCEA). It also clarifies the kinds of ethical concerns that can and cannot be addressed by DCEA. Four ways of thinking about ethics are distinguished: value maximizing, moral rights, fair shares, and fair processes. When considering whether and how DCEA can be used to address a specific equity concern raised by decision makers, it is important to clarify which of these four ways of thinking underpins the concern. DCEA methods for evaluating distributions are based on the value maximizing way of thinking, but the information provided by DCEA about the distributional consequences of decisions can also help to address equity concerns relating to moral rights, fair shares, and fair processes.

Future challenges

In this chapter we discuss some of the challenges facing the field of distributional cost-effectiveness analysis (DCEA). We cover four methodological challenges for researchers: (1) modelling complexities such as economies of scale, spillovers, and behavioural responses; (2) ex post DCEA based on distributions of realized outcomes rather than expected outcomes; (3) cross-sectoral DCEA combining information about health and non-health dimensions of well-being; and (4) fair shares DCEA based on distributing in proportion to strength of claim rather than maximizing value. We also discuss the practical challenge of making DCEA more useful to decision makers.

The weight of fairness

Many philosophers argue that individuals have duties to do their fair shares of the demands of achieving important common ends. But what happens when some individuals fail to do their fair shares? Are the remaining duty bearers required to take up the slack? The most prominent view, Fair Shares, holds that individuals are never required to take up the slack. But this view has counterintuitive implications; in many cases, it would show callous disregard not to take up the slack to help those in dire need. The central alternative, Slack-Taking, holds that considerations of fairness have no bearing in determining whether individuals are required to take up the slack. But this view fails to capture the practical importance of fairness in nonideal circumstances. I defend an alternative view, Weighing, according to which individuals properly weigh the value of fairness against the value of taking up the slack in determining whether they are all-things-considered required to take up the slack. While this view has been suggested before in the literature, I develop it by clarifying its structure and underlying rationale and defending it against important recent objections.

Historical Emissions Debt

This chapter turns to the question of historical responsibility for unavoided climate impacts. It introduces the climate debt claim, according to which certain wealthy or industrialized states owe a debt of compensation to some of those suffering from the unavoided impacts of climate change; where the notion of a debt indicates that the obligation in question falls within the domain of rectificatory justice. The Historical Emissions Debt view, according to which climate debts arise when parties emit more than their fair share of greenhouse gases, is rejected on the basis that there is no fair shares principle for historical use of the climate sink considered in isolation. Two interpretations of the beneficiary pays principle are found to face similar problems. Since none of these accounts appear defensible, it is concluded that those seeking to substantiate a climate debt claim would do better to attempt this by other means.