1 Otsuka Michael and Voorhoeve Alex, ‘Why It Matters That Some Are Worse Off Than Others: An Argument against the Priority View’, Philosophy & Public Affairs 37.2 (2009), pp. 171–99.
2 I use ‘prioritarianism’ and ‘the Priority View’ interchangeably.
3 ‘Why It Matters’, pp. 173–4.
4 ‘Why It Matters’, p. 178.
5 See ‘Why It Matters’, p. 174, and Nord Erik et al. , ‘Incorporating Societal Concerns for Fairness in Numerical Valuations of Health Programmes’, Health Economics 9 (1999), pp. 25–39.
6 Further on, Otsuka and Voorhoeve, ‘Why It Matters’, p. 192, n. 32, cite research that, they claim, ‘reports no significant difference between the treatments people would prefer’ when ‘they imagine themselves in a position of a third party thinking about the appropriate treatment for a single person considered in isolation’ as compared to ‘when considering treatments for themselves’. It's not clear, however, that the research (Ubel Peter et al. , ‘Value Measurement in Cost-Utility Analysis: Explaining the Discrepancy between Rating Scale and Person Trade-Off Elicitations’, Health Policy 43 (1998), pp. 33–44) supports this conclusion. The researchers report no significant difference between people's judgements when they rate (on a scale between death and ‘normal health’) conditions imagined to be conditions suffered by themselves and their judgements when they rate the same conditions, as well as the benefit of curing them, when these are imagined to be conditions suffered by others (considered in isolation). But someone's judgement giving a rating, on a scale between death and health, for a condition understood to be suffered by others cannot without argument be taken to be equivalent to her judgement about the morally appropriate treatment for such a person. At the very least, the possibility that the rating judgement should be treated as a kind of sympathetic first-personal judgement on behalf of the person being imagined must be ruled out. So far as I can see, nothing in ‘Value Measurement in Cost-Utility Analysis’ does so.
7 ‘Why It Matters’, pp. 187–8.
8 ‘Why It Matters’, p. 171.
9 Even if Otsuka and Voorhoeve's intuitions are widely shared, prioritarians can argue that their reasoning explains why these intuitions should be rejected. So, the point about intuitions would not be decisive on its own anyway.
10 ‘Why It Matters’, p. 179.
11 ‘Why It Matters’, p. 180.
12 ‘Why It Matters’, p. 180.
13 See Brink , ‘The Separateness of Persons, Distributive Norms, and Moral Theory’, Value, Welfare, and Morality, ed. Frey R. G. and Morris Christopher W. (Cambridge, 1993), pp. 252–89, at 253–8. Strictly speaking, moves to Pareto-indifferent and to Pareto-inferior distributions are also separateness-of-persons-respecting.
14 See ‘The Separateness of Persons’, pp. 257–8.
15 ‘The Separateness of Persons’, p. 258 (emphasis added).
16 ‘Why It Matters’, p. 183.
17 ‘Why It Matters’, p. 183.
18 Rawls's difference principle, on standard interpretations, understands complaints in the same way, but aims to minimize only the greatest complaint.
19 See ‘Why It Matters’, p. 188.
20 ‘Why It Matters’, p. 188.
21 ‘Why It Matters’, p. 188.
22 If ‘to justify’ is a success verb, so that the mere availability of a justification entails that it successfully justifies what it purports to justify, then insert ‘purportedly’ before the relevant instances of ‘justifies’ (and so on).
23 One reason that we might think that the justification shouldn't get any purchase in your deliberations is that punishment isn't concerned with the good of those being punished. But distributive justice, we might think, is concerned with the good of those among whom goods are distributed. That being so, it's much less plausible to suppose that the unity-of-the-individual justification shouldn't get any purchase in the prioritarian's deliberations. However, not all retributive theories of punishment take it to be unconcerned with the good of those being punished. Hegel, for example, holds that a criminal ‘is denied his honour’ unless he is punished (see Hegel G. W. F., Elements of the Philosophy of Right, ed. Wood Allen W. (Cambridge, 1991), p. 126). A concern with one's honour can plausibly be construed as a concern with one's good. Yet the unity-of-the-individual justification gets no more purchase in a Hegelian's deliberations than in those of a retributivist for whom retribution is unconcerned with the good of those being punished. Thanks to Andrew Williams for suggesting this line of response.
24 ‘Why It Matters’, p. 189.
25 I take prioritarianism to be a view about distributive justice, rather than, as would be implausible, a view intended to capture the whole of morality.
26 See n. 22 above about the way I understand ‘to justify’ for the purposes of this argument.
27 Assuming that prioritarianism itself is nevertheless supposed to apply in these cases, as I have been assuming.
28 This defence of prioritarianism commits prioritarians to the view that if in a one-person case one maximizes the relevant individual's expected utility as opposed to adopting the prioritarian approach, one commits an injustice, which may seem counterintuitive. I think that the counterintuitiveness in the prioritarian case can be explained, however, in part by suspicion of the idea that it could be unjust to act in a way that was preferred by all affected – a suspicion that is normally silenced in the punishment case by the deep hold that considerations of desert and retribution have on our thinking. It is not obvious that the suspicion is well founded: not only retributivists but also strong egalitarians and advocates of proportional justice are committed to seeing some acts as unjust even though they may be preferred by all affected. (Temkin Larry has written extensively on this point. See for example his ‘Egalitarianism Defended’, Ethics 113 (2003), pp. 764–82.) Note that although such views may have counterintuitive implications in ‘levelling down’ situations, the counterintuitiveness is not usually supposed to be simply the result of their taking this to be an issue of justice and injustice.
The counterintuitiveness in the prioritarian case may also be explained in part by the supposition that justice doesn't apply in what in n. 30 below I call unity-of-the-individual cases. Note, however, that the supposition that justice doesn't apply in cases involving only one individual (apart from the distributing stranger) doesn't license the conclusion that justice doesn't have application in unity-of-the-individual cases, since the latter cases need not involve only one individual (see n. 29 below).
29 Otsuka and Voorhoeve, ‘Why It Matters’, p. 175, n. 8, note that there are ways in which their one-person cases can be transformed into multi-person cases without producing any change in their intuitions about them. But the criticism that they offer of prioritarian recommendations in such cases remains, in effect, that prioritarians ignore the unity of the individual. So, the possibility of a multi-person presentation of their one-person intuitive case does not show that in the standard multi-person cases that I've been discussing, they have an objection to the prioritarian approach.
30 I'll use this qualification henceforth to distinguish the cases I mean from multi-person cases that are variants on the one-person cases in the way mentioned in n. 29 above. I'll refer to cases of the latter type (including the one-person cases) henceforth as unity-of-the-individual cases.
31 They repeat the emphasis on the separateness of persons at ‘Why It Matters’, p. 192.
32 Otsuka and Voorhoeve ‘Why It Matters’, pp. 185–6, countenance the possibility that considerations of autonomy might give us reason to depart from the prioritarian approach in their one-person case. They deal with this possibility not by arguing that prioritarianism is shown to be false by the appropriateness of the departure, but by pointing out that considerations of autonomy happen not to be present. That suggests that with regard to a one-person case in which considerations of autonomy were present, they wouldn't take it to be an objection to prioritarianism that the appropriate course of action was to respect the person's autonomy rather than to comply with prioritarian recommendations.
If this is right, then one might think that it's also no objection to prioritarianism if it's appropriate to depart from the prioritarian approach when a unity-of-the-individual justification is present. For that justification might be analogous to the autonomy-based justification. I have, of course, attempted to go further than this and show that prioritarians need not even accept that it's appropriate to depart from the prioritarian approach when the unity-of-the-individual justification is present. But even if I'm wrong about that, the foregoing suggests that prioritarianism can still be defended.
33 This article was presented as a paper in Manchester at a 2010 conference on the Priority View, organized by the Manchester Centre for Political Theory. Thanks to those who participated for helpful questions and comments. Special thanks to Michael Otsuka, Alex Voorhoeve and Jonathan Quong for their criticisms and suggestions.