Prioritarianism in Health-Care: Resisting the Reduction to Utilitarianism

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Massimo Reichlin


Tännsjö’s book Setting Health-Care Priorities defends the view that there are three main normative theories in the domain of distributive justice, and that these theories are both highly plausible in themselves, and practically convergent in their normative conclusions. All three theories (utilitarianism, the maximin/leximin theory and egalitarianism) point to a somewhat radical departure from the present distribution of medical resources: in particular, they suggest redirecting resources from marginal life extension to the care of mentally ill patients. In this paper I wish to argue, firstly, that prioritarianism should not be considered as an amendment to utilitarianism, as it is in Tännsjö’s view, but as a distinctive fourth option. This can best be appreciated if we focus on a reading of the theory that emphasizes its derivation from egalitarianism and its attempt to develop an intermediate approach between utilitarian and egalitarian intuitions. Secondly, in response to Tännsjö’s central objection to prioritarianism, I will argue that the theory does not apply in intrapersonal cases but is only relevant for decisions regarding the interpersonal distribution of benefits. Finally, I will suggest that a practical convergence of the four theories on specific issues such as artificial reproduction or mood enhancement is far less likely than Tännsjö seems to believe.


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Reichlin, Massimo. (2021) 2021. “Prioritarianism in Health-Care: Resisting the Reduction to Utilitarianism”. Diametros 18 (69):20-32.
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Arneson R.J. (2000), “Luck Egalitarianism and Prioritarianism,” Ethics 110 (2): 339–349.

Brock D.W. (2009), “Cost-Effectiveness and Disability Discrimination,” Economics and Philosophy 25 (1): 27–47.

Broome J. (2004), Weighing Lives, Oxford University Press, Oxford.

Buchanan A., Brock D.W., Daniels N. and Wikler D. (2000), From Chance to Choice: Genetics and Justice, Cambridge University Press, New York.

Daniels N. (1985), Just Health Care, Cambridge University Press, New York.

Daniels N. (2008), Just Health. Meeting Health Needs Fairly, Cambridge University Press, Cambridge.

Fleurbaey, M. (2015), “Equality versus Priority: How Relevant Is the Distinction?,” Economics and Philosophy 31 (2): 203–217.

Fleurbaey M., Tungodden B., Vallentyne P. (2009), “On the possibility of nonaggregative priority for the worst off,” Social Philosophy and Policy 26 (1): 258–285.

Harris J. (1987), “QALYfying the Value of Life,” Journal of Medical Ethics 13 (3): 117–123.

Holtug N. (2007), “Prioritarianism,” [in:] Egalitarianism: New Essays on the Nature and Value of Equality, N. Holtug, K. Lippert-Rasmussen (eds), Clarendon Press, Oxford: 125–156.

Jensen K.K. (2003), “What is the difference between (moderate) egalitarianism and prioritarianism?,” Economics & Philosophy 19 (1): 89–109.

Nagel T. (1978), “The Justification of Equality,” Crítica: Revista Hispanoamericana de Filosofía 10 (28): 3–31.

Nagel T. (1991), Equality and Partiality, Oxford University Press, New York.

O’Neill M. (2012), “Priority, Preference, and Value,” Utilitas 24 (3): 332–348.

Otsuka M., Voorhoeve A. (2009), “Why It Matters That Some Are Worse Off Than Others: An Argument Against the Priority View,” Philosophy and Public Affairs 37 (2): 171–199.

Parfit D. (1997), “Equality and Partiality,” Ratio 10 (3): 202–221.

Parfit D. (2011), On What Matters, vol. 1, Oxford University Press, Oxford.

Parfit D. (2012), “Another Defence of the Priority View,” Utilitas 24 (3): 399–440.

Persson I. (2008) “Why levelling down could be worse for prioritarianism than for egalitarianism,” Ethical Theory and Moral Practice 11 (3): 295–303.

Porter T. (2011), “Prioritarianism and the Levelling Down Objection,” Ethical Theory and Moral Practice 14 (2): 197–206.

Rabinowicz W. (2002), “Prioritarianism and Uncertainty: On the Interpersonal Addition Theorem and the Priority View,” [in:] Exploring Practical Philosophy: From Action to Values, D. Egonsson, J. Josefsson, B. Petersson, T. Ronnow-Rasmussen, I. Persson (eds), Ashgate, Aldershot (UK): 139–165.

Segall S. (2016), Why Inequality Matters: Luck Egalitarianism, Its Meaning and Value, Cambridge University Press, Cambridge.

Sidgwick H. (1981), The Methods of Ethics, Hackett Publishing Company, Indianapolis/Cambridge.

Tännsjö T. (2019), Setting Health-Care Priorities: What Ethical Theories Tell Us, Oxford University Press, New York.