Abstract
This chapter is a commentary on T. M. Scanlon’s Lanson Lecture in Bioethics. It discusses whether the existence of disagreement affects the justifiability of “libertarian paternalism” and whether Scanlon’s “Value of Choice” account fits better with our considered judgments on allocation of health resources than luck egalitarianism.
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Notes
- 1.
T. M. Scanlon, What We Owe to Each Other (Cambridge: Harvard University Press, 1998), 249. Scanlon contrasts “substantive responsibility” with “responsibility as attributability.”
- 2.
Ibid., 253.
- 3.
Scanlon, “Responsibility for Health and the Value of Choice,” this volume, 96.
- 4.
Scanlon, What We Owe to Each Other, 249.
- 5.
R. H. Thaler and C. R. Sunstein, Nudge (New York: Penguin Books, 2009).
- 6.
J. Le Grand, “Individual Responsibility, Health, and Health Care,” in N. Eyal., S. A. Hurst, O. M. Norheim, and D. Wikler (eds.), Inequalities in Health (Oxford: Oxford University Press, 2013).
- 7.
Scanlon, “Responsibility for Health and the Value of Choice,” 101.
- 8.
Ibid.
- 9.
Ibid., 102.
- 10.
Ibid., 103.
- 11.
Ibid., 102.
- 12.
Ibid.
- 13.
Scanlon sometimes talks in terms of simply “disagreement” and sometimes in terms of “reasonable” disagreement. See, e.g., ibid., 99, 101. I will omit the phrase “reasonable” in what follows for brevity, but I believe that what I write about the insignificance of disagreement applies even if the disagreement is reasonable.
- 14.
Ibid., 103.
- 15.
A number of writers have argued for political perfectionist positions that give an important place to autonomy. See, e.g., J. Raz, The Morality of Freedom (Oxford: Oxford University Press, 1988); J. Chan, “Legitimacy, Unanimity, and Perfectionism,” Philosophy and Public Affairs 29(1) (2000): 5–42.
- 16.
Scanlon, “Responsibility for Health and the Value of Choice,” 97.
- 17.
Le Grand, “Individual Responsibility, Health, and Health Care,” 299.
- 18.
For some of these examples, see Scanlon, “Responsibility for Health and the Value of Choice,” 95, 105.
- 19.
Ibid., 104.
- 20.
Ibid., 106–107.
- 21.
Ibid.
- 22.
Ibid., 106.
- 23.
Ibid., 107.
- 24.
Ibid., 106.
- 25.
See R. Arneson, “Luck Egalitarianism Interpreted and Defended,” Philosophical Topics 32(1/2) (2004): 1–20.
- 26.
A. Voorhoeve, “Scanlon on Substantive Responsibility,” Journal of Political Philosophy 16(2) (2008): 184–200; Scanlon, What We Owe to Each Other, 256–258.
- 27.
Voorhoeve, “Scanlon on Substantive Responsibility”; Z. Stemplowska, “Harmful Choices: Scanlon and Voorhoeve on Substantive Responsibility,” Journal of Moral Philosophy 10(4) (2013): 488–507. See also A. Williams, “Liberty, Liability, and Contractualism,” in N. Holtug and K. Lippert-Rasmussen (eds.), Egalitarianism: New Essays on The Nature and Value of Equality (Oxford: Oxford University Press, 2007), 254–255, which raises a similar point.
- 28.
Assuming here, of course, that the cost to third parties are the same.
- 29.
Because, according to Scanlon, “[n]o one has reason to place a positive value on having the opportunity to be exposed to hazardous chemicals.” Scanlon, What We Owe to Each Other, 257.
- 30.
Scanlon, “Responsibility for Health and the Value of Choice,” 104.
- 31.
Stemplowska, “Harmful Choices,” 494.
- 32.
T. M. Scanlon, “Reply to Stemplowska,” Journal of Moral Philosophy 10(4) (2013): 508–514, 511, 512.
- 33.
Ibid., 511.
- 34.
An earlier response by Scanlon focuses on the idea of “generic reasons.” See Scanlon, What We Owe to Each Other, 263. For problems with this response, see Voorhoeve, “Scanlon on Substantive Responsibility,” 189–190; Stemplowska, “Harmful Choices,” 495.
- 35.
Scanlon, “Reply to Stemplowska,” 511–512.
- 36.
Ibid., 511.
- 37.
Ibid., 512–513.
- 38.
Scanlon, “Responsibility for Health and the Value of Choice,” 107.
- 39.
Scanlon’s further response to the first difficulty seems to be based on the idea that there is a morally significant difference between probability that is natural in some sense and probability that is “artificially” introduced (Scanlon, “Reply to Stemplowska,” 512). But I find this response hard to grasp. In fact, Scanlon acknowledges that some people may question “why one should care about this difference” and that his response is “controversial” (512–513). So, if Scanlon intends to rely on this response, it would be helpful if he could defend the moral significance of the difference in greater detail.
- 40.
For a related point, see Stemplowska, “Hard Choices,” 495.
- 41.
Scanlon, “Reply to Stemplowska,” 512–513.
- 42.
Scanlon, “Responsibility for Health and the Value of Choice,” 106–107.
- 43.
Scanlon emphasizes a related distinction in “Reply to Olsaretti,” Journal of Moral Philosophy 10(4) (2013): 484–487, 487.
- 44.
For a similar point, see S. Olsaretti, “Scanlon on Responsibility and the Value of Choice,” Journal of Moral Philosophy 10(4) (2013): 465–483, 474.
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Chau, P. (2024). Commentary on “Responsibility for Health and the Value of Choice”. In: Li, HL. (eds) Lanson Lectures in Bioethics (2016-2022). Palgrave Macmillan, Cham. https://doi.org/10.1007/978-3-031-42052-8_8
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