Drinking in the last chance saloon: luck egalitarianism, alcohol consumption, and the organ transplant waiting list
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The scarcity of livers available for transplants forces tough choices upon us. Lives for those not receiving a transplant are likely to be short. One large group of potential recipients needs a new liver because of alcohol consumption, while others suffer for reasons unrelated to their own behaviour. Should the former group receive lower priority when scarce livers are allocated? This discussion connects with one of the most pertinent issues in contemporary political philosophy; the role of personal responsibility in distributive justice. One prominent theory of distributive justice, luck egalitarianism, assesses distributions as just if, and only if, people’s relative positions reflect their exercises of responsibility. There is a principled luck egalitarian case for giving lower priority to those who are responsible for their need. Compared to the existing literature favouring such differentiation, luck egalitarianism provides a clearer rationale of fairness, acknowledges the need for individual assessments of responsibility, and requires initiatives both inside and outside of the allocation systems aimed at mitigating the influence from social circumstances. Furthermore, the concrete policies that luck egalitarians can recommend are neither too harsh on those who make imprudent choices nor excessively intrusive towards those whose exercises of responsibility are assessed.
KeywordsDistributive justice Liver transplantation Medical ethics Health inequalities Luck egalitarianism Organ allocation Organ shortage Personal responsibility Transplantation Waiting list Organ waiting list Organ transplant waiting list MELD
This article has benefitted from helpful and encouraging comments received on several occasions. It has been presented at the Political Philosophy Group, University of Stirling, March 2013; at the PGR-seminar, Department of Politics, University of Glasgow, May 2013; at the Association for Legal and Social Philosophy, Stirling, June 2013; at the Political Theory Section, Department of Political Science, Aarhus University, September 2013. I am especially grateful for the comments received from: David Axelsen; Andrea Baumeister, Rowan Cruft, Brian Ho, Kasper Lippert-Rasmussen, Lasse Nielsen, Tore Vincents Olsen, Ben Sachs, Ben Saunders, Asbjørn Aagaard Schmidt, Kate Spence, Jens Damgaard Thaysen, Ricardo Villanueva, Kristin Voigt and Anna Zielinska. Furthermore the written comments provided by Carl Knight and Søren Flinch Midtgaard have been essential in the writing of the paper. The paper was written during a research stay at University of Glasgow, I am grateful for the hospitality shown to me there and to my supervisor during the stay, Carl Knight.
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