Distributive Justice and Disability

Distributive Justice and Disability: Utilitarianism against Egalitarianism

MARK S. STEIN
Copyright Date: 2006
Published by: Yale University Press
Pages: 316
https://www.jstor.org/stable/j.ctt1nprfw
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  • Book Info
    Distributive Justice and Disability
    Book Description:

    Theories of distributive justice are most severely tested in the area of disability. In this book, Mark Stein argues that utilitarianism performs better than egalitarian theories in this area: whereas egalitarian theories help the disabled either too little or too much, utilitarianism achieves the proper balance by placing resources where they will do the most good.Stein offers what may be the broadest critique of egalitarian theory from a utilitarian perspective. He addresses the work of egalitarian theorists John Rawls, Ronald Dworkin, Amartya Sen, Bruce Ackerman, Martha Nussbaum, Norman Daniels, Philippe Van Parijs, and others. Stein claims that egalitarians are often driven to borrow elements of utilitarianism in order to make their theories at all plausible.The book concludes with an acknowledgment that both utilitarians and egalitarians face problems in the distribution of life-saving medical resources. Stein advocates a version of utilitarianism that would distribute life-saving resources based on life expectancy, not quality of life. Egalitarian theories, he argues, ignore life expectancy and so are again found wanting.Distributive Justice and Disabilityis a powerful and engaging book that helps to reframe the debate between egalitarian and utilitarian thinkers.

    eISBN: 978-0-300-12825-3
    Subjects: Philosophy

Table of Contents

  1. Front Matter
    (pp. i-vi)
  2. Table of Contents
    (pp. vii-viii)
  3. Acknowledgments
    (pp. ix-xii)
  4. I Introduction
    (pp. 1-10)

    This book is about the contest between utilitarianism and egalitarianism. Utilitarianism, as a theory of distributive justice, tells us to help those who can most benefit, those who can gain the greatest increase in welfare. Egalitarian theories of distributive justice tell us to help those who are in some way worse off.¹ I advocate utilitarianism.

    There is sometimes a convergence between utilitarianism and egalitarian theories; sometimes, those who can most benefit are those who are worse off in various ways. At other times, the theories diverge. One area in which utilitarianism often diverges from egalitarian theories is the area of...

  5. II Intuitionist Theory and Interpersonal Comparisons
    (pp. 11-22)

    Like many works of normative theory, this book takes an intuitionist approach.¹ I discuss situations, real and imagined, in which utilitarianism seems to me to yield just results and egalitarian theories seem to me to yield unjust results. I invite the reader to share my intuitions about the justice of certain results and further invite her to share my conclusion that these intuitions support utilitarianism. While I do not expect to convert opponents of utilitarianism into ardent utilitarians, I hope to convince at least some readers that utilitarianism is more intuitively appealing than they may have supposed.

    This book is...

  6. III Disability and Welfare
    (pp. 23-32)

    Both moral intuition and hedonic intuition can be influenced by our knowledge of the world. In this chapter I consider what we can know about the effect of disability on welfare.

    First, what is disability? This is a surprisingly difficult question; there is no agreed-upon definition.¹ The Americans with Disabilities Act defines “disability” as “a physical or mental impairment that substantially limits one or more of the major life activities.”² Under this definition, pain might not be a disability if it did not impair function. Indeed, one prominent distributive theorist—G.A. Cohen—has suggested that pain alone would not be...

  7. IV Utilitarianism and Distribution to the Disabled
    (pp. 33-54)

    In this chapter I discuss some basic aspects of the utilitarian approach to the distribution of resources between disabled people and nondisabled people, and among people with different disabilities.¹ I do not try to resolve all the problems of utilitarianism.² I do, however, try to show that some of the supposed problems of utilitarianism are actually among its strengths. Though my focus is on utilitarianism, I also draw some contrasts between utilitarianism and egalitarian approaches.

    Utilitarianism seeks to maximize welfare. The first-order distributive principle of utilitarianism is to distribute resources to the people who would most benefit from those resources,...

  8. V Egalitarianism and Distribution to the Disabled
    (pp. 55-101)

    There are many kinds of utilitarianism, but there are even more kinds of egalitarianism. The distinction I most stress in this book is that between resource egalitarianism, which would distribute too few resources to some who are disabled, and welfare egalitarianism, which would distribute too many resources to some who are disabled. The common fault of both these egalitarian theories is that they do not consider the extent to which people can benefit from resources. Because resource egalitarianism is insensitive to relative benefit, it distributes too few resources to disabled people who could benefit greatly from additional resources. Because welfare...

  9. VI Rawls
    (pp. 102-118)

    In this and the following two chapters, I discuss the major resource-egalitarian theorists John Rawls, Ronald Dworkin, and Bruce Ackerman. In dealing with disability, resource egalitarians actually oscillate between resource egalitarianism, welfare egalitarianism, and utilitarianism. They begin by trying to maintain the ideal of resource equality. They realize, however, that it would be unfair not to distribute additional resources to disabled people who would suffer horribly without those additional resources. They modify their theories in order to justify extra resources for the disabled, but these modifications threaten to push them all the way to welfare egalitarianism. They then search for...

  10. VII Dworkin
    (pp. 119-157)

    Ronald Dworkin is well known as an opponent of utilitarianism.¹ Dworkin has purported to offer a nonutilitarian and intuitively appealing solution to the problem of redistribution to the disabled: hypothetical insurance.² The device of hypothetical insurance is a major element in Dworkin’s bookSovereign Virtue,a collection of some of his important articles on distributive justice.³

    In this chapter I argue that Dworkin’s hypothetical insurance is actually a form of utilitarianism, though not the most attractive form.⁴ I first show that hypothetical insurance makes use of a greater-benefit criterion, in a manner similar to utilitarianism. I next argue that hypothetical...

  11. VIII Ackerman
    (pp. 158-179)

    In this chapter I discuss Bruce Ackerman’s approach to compensating the disabled. At the end of the chapter I consider Philippe Van Parijs’s adaptation of Ackerman’s approach.

    For Ackerman, equality of resources is a provisional default rule. InSocial Justice in the Liberal State,¹ Ackerman argues that resource holdings and other forms of power are illegitimate unless they can be justified through “Neutral” dialogue.He posits a two-part principle of Neutrality:

    No reason is a good reason if it requires the power holder to assert:

    (a) that his conception of the good is better than that asserted by any of his...

  12. IX Welfarism Weighted or Unweighted?
    (pp. 180-206)

    Resource egalitarians have some difficulty incorporating utilitarianism into their distributive theories; they cannot accomplish the feat without some contortion. Welfare egalitarians have somewhat less difficulty, as they generally do not even pretend that the sole distributive principle should be equality of welfare.

    The acknowledgment by welfare egalitarians that equality of welfare cannot serve as the sole distributive principle generally occurs in the context of a discussion of redistribution to the disabled. It is often evident from these discussions that welfare egalitarians include an element of utilitarianism in their theories: they are not prepared to impose a massive welfare loss on...

  13. X Intuition about Aggregation
    (pp. 207-221)

    Up to now I have not sharply confronted an aspect of distributive justice that poses some problems for utilitarianism. It is sometimes thought that utilitarianism produces counterintuitive results in cases involving aggregation.¹ Suppose that we can provide many people with smaller benefits or can instead provide a few people with larger benefits. Utilitarianism would aggregate the benefits to be received by each group. If the many smaller benefits sum to more than the few larger benefits, utilitarianism would tell us to help the many rather than the few. Some believe that this is wrong, or that it could be wrong.²...

  14. XI Distribution of Life
    (pp. 222-265)

    In this chapter I discuss utilitarian and egalitarian approaches to the distribution of scarce life-saving medical resources (hereinafter the distribution of life). Utilitarianism faces more problems here than in other areas. Nevertheless, a version of utilitarianism is still more attractive than egalitarian alternatives.¹

    In most distributive contexts, I have argued, utilitarianism has considerable intuitive appeal. Its sensitivity to relative benefit allows it to strike the right balance in helping the disabled. By contrast, egalitarian theories that are insensitive to relative benefit have to be modified in the direction of utilitarianism in order to gain intuitive appeal. They must find some...

  15. XII Conclusion: Philosophy and Policy
    (pp. 266-272)

    Many of us first approach the topic of distributive justice thinking about rich and poor, not disabled and nondisabled. We find that we support redistribution from rich to poor, within nations and between nations. This is a political position, not a philosophical position. Many of us take this position long before considering what its philosophical justification might be.

    Utilitarianism, resource egalitarianism, and welfare egalitarianism can all claim to justify redistribution from rich to poor. Utilitarianism can claim to do so on the ground that the poor benefit more from additional money than do the rich; resource egalitarianism can claim to...

  16. Notes
    (pp. 273-300)
  17. Index
    (pp. 301-304)