[Elster, Jon (1995), The idea of equality revisited, Chapter I in J. ltha! and ". #arrison, eds.

, $orld, %ind, and Ethi&s' a (ests&hrift for )ernard $illia!s, Ca!*rid+e ,niversity -ress, pp. ./101

The idea of equality revisited

[start of pa+e .1

)ernard $illia!s pu*lished 2The idea of equality2 in 1934.1 In the al!ost thirty years that have passed, the study of distri*utive 5usti&e has e6panded vastly. The 7or8 of John "a7ls and !artya 9en, a!on+ that of !any others, has ena*led us to pro+ress further in statin+ the pro*le!s and &anvassin+ plausi*le solutions. $illia!s hi!self has returned to issues of politi&al philosophy on a nu!*er of o&&asions. :et I *elieve the early arti&le retains its &lai!s on our attention, partly *e&ause it !a8es so!e interestin+ and insuffi&iently &riti&i;ed !ista8es, partly *e&ause it &ontains so!e valua*le and insuffi&iently e6plored su++estions. In this &hapter I try to re!edy *oth defi&ien&ies. I shall not su!!ari;e $illia!s< ar+u!ent in 2The idea of equality,2 *ut only state so!e of his !ain distin&tions and &on&lusions. #e +ives &onsidera*le attention to the notion of equality of persons, i.e. their &lai! to 7hat "onald =7or8in has &alled 2equal &on&ern and respe&t.2 nd he is &on&erned 7ith sho7in+ that this ideal has so!e *ite, in that it su++ests spe&ifi& distri*utive &on&lusions. #e also &onsiders situations in 7hi&h there is a pri!a/fa&ie ar+u!ent for unequal distri*ution, on the *asis of need and !erit. >eed is ta8en as &onstitutin+ una!*i+uous and unpro*le!ati& +rounds for a&&ess to s&ar&e +oods? I shall ar+ue that it is *oth a!*i+uous and pro*le!ati&. %erit, in $illia!s< e6position, is dou*ly questiona*le as a &riterion for the allo&ation of s&ar&e +oods, su&h as a&&ess to hi+h/quality edu&ation. In the first pla&e, it is in&onsistent 7ith the ideal of equality of persons. In the se&ond pla&e, !ore distur*in+ly, atte!pts to redress this fla7 !ay the!selves &onfli&t 7ith that ideal. The only referen&es $illia!s !a8es to a&tual distri*utive issues are to health &are and edu&ation, 7ith a very *rief !ention of une!ploy!ent *enefits. >one of these referen&es have any e!piri&al
[end of pa+e ., start of pa+e 51

flesh and *lood? they are presented in a very &ursory and styli;ed !anner. I a! &onvin&ed that &on&eptual and theoreti&al pro+ress on these issues &an *e !ade only if !ore attention is +iven to a&tual distri*utive issues &tual &ases differ? differen&es su++est distin&tions? distin&tions su++est &on&epts and !ore +eneral propositions. This is not a plea for an indu&tive approa&h to distri*utive 5usti&e, *ut for so!ethin+ li8e "a7ls< !ethod of refle&tive equili*riu!. ,nli8e "a7ls, ho7ever, I *elieve that, in our sear&h for the data that partly &onstrains a theory of 5usti&e, 7e should +o *eyond our o7n intuitions.4 The a&tual allo&ative &hoi&es !ade *y institutions, even if i!pure in *ein+ the produ&t of a lar+e nu!*er of deter!inants, !any of 7hi&h are o*viously irrelevant fro! the point of vie7 of 5usti&e, &an serve as a !ore independent &he&8 on our 5ud+!ents of fairness.@

)e that as it !ay, in evaluatin+ $illia!s< ar+u!ents I shall dra7 heavily on allo&ative de&ision/!a8in+ in pra&ti&e. (ollo7in+ his lead, I shall &onsider the allo&ation of s&ar&e !edi&al resour&es, nota*ly hearts, livers, and 8idneys for transplantation, and the allo&ation of edu&ational resour&es, nota*ly ad!ission to institutions of hi+her edu&ation. I *e+in *y &onsiderin+ his influential state!ent that 2the proper +round of distri*ution of !edi&al &are is ill health' this is a ne&essary truth.2. I shall first point out a &ounter/intuitive i!pli&ation of the state!ent, and then dis&uss so!e additional ar+u!ents a+ainst a !ore attra&tive (even if te6tually less plausi*le) readin+ of the state!ent. I read the state!ent as sayin+ that there is a !onotoni& relationship *et7een de+ree of ill health and quantity of !edi&al resour&es' the 7orse your health, the !ore and the *etter !edi&al treat!ent you should +et. The ri&h should not *e a*le to *uy s&ar&e !edi&al resour&es to treat their s!all ail!ents 7hen the poor have serious illnesses that +o untreated. Thus stated, the prin&iple is appealin+. 9tated in a !ore fine/+rained 7ay, ho7ever, it is far fro! o*viously true. )efore I pro&eed to sho7 this, I need to !a8e so!e +eneral points that apply to !any allo&ative situations. Aet us suppose that there is so!e s&ar&e +ood B that is to *e allo&ated, and so!e quantifia*le property of people 7hi&h that +ood tends to in&rease. Thus B &ould *e livers or hearts for transplantation, and : &ould *e either total lifespan or pro*a*ility of short/ ter! survival? B &ould *e the assi+n!ent of reha*ilitation offi&ers, and : the pro*a*ility of reha*ili/
[end of pa+e 5, start of pa+e 31

tation of prisoners? B &ould *e edu&ational resour&es, and : &ould *e the e6tent of 8no7led+e. %ost +enerally, B &ould *e any +ood 7hatsoever, and : &ould *e utility or 7elfare in so!e suita*ly *road sense. Aet us suppose, !oreover, that there is a &hoi&e *et7een +ivin+ one unit of the s&ar&e +ood to individual I and +ivin+ it to individual II, 7hose situations &an *e des&ri*ed *y the follo7in+ para!eters. If not +iven the +ood the individuals 7ould he at levels :I and :II respe&tively. If +iven the +ood, they 7ould attain levels :<I and :<II respe&tively. T7o allo&ative prin&iples su++est the!selves. (ollo7in+ the level principle, one should +ive the +ood to I if and only if :I II. (ollo7in+ the increment principle, one should +ive the +ood to I if and only if (:<I / :I ) C (:<11 / :11) . The for!er &orresponds to the vie7 that 7e should +ive priority to the 7orst/off, the latter to the idea that 7e should prefer those 7ho &an use the +ood *est.5 Consider first the &ase of 7elfare or utility. (or the sa8e of ar+u!ent I shall !a8e a nu!*er of questiona*le assu!ptions' utility allo7s for full (unit and level) &o!parison a&ross individuals? the utility fun&tions of different individuals are rou+hly si!ilar? !ar+inal utility is (de&reasin+. ,nder these assu!ptions, the level and in&re!ent prin&iples al7ays di&tate the sa!e solution. The 7orst off should re&eive the s&ar&e +ood *e&ause they &an use it !ore effi&iently, i.e. derive a lar+er utility in&re!ent fro! it. 9o!ethin+ li8e this idea underlies the traditional utilitarian ar+u!ent for the redistri*utive 7elfare state.3 Consider ne6t the in&rease of 8no7led+e *y edu&ational resour&es. $illia!s does not say that the proper +round of distri*ution of edu&ation is la&8 of 8no7led+e, nor that the proper +round is the assi!ilation of 8no7led+e. )oth ideas, ho7ever, are an i!portant part of the edu&ational philosophy. In this &ase, ho7ever, it is less &lear that they point in the sa!e dire&tion. It !i+ht he the &ase / this 7as a&tually ar+ued *y Aei*ni;D / that, even if individuals

have identi&al intelle&tual &apa&ities, the effi&ient assi!ilation of 8no7led+e requires that edu&ational resour&es *e &on&entrated in a fe7 (perhaps rando!ly sele&ted) individuals, rather than spread thinly over !any. Consider finally the reha*ilitation of prisoners. #ere, a+ain, the t7o prin&iples !i+ht diver+e, al*eit for a different reason. 9o!e of those 7ho leave prison 7ill have a spontaneous re&idivis! rate very &lose to 1EE per&ent. t the other e6tre!e are those 7ho are &ertain
[end of pa+e 3, start of pa+e D1

to +et and 8eep a re+ular 5o*. The inter!ediate &ate+ory is !ade up of those 7ho !ay or !ay not !ana+e to stay out trou*le 7ithout any assistan&e. Clearly, the reha*ilitation offi&er should not spend his ti!e on those 7ho 7ill do 7ell 7ithout his assistan&e, althou+h doin+ so 7ould !a8e for an easier life. >or, !ore &ontroversially, should he &on&entrate on those in the first &ate+ory. Enhardened &ri!inals are unli8ely to *e s7ayed *y efforts to 8eep the! a7ay fro! &ri!e. Instead, the offi&er should &on&entrate on the inter!ediate &ate+ory, 7here his 7or8 &ould a&tually !a8e a differen&e. In the allo&ation of !edi&al resour&es the t7o prin&iples so!eti!es &oin&ide. Aet us &onsider or+an transplantation, and !a8e the unrealisti& assu!ption that 7e are &o!parin+ &ases in 7hi&h the +raft is &ertain to su&&eed. $e !i+ht then have t7o reasons for +ivin+ the or+an to a youn+ !art rather than to an old !an' the youn+ !an has a shorter life *ehind hi! and he 7ill, if treated, have a lon+er life *efore hi!. In a different set of &hoi&e situations, ho7ever, the level and in&re!ent prin&iples point in opposite dire&tions. $hen the &andidates for transplantation differ in pro*a*ility of spontaneous re!ission rather than in a+e, the dile!!a is !ore si!ilar to that fa&in+ the prison reha*ilitation offi&er.0 The relationship loo8s rou+hly as in (i+ure 1.1. (i+. 1.1
[end of pa+e D, start of pa+e 01

In these eases, the level prin&iple 7ill tell do&tors to +ive priority to patients at , 7hereas the in&re!ent prin&iple tells the! to prefer patients at ). (If, a*ove all, they 7ant a +ood re&ord or a quiet life, they 7ill prefer patients at C.) I understand $illia!s to *e espousin+ the level prin&iple, at least *y i!pli&ation. %any do&tors do the sa!e, *e&ause their professional trainin+ e!phasi;es nor!s of &o!passion and of thorou+hness. >o7, an unrestri&ted version of that prin&iple is o*viously indefensi*le. It 7ould a!ount to +ivin+ priority to patients 7ho are so ill that they are sure to die in any &ase. Fn +rounds of fairness, one !i+ht, nevertheless, ar+ue that even the severely ill should have so!e &han&e of *ein+ sele&ted for transplantation. I return to that issue later. #ere I si!ply 7ant to note that $illia!s< unqualified e!phasis on 2ill health2 is !ispla&ed. Some a&&ount !ust *e ta8en of the e6tent to 7hi&h that ill health &an he i!proved *y !edi&al &are. I a! quite &onfident that $illia!s 7ould a+ree. Fn a !ore &harita*le, if less literal, readin+ of his state!ent, the notion of ill health 7ould in&lude so!e de+ree of i!prova*ility. Aet !e, therefore, see 7hether the state!ent, thus interpreted, is !ore defensi*le. I *elieve it runs into at least three diffi&ulties, 7hi&h &an *e *riefly su!!ari;ed as in&entive pro*le!s, paternalis!, and envy.9

9o!eti!es, ill health is the predi&ta*le out&o!e of earlier *ehaviour. In su&h &ases, one !i+ht 7ant to li!it the e6tent of free treat!ent provided. 9u&h restri&tions &ould *e 5ustified *y *a&87ard/loo8in+ ar+u!ents, in ter!s of !erit. They &ould also, and !ore &onvin&in+ly, *e 5ustified on rule/utilitarian +rounds. If people 8ne7 that so&iety 7ill not *ail the! out 7hen their health fails as the predi&ta*le result of their o7n *ehaviour, they !i+ht a*stain fro! *ehavin+ in that 7ay. Fr a+ain, they !i+ht not. >ot every*ody is equally open to in&entive ar+u!ents. %ore to the point, those 7ho !i+ht *e rea&hed *y su&h ar+u!ents are !ainly the 7ell edu&ated and affluent. t this point, 7e &an dra7 on 7hat $illia!s has to say a*out !erit as a +round of a&&ess to edu&ational resour&es. If a&&ess to !erit is shaped in part *y a 2&ura*le environ!ent,2 the *asi& equality of persons de!and that this a&&ess *e itself equali;ed to that e6tent. 9i!ilarly, if !edi&al need 5ustifies treat!ent only if that need is not 8no7in+ly self/infli&ted, one !i+ht i!pose the additional &ondition that the a*ility to *e s7ayed *y in&entive ar+u!ents *e itself equali;ed, to the e6tent that it &an *e affe&ted *y a &ura*le
[end of pa+e 0, start of pa+e 91

environ!ent. )efore +ross poverty has *een eli!inated, in&entive ar+u!ents are ina&&epta*le in health &are. This see!s ri+ht. 9o!e !i+ht 7ant to +o further, and ar+ue that in&entive/ effe&t ar+u!ents are never appropriate in this area. There 7ill al7ays *e so!e persons, in all &lasses of edu&ation and in&o!e, 7ho are too re&8less or thou+htless to ta8e proper a&&ount of the ris8s they are runnin+. fter all, !ost of the predi&tions one &an !a8e in this are statisti&al ones, 7hi&h do not rea&h people as dire&tly as do unqualified 7arnin+s. It 7ould *e &allous to leave a &ar a&&ident vi&ti! to die 5ust *e&ause he has thou+htlessly failed to use a safety *elt and to ta8e out private insuran&e. This see!s ri+ht too, *ut only *e&ause the e6a!ple is so dra!ati&. =ental &are provides a !ore instru&tive e6a!ple. This treat!ent is rei!*ursed *y so&ial se&urity in the ,G and (ran&e, *ut not in >or7ay. The >or7e+ian pra&ti&e !i+ht *e 5ustified on the +rounds that !ost people 7ill ta8e &are of their teeth 7hen they 8no7 they 7ill have to pay the dentist<s *ill the!selves, and that it is !ore a&&epta*le to say 2you have !ade your *ed, so you &an lie in it2 to those 7ho do not, 7hen the dis&o!forts of the *ed are !inor and the &osts of repairin+ it s!all. It +oes a+ainst $illia!s< 2ne&essary truth2 if ri&h people 7ho ne+le&t their teeth +et *etter dental &are than other ne+li+ent people, *ut &ould not that in&onsisten&y &ount a+ainst his assertion, rather than a+ainst the pra&ti&eH1E 9e&ondly, one !i+ht o*5e&t that $illia!s< 2ne&essary truth2 is a for! of dis+uised, and possi*ly !is+uided, paternalis! To *e sure, on&e an individual needs a 8idney, heart, or liver transplantation, he 7ould 7ant to have one. #e 7ould not say 2I<d rather ta8e the !oney,2 sin&e 7ithout the operation he 7ould not *e around to en5oy the !oney. It suffi&es to i!pose a thin veil of i+noran&e, ho7ever, to !a8e it plausi*le that he !i+ht prefer the !oney. (or 2the poor la&8 a +reat !any +oods. -erhaps they 7ould prefer to have so!e of their other needs !et 7ith the !oney that &ould *e set aside for or+an transplants.211 This loo8s li8e a 8no&8/do7n ar+u!ent, and perhaps it is. Aet !e try to sho7, nevertheless, ho7 it &ould *e !et, so!e7hat (if I have understood hi! ri+ht) in the spirit of $illia!s< o7n ar+u!ent. Fne &an i!a+ine t7o sorts of replies to the o*5e&tion. (irst, one !i+ht say that paternalis! is 5ustified under &ir&u!stan&es in 7hi&h so!e people are so poor that they are te!pted, a+ainst their real interest, to trade off their lon+/ter! health a+ainst i!!ediate
[end of pa+e 9, start of pa+e 1E1

*etter!ent. Their &apa&ity for !a8in+ autono!ous de&isions is so i!paired *y poverty that they have to *e prote&ted a+ainst the!selves. 9e&ondly, one !i+ht ar+ue that in &apitalist &ountries the only redistri*utive poli&ies that 7or8 are in/8ind +uarantees li8e free a&&ess to edu&ation or !edi&al +oods, *e&ause &ash transfers, even 7hen intended to *enefit the poor, are lar+ely &aptured *y the !iddle/&lass. 14 In short, they 7ould not +et their share of the !oney set aside for transplants? and if they did, they 7ould use it un7isely.. These re*uttals are po7erful, *ut insuffi&ient. E!piri&al &lai!s li8e this &annot *e part of the ar+u!ent for a ne&essary truth. lso, the &lai!s the!selves ar& far fro! *ein+ o*viously true. de&ision to fore+o &ostly insuran&e a+ainst a hi+hly i!pro*a*le event need not he irrationally !yopi&. syste! of lar+ely &o!pulsory health insuran&e !i+ht in&lude so!e optional features that &ould *e traded in for &ash.1@ Transplantation could pro*a*ly not *e one of these features. nti&ipation of the pu*li& out&ry 7hen non/insurers are turned a7ay fro! transplantation &enters 7ould prevent any su&h s&he!e fro! +ettin+ off the +round.1. )ut perhaps I &ould *e allo7ed to fore+o !y ri+ht to *e operated for vari&ose veins and ta8e the &ash equivalent insteadH The third o*5e&tion is that $illia!s< prin&iple !i+ht partly *e *ased on envy. In the provision of e6pensive life/savin+ health &are, there is an 2all or none2 tenden&y, and a &orrespondin+ aversion to sele&tive provision. If it is te&hni&ally feasi*le to +ive the treat!ent to all 7ho need it, one should do so? if not, no one should +et it.15 In *oth &ases, equality of !edi&al &are is reali;ed. The !eri&an end/sta+e renal disease pro+ra! is an e6a!ple of the for!er. Eventually, dialysis 7as !ade freely availa*le to virtually every*ody 7ho 7as !edi&al indi&ted for it. The re&ent Fre+on !oratoriu! on heart arid liver transplantations is an e6a!ple of the latter.13 partially si!ilar poli&y 7as follo7ed in %assa&husetts,1D 7here transplantations 7ere allo7ed only 7ithin very ti+ht *ud+etary &onstraints. The follo7in+ &o!!ent on the report of the %assa&husetts Tas8 (or&e on Fr+an Transplantation should provide food for thou+ht for those 7ho still *elieve in the 2ne&essary truth2' 9uppose 7e then assu!e that there is no intrinsi& !erit to a fi6ed !edi&al or hospital &are *ud+et. 9uppose 7e also assu!e, as the "eport itself su++ests, that 7ith feasi*le arran+e!ents the supply of or+ans for trans/
[end of pa+e 1E, start of pa+e 111

plantation 7ill *e adequate for all 7ho desire transplants. 9uppose that heart and liver transplant have passed the resear&h sta+e, and are 8no7n to he effe&tive, if e6pensive, 7ays of e6tendin+ life, and that a&&urate infor!ation &on&ernin+ the transplants is trans!itted to patients and insurers. (inally, suppose that a finan&in+ !ethod is developed in 7hi&h so!eone 7ho re&eives a transplant is &har+ed the full resour&e &osts of <<produ&in+<< that transplant. The pur&haser, in effe&t, &auses no additional &osts to *e i!posed on anyone e6&ept his household if he o*tains a transplant. There &ould he insuran&e &overa+e of su&h e6penses, *ut the pre!iu!s 7ould apply only to those 7ho had spe&ifi&ally ele&ted transplant &overa+e? there 7ould *e no +eneral spillover onto other insureds, either for transplant sur+ery, or for the follo7/up &are. %y understandin+ of the Tas8 (or&e<s re&o!!endations is that they 7ould prohi*it a person 7ho lives in %assa&husetts fro! *uyin+ a transplant under su&h &ir&u!stan&es. In effe&t, the Tas8 (or&e finds o*5e&tiona*le a fa!ily<s de&ision that it is 7illin+ to sa&rifi&e other thin+s it !i+ht &onsu!e in order to prolon+ the life of one of its !e!*ers.

$hat &an *e said in favor of this sort of distri*utionH In a so&iety shot throu+h 7ith envy, su&h a vie7 !i+ht !a8e sense, *ut the Tas8 (or&e offered no e!piri&al eviden&e for su&h envy (or, for that !atter, for its assertions a*out &iti;ens< *elief a*out fairness). Its the a*sen&e of su&h eviden&e, I have serious diffi&ulties a*out raisin+ envy as a !oral prin&iple equal to altruis!. In any &ase, envy 7ould &all for at !ost an e6&ise (su!ptuary) ta6 on pur&hased transplants, not a total prohi*ition.10 The se&ond and third o*5e&tions to $illia!s< ar+u!ent !ay *e &o!*ined as follo7s. 9uppose that 7e are dealin+ 7ith a s&ar&e indivisi*le !edi&al +ood in totally inelasti& supply. The poor ill and the ri&h ill have the sa!e &han&e of *ein+ dra7n fro! the 7aitin+ list. $hy should not a poor person *e allo7ed / prior to the develop!ent of any illness / to sell his ri+ht to *e pla&ed on the 7aitin+/list to a ri&h person, so that the latter 7ould, in effe&t, have t7o ti&8ets in the lotteryH Fne !i+ht even i!pose the &ondition that the ri&h pur&hase the e6tra ti&8et or ti&8ets prior to his develop!ent of the illness, so as to redu&e the ris8 that he !i+ht rise his 7ealth to &oer&e others to +ive up their ri+hts. In >o;i&8<s phrase, this is a &apitalisti& a&t *et7een &onsentin+ adults that i!poses no har! on third parties. In for*iddin+ it, 7e e6press paternalis! to7ards the poor or envy to7ards the ri&h, or *oth. $e !ay deplore inequalities of in&o!e. $e !ay 7ish for a so&iety in 7hi&h there 7ere no !illionaires 7ho &ould *uy transplantations 7hen the nu!*er of pu*li&ly finan&ed operations 7as e6hausted, and no poor 7ho !i+ht prefer, ho7ever autono!ously, the &ash
[end of pa+e 11, start of pa+e 141

equivalent of so!e of their !edi&al ri+hts. >ote, ho7ever, that the pur&hase and sale of !edi&al options !i+ht also o&&ur, if allo7ed, in a so&iety of &o!plete equality of in&o!e, as lon+ as preferen&es differ. It is not 5ust the poor 7ho !i+ht prefer the &ash equivalent of the ri+ht to *e put on the 7aitin+ list for transplantation? a less than avera+e de+ree of ris8 aversion !i+ht have the sa!e effe&t. Fthers !i+ht *e so ris8/averse as to *uy e6pensive assuran&e for very i!pro*a*le events. In that &ase, 7ould not 2equality of persons2 en5oin us to respe&t the desire to opt out of or *uy into the !edi&al syste!H Totally re&8less *ehaviour, li8e e6tre!e !yopia, is a si+n of irrationality. $hen 7e find it, as 7e often do in youn+ &hildren, it provides suffi&ient +rounds for paternalis!. E6tre!e ris8/aversion &an *e assi!ilated to a pho*ia, 7hi&h is also a si+n of irrationality. Aess e6tre!e attitudes to7ards ris8 !ay, ho7ever, he part of the quiddity of individual &hara&ter that, in other 7ritin+s, $illia!s has ur+ed us to respe&t. #o7 &an one respe&t a person if one treats his &entral &hara&ter traits as +rounds for prote&tin+ hi! a+ainst hi!selfH I a! not quite sure 7here this !edley of ar+u!ents leads !e. Fne &on&lusion / or is it a pre!iseH / is the follo7in+. ,nli8e $illia!s and $al;er, I do not *elieve in the inherent autono!y of spheres of 5usti&e. There are no ne&essary truths that re+ulate the distri*ution of sphere/spe&ifi& +oods, li8e !edi&al &are or e6e!ption fro! !ilitary servi&e.19 ,nli8e $al;er (and $illia!sH), I do *elieve that the distri*ution of in&o!e should *e !u&h !ore equal than it is in !ost $estern so&ieties today. (or one thin+, equality of in&o!e is a +ood thin+ in itself, as lon+ as it does not interfere too !u&h 7ith effi&ien&y. (or another, in&o!e inequalities detra&t fro! the autono!y of &hoi&es, in t7o 7ays. If I a! poor, I !ay not *e a*le to re&o+ni;e 7here !y interest lies. nd, even if I do, the ri&h !ay use their 7ealth to &oer&e !e to a&t a+ainst it. ,nder these i!perfe&t &ir&u!stan&es, the insisten&e on the autono!y of spheres !ay *e 5ustified, not as a first/*est prin&iple, *ut as a 7ay of &opin+ 7ith 7ea8ness of 7ill or understandin+ and 7ith &oer&ive po7er. ,nder a !ore equal distri*ution

of in&o!e, the autono!y of spheres 7ould *e less i!portant. It !i+ht, in fa&t, *e&o!e a pointless o*sta&le to the free &hoi&e of life style and priorities. I no7 turn to a different set of issues. I said earlier that, in $illia!s< vie7, the prin&iple of the equality of persons !i+ht &onfli&t dou*ly 7ith the !erito&rati& allo&ation of edu&ation. The first
[end of pa+e 14, start of pa+e 1@1

&onfli&t arises *e&ause 2one is not really offerin+ equality of opportunity to 9!ith and Jones if one &ontents oneself 7ith applyin+ the sa!e &riteria to 9!ith and Jones at, say, the a+e of 11? 7hat one is doin+ there is to apply the sa!e &riteria to 9!ith as affe&ted *y favoura*le &onditions and to Jones as affe&ted *y unfavoura*le *ut &ura*le &onditions.2 4E Equality of persons as they are in the!selves, in a*stra&tion fro! the environ!ent then de!ands that the &ura*le environ!ent *e &ured. ssu!e that the &ure has *een effe&ted, so that talents are allo7ed to develop unfettered *y unfavora*le environ!ents. $illia!s ar+ues41 that in this truly !erito&rati& 7orld, people 7ould *e 2over&on&erned 7ith su&&ess2 and pla&e far too !u&h e!phasis on a*ilities. The values of the &o!!unity and !utual respe&t 7ould 7ither. The ideal of eqality of persons 7ould *e under!ined, as a result of refor!s !otivated *y that very prin&iple. I a+ree 7ith $illia!s that this is a possi*le and undesira*le side effe&t of other7ise desira*le refor!s. Aet !e also assu!e, for the sa8e of ar+u!ent, that the side effe&t &ould out7ei+h the !ain intended effe&ts. $hat, then, are the alternativesH Fne ans7er !i+ht *e that the present syste! is, all thin+s &onsidered, superior to the !erito&rati& ni+ht!are. )e&ause every*ody 8no7s that talent is often fettered *y &ir&u!stan&es, less *la!e is atta&hed to lo7 a&hieve!ents than if it 7as 8no7n that a&hieve!ent and a*ility 7ere perfe&tly &orrelated. Aosers in the rat ra&e &an retain their self/ respe&t and the respe&t of others as lon+ as there is suffi&ient un&ertainty a*out the relative i!portan&e of so&ial and +eneti& &auses of su&&ess and failure. If so&ial &auses 7ere to *e eli!inated, so 7ould the salutary un&ertainty. )etter let thin+s *e as they are. I &annot *elieve that $illia!s 7ould a&&ept this proposal. It s!a&8s too !u&h of Evelyn $au+h. )ut it is not at all &lear 7hat he 7ould say. In his &on&ludin+ para+raph, he essentially thro7s up his hands to &onfess i+noran&e and advo&ate ad-hoc pra+!atis!. I shall atte!pt to &arry the dis&ussion so!e7hat further *y dis&ussin+ a proposal due to John )roo!e44 and already i!ple!ented, un*e8no7nst to hi!, in the =ut&h edu&ational syste!. The issue *efore us is this. Fn the one hand, !any of us share 7ith $illia!s the *elief that the equality of persons is an i!portant, if va+ue, prin&iple. Fn +rounds of &o!!on hu!anity, people have a ri+ht to equal &on&ern and respe&t. $e 7ould li8e, !oreover, this
[end of pa+e 1@, start of pa+e 1.1

prin&iple to have i!pli&ations for a&tual poli&y/!a8in+ in allo&ative arenas. Fn the other hand, !ost of us also share his *elief that there are differential +rounds for ad!ittin+ people to hi+her edu&ation, in ter!s of 2the e&ono!i& needs of so&iety for &ertain s8ills.2 The !ore talented, presu!a*ly, are to *e +iven priority *y virtue of those needs. si!ilar point &ould

*e !ade 7ith respe&t to the allo&ation of s&ar&e !edi&al resour&es. There are pri!a/fa&ie +rounds for preferential treat!ent of those 7ho &an *enefit !ost fro! the s&ar&e +ood.4@ The =ut&h solution is to ad!it students to !edi&al s&hool *y a s&he!e of weighted lotteries, hi+h s&hool +rades *ein+ used as the 7ei+hts.4. )roo!e 7ould +enerali;e the prin&iple. #e stipulates that one &an usually as&ertain the stren+th of a person<s claim to the s&ar&e +ood in question. person 7ith hi+h +rades has a stron+er &lai! to *ein+ ad!itted to !edi&al s&hool than a person 7ith lo7er +rades. The &lai! of the latter, ho7ever, is 7ea8er rather than non/ e6istent. 9i!ilarly, the &lai! of an old person to re&eive an or+an for transplantation is 7ea8, *ut not non/e6istent. )roo!e ar+ues, therefore, that the appropriate &o!pro!ise *et7een the +eneral equality of persons and spe&ifi& +rounds for preferential treat!ent is to have a 7ei+hted lottery, 7ith the stren+th of the &lai!s *ein+ used as the 7ei+hts. The proposal is attra&tive, if &ontroversial.45 Aet its try to see ho7 it !i+ht 7or8 in the &ase of allo&atin+ or+ans for transplantation.43 It see!s &lear to !e that the +rounds for preferential treat!ent are e6pe&ted pro*a*ility of su&&ess of the transplantation !ultiplied *y e6pe&ted lifeti!e after a su&&essful transplantation.4D +ainst the &ate+ory of patients 7ho *est satisfy this &riterion, there are t7o +roups of patients 7ho !i+ht press their &lai!s. Fn the one hand there are those / nota*ly the old / 7ho &an he e6pe&ted (let us assu!e) to survive the operation as 7ell as any other patient, *ut 7ho are li8ely to die soon of other &auses. Fn the other hand, there are the ur+ent &ases 7ho (let us assu!e) 7ould live as lon+ as any other patient if the operation su&&eeds, *ut for 7ho! the very ur+en&y of the illness !a8es su&&ess less li8ely. #o7 do 7e !easure the stren+th of the &lai!s of these t7o patient &ate+oriesH (or the first &ate+ory, 7e 7ould pro*a*ly !easure the stren+th of the &lai! *y e6pe&ted life e6tension. (or the se&ond &ate+ory, 7e !i+ht !easure it *y e6pe&ted in&re!ent in li8elihood of survival.
[end of pa+e 1., start of pa+e 151

This, ho7ever, !a8es for a pro*le!. If, on these +rounds 7e allo7 transplantations of so!e patients at in (i+ure 1.1, 7e 7ould also have to allo7 so!e patents at C to +et a ti&8et in the lottery. )ut this see!s &ounter/intuitive. (airness and &o!passion *oth su++est that the very ill +et a &han&e, althou+h it involves a near/&ertain 7aste of resour&es. )ut, in a situation of e6tre!e s&ar&ity, it is hard to see 7hy< people 7ho already have a +ood pro+nosis should +et a &han&e to i!prove it. >or do I see any non-ad-hoc 7ay out of the dile!!a that 7ould allo7 us to a&8no7led+e the &lai!s of patients at 7ithout also re&o+ni;in+ those of patients at C. "e+ardless of this and other pro*le!s of i!ple!entation,40 I suspe&t that $illia!s !i+ht not 7ant to +o this 7ay either. In a s&he!e of 7ei+hted lotteries he 7ould hear 2the rattle of !a&hinery.2 It 7ould represent a &on&ern for the a*stra&t hu!an *ein+, not for spe&ifi& individuals. )ut I !i+ht *e 7ron+ here, !ista8enly readin+ $illia!s throu+h the lenses of the &o!!unitarian 7riters 7ho! he has influen&ed and 7ith 7ho! he shares at least so!e ene!ies. )e this as it !ay, I do not thin8 via*le &o!pro!ises *et7een the equality of persons and +rounds/*ased differential treat!ent &an *e rea&hed other7ise than *y so!e s&he!e of this +eneral sort. (or so!e purposes, 7ei+hted lotteries !i+ht serve? for other purposes different &o!pro!ises !i+ht have to *e found. This !i+ht see! to *e fairly &lose to 7hat I &alled $illia!s< "ad hoc pra+!atis!,2 and I suppose it is. The differen&e, if there is any,

!i+ht lie in !y +reater 7illin+ness to a&&ept !e&hani&al s&he!es, and !y e!phasis on the virtues of pu*li&ity and predi&ta*ility e!*odied in su&h s&he!es. NOTES 1 In the follo7in+ I quote fro! the reprint in Problems of the Self, Ca!*rid+e ,niversity -ress, 19D@. 4 I also *elieve 7e !ust +o *eyond la*oratory studies of per&eptions of 5usti&e. The other7ise invalua*le 7or8 *y %. :aari and %. )ar/#illel (see nota*ly their 2Fn dividin+ 5ustly,2 Social Choice and Welfare, I [190.1, 1/45) &annot provide a full e!piri&al foundation for a theory of 5usti&e. @ This is not the pla&e to !a8e this ar+u!ent in +reater detail? nor a! I &ertain that, if &hallen+ed, I &ould !a8e a stron+ and &oherent &ase. %y vie7s on the !atter are lin8ed to 7or8 in pro+ress on 2lo&al 5usti&e. (or a rou+h overvie7, see !y 2lo&al 5usti&e and interpersonal &o!/
[end of pa+e 15, start of pa+e 131

parisons,2 in J. Elster and J. "oe!er (eds.), Interpersonal Comparisons of Well- eing, Ca!*rid+e ,niversity -ress, 1991, pp. 90/143. . )ernard $illia!s, 2The idea of equality,2 p. 4.E. !on+ those 7ho have ta8en their lead fro! this state!ent one !ay nota*ly &ite %. $al;er, Spheres of Justice, >e7 :or8' )asi& )oo8s, 190@. 5 This rese!*les the fa!iliar distin&tion *et7een !a6i!in 5usti&e and utilitarianis!, *ut the t7o distin&tions also differ in !any 7ays, as is easily seen. 3 In that ar+u!ent the t7o prin&iples do not &oin&ide fully, even under the stated assu!ptions, sin&e one !ust ta8e a&&ount of the possi*ility of a ne+ative i!pa&t of distri*ution on the distri*uendu!. Throu+hout this &hapter, ho7ever, I assu!e that the total to *e distri*uted is unaffe&ted *y the 7ay it is distri*uted. Even in the &ase of or+an transplantation, this need not *e true. The ar+u!ent has *een !ade, for instan&e, that if or+ans are allo&ated to non/resident aliens, &iti;ens !i+ht *e less 7illin+ to donate or+ans for transplantation. These are, I *elieve, at !ost se&ond/de&i!al pheno!ena. D 29i la pluralitI des personnes J aider fait o*sta&le, il faut &hoisir &elui dont rIsultera au total le plus +rand *ien? ainsi don&, en &as de &o!pItition, toutes &hoses I+ales d<ailleurs, I& !eilleur, &<est/J/dire le !ieu6 disposI pour le *ien pu*li&. En effet &e qu<on lui apportera sera !ultipliI en Itant reper&utI sur *eau&oup et de la sorte en l<aidant, on aidera plusieurs. Et !K!e en +InIral, toutes &hoses I+ales d<ailleurs, il faut choisir celui !ui a d"#$ situation la meilleure% Fn !ontrera en effet que l<aide pro&Lde non pas &o!!e une addition, !ais &o!!e une !ultipli&ation ... ider, &<est !ultiplier et nuire diviser? la raison en est que &elui qui est aidI est un esprit? or un esprit peut par sa dI!ar&he appliquer tout J tout, &e qui revient J faire un produit ou J !ultiplier. -rends quelqu<un dont la sa+esse soit I+ale J @, le pouvoir J ., la valeur totale de &et ho!!e/lJ sera I+ale J 14, et non J D? en effet il peut user de la sa+esse J n<i!porte quel de+rI de puissan&e. Et *ien plus, dans le &as d<o*5ets de !K!e nature, &elui qui possIde &ent !ille piL&es d<or est plus ri&he que ne le sont &ent personnes dont &ha&une

possLde !ille piL&es. En effet, l<union fait l<utilitI' lui, il +a+nera !K!e en ne faisant rien, les autres perdront !K!e en travaillant.2 (Aei*ni;, Philosophische Schriften, ed. C. I. Merhardt, I, p. D.. Itali&s added.) 0 9upport for the follo7in+ state!ents is found in J. . "o*ertson, 29upply and distri*ution of hearts for transplantation' le+al, ethi&al, and poli&y issues,2 Circulation, D5 (190D), DD/0D and in a nu!*er of pla&es in =. %athieu (ed.), &rgan Substitution 'echnolog(, )oulder and Aondon' $estvie7 -ress, 1900, for e6a!ple, pp. ../5, 91/4, 90/9, 4D0/9. %any of these state!ents &o!pare patients 7ho have had an earlier +raft re5e&ted or are on an artifi&ial heart 7ith other &ate+ories of patients. The for!er have a !ore ur+ent need for transplantation, *ut also hi+her rates of failure. 9 There are other diffi&ulties as 7ell. $illia!s 7ould have to e6&lude the
[end of pa+e 13, start of pa+e 1D1

nu!*er of fa!ily dependents as +rounds for +ivin+ a s&ar&e or+an to one &andidate rather than to another. I &annot see 7hy this &ould not so!eti!es *e a valid &onsideration. 1E s !entioned in note 0, patients often +et several transplans. In itself, this !ay not *e o*5e&tiona*le, even thou+h the or+ans used in the later +rafts &ould have *een !ore effe&tive if +iven to others. )ut 7hat shall 7e say if the need for the later transplants is &reaten *y the patient<s resu!ption of the eatin+, drin8in+, or s!o8in+ ha*its that *rou+ht a*out the need for the first oneH 11 Editorial &o!!ent in =. %athieu (ed. ) , Frgan Substitution, p. 1.3. 14 ). -a+e, Who gets What from )overnmnet* )er8eley and Aos n+eles' ,niversity of California -ress, 190@. 1@ T7o issues are involved here' levels of< in&o!e and equality of in&o!e. $e !ust i!a+ine a so&iety in 7hi&h the !ini!al in&o!e is hi+h enou+h to ensure that no one needs to *e prote&ted a+ainst their o7n irrational !yopia, 7hile thr in&o!e distri*ution is suffi&iently unequal to ensure that so!e people !i+ht ta8e the &ash option *e&ause, at their level of in&o!e, they 7ould rather spend the !oney on other thin+s. The 9&andinavian so&ieties, in !y opinion, approa&h this state of affairs. 1. >ote, ho7ever, that this out&ry &ould 7or8 a+ainst the e+ ante interests of the +roup on *elialfof 7hi&h it is !ade. 15 This is apparently a &entral prin&iple in Je7ish ethi&s. 9ee (. "osner, ,odern ,edicine and Jewish Ethics, >e7 :or8' :eshiva ,niversity -ress, 1903, pp.@.D/0. 13 #. Mil*ert and E. ). Aarson, 2=ealin+ 7ith li!ited resour&es' The Fre+on de&ision to &urtail fundin+ for or+an transplantation,2 -ew England Journal of ,edicine (July 41, 1900), 1D1/@. 1D C. %. #avi+urst and >. %. Gin+, 2Aiver transplantation in %assa&husetts' -u*li& poli&y!a8in+ as a !orality play,2 Indiana .aw /eview, 19 (1903), 955/0D.

10 %. N. -auly, 2Equity and &osts,2 in =. %athieu (ed.), &rgan Substitution, pp.1D4/@. 19 I en5oin the reader to +o throu+h the follo7in+ thou+ht e6peri!ent. 9uppose that the +ood so&iety has *een rea&hed. There is full equality of in&o!e. There are no 7ars, and no need for !ilitary servi&e. There is, ho7ever, a need for 2national servi&e2 to &ope 7ith frequently re&urrin+ natural disasters. s!all nu!*er of youn+ !en are &hosen ea&h year *y lot for this vital *ut ris8y tas8. 9hould one allo7 su*stitution, so that a !an sele&ted *y lot &ould pay another to ta8e his pla&eH 9hould one allo7 &o!!utation, so that he &ould +o free *y payin+ a fee to the state, set at a level suffi&ient to indu&e volunteersH If not, 7hy notH 4E $illia!s, 2The idea of equality,2 pp.4.5/3. 41 t least, I *elieve the follo7in+ represents his vie7s on the su*5e&t. $hat he a&tually says refers to a s&ien&e/fi&tion e6a!ple so re!oved fro! the real 7orld that it is hard to 8no7 7hat to infer fro! it. 44 John )roo!e, 2(airness and the rando! distri*ution of +oods2
[end of pa+e 1D, start of pa+e 101

(unpu*lished !anus&ript 190D). 4@ ,nli8e the reasons +iven for +ivin+ the talented preferential a&&ess to hi+her edu&ation, this ar+u!ent does not rely on the e&ono!i& *enefits 7hi&h the re&ipients of !edi&al treat!ent 7ill *e a*le to provide for other people. -eople 7ho have re&eived transplants are, *y and lar+e, una*le to do !u&h produ&tive 7or8. 4. (or a des&ription of the syste!, see $. G. ). #ofstee, 2The &ase for &o!pro!ise in edu&ational sele&tion and +radin+,<< in 9. ). nderson and J. 9. #el!i&8 (eds.), &n Educational 'esting, 9an (ran&is&o' Jossey )ass, pp 1E9/4D 45 (or so!e in&on&lusive &o!!ents, see !y Solomonic Judgements, Ca!*rid+e ,niversity -ress, 1909, pp. 11./15. 43 (or one version of this idea, see =. )ro&8, 2Ethi&al issues in re&ipient sele&tion for or+an transplantations2 in =. %athieu (ed.), &rgan Substitution, pp. 03/9E, at p. 9D. #is proposal is rather &oarse/+rained, as it does not distin+uish *et7een the t7o reasons 7hy people !i+ht not *enefit fro! an or+an transplantation' lo7, pro*a*ility of su&&ess of the operation and lo7 e6pe&ted lifeti!e follo7in+ a su&&essful operation. 4D (or reasons *riefly stated in !y 2Ao&al 5usti&e and interpersonal &o!parisons,2 I do not thin8 one should !easure the life e6tension in 2quality/ad5usted life years.2 40 !on+ the other pro*le!s, &onsider &lai!s *ased on fa!ily dependents (note 0 a*ove). If these are ad!itted, ho7 should they *e inte+rated 7ith other &lai!s into one overall &lai!H
[end of pa+e 101

[Elster, Jon (1995), The idea of equality revisited, Chapter I in J. ltha! and ". #arrison,

eds., $orld, %ind, and Ethi&s' a (ests&hrift for )ernard $illia!s, Ca!*rid+e ,niversity -ress, pp. ./101