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Meaning, Medicine, and Merit

  • Andreas L. Mogensen (a1)


Given the inevitability of scarcity, should public institutions ration healthcare resources so as to prioritize those who contribute more to society? Intuitively, we may feel that this would be somehow inegalitarian. I argue that the egalitarian objection to prioritizing treatment on the basis of patients’ usefulness to others is best thought of as semiotic: i.e. as having to do with what this practice would mean, convey, or express about a person's standing. I explore the implications of this conclusion when taken in conjunction with the observation that semiotic objections are generally flimsy, failing to identify anything wrong with a practice as such and having limited capacity to generalize beyond particular contexts.


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3 Thanks to an anonymous referee for suggesting this example.

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8 Parfit, Derek, Equality or Priority? The Lindley Lecture (Lawrence, KS, 1991).

9 Nozick, Robert, Anarchy, State, and Utopia (Oxford, 1974), pp. 30–3; Kamm, F. M., ‘Harming Some to Save Others’, Philosophical Studies 57 (1989), pp. 227–60.

10 Walzer, Michael, Spheres of Justice: A Defence of Pluralism and Equality (Oxford, 1983).

11 Walzer, Spheres of Justice, p. 75.

12 Brock, Dan, ‘Separate Spheres and Indirect Benefits’, Cost Effectiveness and Resource Allocation 1 (2003); Broome, ‘Fairness’; Kornhauser, Lewis and Sager, Lawrence, ‘Just lotteries’, Social Science Information 27 (1988), pp. 483516.

13 Henning, Tim, ‘From Choice to Chance? Saving People, Fairness, and Lotteries’, The Philosophical Review 124 (2015), pp. 169206.

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15 Anderson, ‘What is the Point of Equality?’, p. 313.

16 Lippert-Rasmussen, Compare Kasper and Lauridsen, Sigurd, ‘Justice and the Allocation of Healthcare Resources: Should Indirect, Non-health Effects Count?’, Medicine, Health Care and Philosophy 13 (2010), pp. 237–46.

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23 As per Abell, ‘Canny Resemblance’, Hopkins, Picture, Image, and Experience.

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26 Hellman, ‘Racial Profiling and the Meaning of Racial Categories’, p. 237.

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32 NHS Constitution for England, p. 3.

33 A notable exception being Miller, David, Principles of Social Justice (Cambridge, MA, 1999).

34 Bamfield, Louise and Horton, Tim, Understanding Attitudes to Tackling Economic Inequality (York, 2009).

35 McKie and Richardson, ‘Social Preferences for the Inclusion of Indirect Benefits’.

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39 Brennan, Jason and Jaworski, Peter Martin, ‘Markets without Symbolic Limits’, Ethics 125 (2015), pp. 1053–77.

40 Kamm, F. M., Morality Mortality, vol. 1: Death and Whom to Save From It (Oxford, 1993).

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44 Jamison, Dean, Gelband, Hellen, Horton, Susan, Jha, Prabhat, Laxminarayan, Ramanan, Mock, Charles, and Nugent, Rachel (eds.), Disease Control Priorities: Improving Health and Reducing Poverty (Washington D.C., 2018); Ord, Toby, ‘Considering Cost-Effectiveness: The Moral Perspective’, Priority Setting in Health: Building Institutions for Smarter Public Spending, ed. Glassman, Amanda and Chalkidou, Kalipso (Washington D.C., 2012), pp. 1519.

45 Piaget, Jean, The Child's Conception of the World, trans. Tomlinson, Joan and Tomlinson, Andrew (London, 1929).

46 Cimpian, Andrei and Salomon, Erika, ‘The Inherence Heuristic: An Intuitive Means of Making Sense of the World, and a Potential Precursor of Psychological Essentialism’, Behavioral and Brain Sciences 37 (2014), pp. 461–80; Gabbenesch, Howard, ‘The Perception of Social Conventionality by Children and Adults’, Child Development 61 (1990), pp. 2047–59.

47 For valuable comments on previous drafts of this article, I am grateful to Hilary Greaves, William MacAskill, Tom Sinclair, Christian Tarsney, and Teru Thomas, as well as the audience for my presentation at University College Dublin on 25 October 2018. I'd also like to thank two anonymous referees at Utilitas for their helpful comments and suggestions.

Meaning, Medicine, and Merit

  • Andreas L. Mogensen (a1)


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