Explore the vast range of titles available.

We argue that deliberative decision making that is inclusive, transparent and accountable can contribute to more trustworthy and legitimate decisions on difficult ethical questions and political trade-offs during the pandemic and beyond.

Following endorsement by WHO,1,2 the World Bank,3 and the UN's Sustainable Development Goals,4 the drive towards universal health coverage (UHC) is now one of the most prominent global health policies. As countries progress towards UHC, they are forced to make difficult choices about how to prioritise health issues and expenditure: which services to expand first, whom to include first, and how to shift from out-of-pocket payment towards prepayment.

We summarise key messages from the World Bank Report Open and Inclusive: Fair Processes for Financing Universal Health Coverage. A central lesson of the Report is that in decision-making on the path to Universal Health Coverage (UHC), procedural fairness matters alongside substantive fairness. Decision systems should be assessed using a complete conception of procedural fairness that embodies core commitments to impartial and equal consideration of interests and perspectives. These commitments demand that comprehensive information is gathered and disclosed and that justifications for policies are publicly debated; that participation in decision-making is enabled; and that these characteristics of the decision system are institutionalised rather than up to the good will of decision-makers. Procedural fairness can improve equity in outcomes, raise legitimacy and trust, and can help make reforms last. While improving procedural fairness can be costly and there are barriers to achieving it, the range of instruments that countries at varying levels of income and institutional capacity have used with some success shows that, in many contexts, advances in procedural fairness in health financing are possible and worthwhile.

In response to our critics, we clarify and defend key ideas in the report Open and Inclusive: Fair Processes for Financing Universal Health Coverage. First, we argue that procedural fairness has greater value than Dan Hausman allows. Second, we argue that the Report aligns with John Kinuthia's view that a knowledgeable public and a capable civil society, alongside good facilitation, are important for effective public deliberation. Moreover, we agree with Kinuthia that the Report's framework for procedural fairness applies not merely within the health sector, but also to the wider budget process. Third, we argue that while Dheepa Rajan and Benjamin Rouffy-Ly are right that robust processes for equal participation are often central to a fair process, sometimes improvements in other aspects of procedural fairness, such as transparency, can take priority over strengthening participation. Fourth, while we welcome Sara Bennett and Maria Merritt's fascinating use of the Report's principles of procedural fairness to assess the US President's Emergency Plan for AIDS Relief, we argue that their application of the Report's principle of equality to development partners' decision-making requires further justification.

Many believe that we ought to save a large number from being permanently bedridden rather than save one from death. Many also believe that we ought to save one from death rather than a multitude from a very minor harm, no matter how large this multitude. I argue that a principle I call Aggregate Relevant Claims satisfactorily explains these judgments. I offer a rationale for this principle and defend it against objections.

The experience of Costa Rica highlights the potential for conflicts between the right to health and fair priority setting. For example, one study found that most favorable rulings by the Costa Rican constitutional court concerning claims for medications under the right to health were either for experimental treatments or for medicines that should have low priority based on health gain per unit of expenditure and severity of disease.1 In order to better align rulings with priority setting criteria, in 2014, the court initiated a reform in its assessment of claims for medicine. This paper assesses this reform’s impact on the fairness of resource allocation. It finds three apparent effects: (1) a reduction in successful claims for experimental medication, which is beneficial; (2) an increase in the success rate of medication lawsuits, which is detrimental because most claims are for extremely cost-ineffective medications; and (3) a decline in the number of claims for medicine, which is beneficial because it forestalls such low-priority spending. This paper estimates that, taking all three effects into account, the reform has had a modest net positive impact on overall resource allocation. However, it also argues that there is a need for further reforms to lower the number of claims to low-priority medicines that are granted.

A possible person's conditional expected well-being is what the quality of their prospects would be if they were to come into existence. This article examines the role that this form of expected well-being should play in distributing benefits among prospective people and in deciding whom to bring into existence. It argues for a novel egalitarian view on which it is important to ensure equality in people's life prospects, not merely between actual individuals, but also between all individuals who, given our choices, have a chance of coming into existence. The article argues that such egalitarianism for prospective people springs from equal concern for each prospective person and has plausible implications. It further shows that it has a rationale in respect for both the unity of the individual and the separateness of persons. Finally, it defends this view against a key objection and shows it is superior to a rival view.

Epicurus posited that the best life involves the greatest pleasures. He also held that it involves attaining tranquillity. Many commentators, including Ken Binmore, have expressed scepticism that these two claims are compatible. For, they argue, Epicurus’ tranquil life is so austere that it is hard to see how it could be maximally pleasurable. Here, I offer an Epicurean account of the pleasures of tranquillity. I also consider different ways of valuing lives from a hedonistic point of view. Benthamite hedonists value lives by the sum of pleasures minus the sum of pains, weighted by intensity and duration. Meanwhile, Binmore proposes that Epicurus valued lives by their worst episode. In contrast, I outline an Epicurean argument for why the best life is one in which a person attains tranquillity and tastes its pleasures until death.

The difference between the unity of the individual and the separateness of persons requires that there be a shift in the moral weight that we accord to changes in utility when we move from making intrapersonal trade-offs to making interpersonal trade-offs. We examine which forms of egalitarianism can, and which cannot, account for this shift. We argue that a form of egalitarianism which is concerned only with the extent of outcome inequality cannot account for this shift. We also argue that a view which is concerned with both outcome inequality and with the unfairness of inequality in individuals’ expected utilities can account for this shift. Finally, we limn an alternative view, on which such inequalities are not intrinsically bad, but nonetheless determine the strength of individuals’ competing claims. We argue that this ‘Competing Claims View’ can also account for the shift.

Suppose that you must make choices that may influence the well-being and the identities of the people who will exist, though not the number of people who will exist. How ought you to choose? This article answers this question. It argues that the currency of distributive ethics in such cases is a combination of an individual's final well-being and her expected well-being conditional on her existence. It also argues that this currency should be distributed in an egalitarian, rather than a prioritarian, manner.