Saturday, March 24, 2007

Pinker on the Decline of Violence

Turn the evening news on any day of the week and one is bound to hear a report about violence or war somewhere in the world. And the repeated exposure to such stories, day in and day out, will no doubt lead one to form the perception that we are currently living in a truly dire episode in human history. But how accurate is this popular perception? What is the benchmark by which we should judge how bad things really are?

Like most things in life, it's often helpful to stand back from the immediacy of one’s situation and look at things from the “big picture” perspective. To do this we need to appreciate the realities of human history. Is the world really a worse place to be than it once was? Are we actually getting more violent?

The March 19th issue of The New Republic has an interesting piece by Steven Pinker entitled "A History of Violence". Here are some snippets from Pinker's article:

In sixteenth-century Paris, a popular form of entertainment was cat-burning, in which a cat was hoisted in a sling on a stage and slowly lowered into a fire. According to historian Norman Davies, "[T]he spectators, including kings and queens, shrieked with laughter as the animals, howling with pain, were singed, roasted, and finally carbonized." Today, such sadism would be unthinkable in most of the world. This change in sensibilities is just one example of perhaps the most important and most underappreciated trend in the human saga: Violence has been in decline over long stretches of history, and today we are probably living in the most peaceful moment of our species' time on earth.

In the decade of Darfur and Iraq, and shortly after the century of Stalin, Hitler, and Mao, the claim that violence has been diminishing may seem somewhere between hallucinatory and obscene. Yet recent studies that seek to quantify the historical ebb and flow of violence point to exactly that conclusion.

....The decline of killing and cruelty poses several challenges to our ability to make sense of the world. To begin with, how could so many people be so wrong about something so important? Partly, it's because of a cognitive illusion: We estimate the probability of an event from how easy it is to recall examples. Scenes of carnage are more likely to be relayed to our living rooms and burned into our memories than footage of people dying of old age. Partly, it's an intellectual culture that is loath to admit that there could be anything good about the institutions of civilization and Western society. Partly, it's the incentive structure of the activism and opinion markets: No one ever attracted followers and donations by announcing that things keep getting better. And part of the explanation lies in the phenomenon itself. The decline of violent behavior has been paralleled by a decline in attitudes that tolerate or glorify violence, and often the attitudes are in the lead. As deplorable as they are, the abuses at Abu Ghraib and the lethal injections of a few murderers in Texas are mild by the standards of atrocities in human history. But, from a contemporary vantage point, we see them as signs of how low our behavior can sink, not of how high our standards have risen.

....Whatever its causes, the decline of violence has profound implications. It is not a license for complacency: We enjoy the peace we find today because people in past generations were appalled by the violence in their time and worked to end it, and so we should work to end the appalling violence in our time. Nor is it necessarily grounds for optimism about the immediate future, since the world has never before had national leaders who combine pre-modern sensibilities with modern weapons.

But the phenomenon does force us to rethink our understanding of violence. Man's inhumanity to man has long been a subject for moralization. With the knowledge that something has driven it dramatically down, we can also treat it as a matter of cause and effect. Instead of asking, "Why is there war?" we might ask, "Why is there peace?" From the likelihood that states will commit genocide to the way that people treat cats, we must have been doing something right. And it would be nice to know what, exactly, it is.

Understanding human history can help us better appreciate the magnitude and complexities of the predicaments we face. And we will be better equipped to tackle our current and future challenges if we appreciate how far we have come as a species, and the amazing things our innovation and hard work have accomplished.

So while the “Age of Enlightenment” still has lots of work to do, steady progress has been made. And we must not become complacent in our struggle against oppression, ignorance, dogma, etc. The spirit of enlightenment, perhaps more than anything else, will help ensure that we leave a better world for our grandchildren than the world we ourselves inherited.


Harm of Drug Misuse

The latest issue of The Lancet has this Health Policy report on the harm of drug misuse. Here is the abstract:

"Development of a rational scale to assess the harm of drugs of potential misuse" The Lancet, March 24th 2007
Drug misuse and abuse are major health problems. Harmful drugs are regulated according to classification systems that purport to relate to the harms and risks of each drug. However, the methodology and processes underlying classification systems are generally neither specified nor transparent, which reduces confidence in their accuracy and undermines health education messages. We developed and explored the feasibility of the use of a nine-category matrix of harm, with an expert delphic procedure, to assess the harms of a range of illicit drugs in an evidence-based fashion. We also included five legal drugs of misuse (alcohol, khat, solvents, alkyl nitrites, and tobacco) and one that has since been classified (ketamine) for reference. The process proved practicable, and yielded roughly similar scores and rankings of drug harm when used by two separate groups of experts. The ranking of drugs produced by our assessment of harm differed from those used by current regulatory systems. Our methodology offers a systematic framework and process that could be used by national and international regulatory bodies to assess the harm of current and future drugs of abuse.

The Guardian also has an article about the report here, emphasising the findings that alcohol and tobacco are rated as more dangerous than cannabis, LSD and ecstasy. Here are a few brief excerpts from the report:

Categories of harm
There are three main factors that together determine the harm associated with any drug of potential abuse: the physical harm to the individual user caused by the drug; the tendency of the drug to induce dependence; and the effect of drug use on families, communities, and society

....Our findings raise questions about the validity of the current Misuse of Drugs Act classification, despite the fact that it is nominally based on an assessment of risk to users and society. The discrepancies between our findings and current classifications are especially striking in relation to psychedelic-type drugs. Our results also emphasise that the exclusion of alcohol and tobacco from the Misuse of Drugs Act is, from a scientific perspective, arbitrary. We saw no clear distinction between socially acceptable and illicit substances. The fact that the two most widely used legal drugs lie in the upper half of the ranking of harm is surely important information that should be taken into account in public debate on illegal drug use. Discussions based on a formal assessment of harm rather than on prejudice and assumptions might help society to engage in a more rational debate about the relative risks and harms of drugs.


Friday, March 23, 2007

Prenatal Gene Therapy

The timing of a genetic intervention (e.g. prenatal vs postnatal) will have an important impact on the efficacy of the intervention. The prospect of being able to administer a safe and effective prenatal therapy is appealing as many early onset genetic diseases begin to manifest early in life. This piece in Nature Medicine contains a useful table which lists the candidate diseases for prenatal gene therapy (diseases like CF). These candidate diseases are life-threatening disorders for which irreparable organ damage early in life is certain and for which no satisfactory treatment is available. And this Review in Gene Therapy (2005) highlights the complex scientific and ethical issues facing prenatal intervention.

This news piece in Medical News Today (also see this report) suggests that a prenatal intervention for CF may be possible in a decade. Here are a few excerpts:

A genetic scientist based at University College, London, Suzanne Buckley, has successfully used HIV as a genetical material carrier or "vector" to correct faulty cystic fybrosis genes in the cells of the lungs of mice.

Suzanne Buckley is presenting her findings on Wednesday 21st March at this week's British Society for Gene Therapy conference in Warwick. The title of her paper is "Significant lung transduction after in utero and neonatal 30 administration of lentiviral vectors".

,,,,Gene therapy introduces the hope that a person can be treated by removing the cause of the sticky mucous, by targetting the faulty CF genes in the lungs, rather than treating the result of the disease.

The idea is to remove faulty genes and insert the correct ones, so that future generations of the cell and the organism inherit the correct code and eliminate the disease.

Viruses are used in gene therapy as "vectors" to carry corrective genes to the target host cells. They are ideal because in their natural state they invade cells of living organisms, hijack their DNA and make it obey instructions that help the virus to replicate. Retroviruses like HIV go one step further, they insert a DNA copy of their RNA and merge it with the genetic material of the host cell.


Monday, March 19, 2007

Early Online Publication of Political Studies Article

My paper "Justice in Ideal Theory: A Refutation" has been posted on the Early Online site for the journal Political Studies. You can download it for free from here. Below is the abstract:

In this article I argue that theorizing about justice at the level of ideal theory is inherently flawed and thus has impoverished liberal egalitarianism. Ideal theorists (falsely) assume that a political philosopher can easily determine (or has privileged access to) what constitutes the ‘best foreseeable conditions’. Furthermore, by assuming full compliance, ideal theorists violate the constraints of a realistic utopia. More specifically I argue that liberal egalitarians who function at the level of ideal theory adopt a cost-blind approach to rights and a narrow view of possible human misfortune. The former issue leads liberal egalitarians to give priority to a serially ordered principle of equal basic liberties or to treat rights as ‘trumps’; and the latter to a stringent prioritarian principle (Rawls’ difference principle) or luck egalitarianism. Taken together, the cost-blind approach to rights, coupled with the narrow view of human misfortune, mean the liberal egalitarian theories of justice cannot address the issue of trade-offs that inevitably arises in real non-ideal societies that face the fact of scarcity.This makes liberal egalitarianism an ineffective theory of social justice.


Friday, March 16, 2007

Blogging...And a Follow up to Yesterday

First, some thoughts about blogging. And then I will get to the point of how those thoughts relate to the issues raised in yesterday's post.

Blogging can have many benefits (and no doubt some drawbacks as well). One benefit of running a blog that relates to one’s academic work is that often one posts some thoughts, or links to a recent article, and then, days, months, or even a year, later the light comes on and you see things from a new perspective, develop some new ideas or link these various things together in a way that didn’t occur beforehand. And you can almost follow the development of one's thought processes through one's blog entries. By having your blog entries handy one can foster greater continuity and connectedness with one's self. And for me this has been the greatest thing about running this blog.

This is not to say that posting one's thoughts online is necessary to achieve these benefits. But for me, storing my thoughts, links to articles etc. on my blog gives me much greater organization than I could ever hope to achieve in the ever-growing mess and chaos that is my office. Keeping things tidy in the "virtual" space of a blog is much easier than in the real physical space of the books, post-it notes, papers, etc that litter my office. I did not consciously setup this blog with the intention of creating a more efficient and reflective system for developing my ideas. Rather, it was a pleasant, unexpected benefit. One I have only recently come to realise and appreciate.

No doubt those who run blogs with the comments feature open enjoy a whole other range of benefits by making diverse people "conversationally present" in their virtual space. If I had another 5 hours in the day, and better IT skills, I would probably entertain that prospect. But even without the comments feature on one can reap many benefits from engaging in the procedural process of making one's thoughts and reflections on different topics "public" on their blog. Such a public venue is less rigid and formal than academic publishing, which can help one be more adventurous than they might otherwise be. But at the same time, because you alone are the "author, editor and publisher", of your blog you need to exercise a good deal of restraint and oversight to ensure certain standards of quality are maintained. And this can help you learn a lot about yourself.

So blogging is therapeutic in many ways. Not in the sense that it is a venue for one to spew their various discontents and give them a public hearing (though many use it in this way). Rather it can help foster self-understanding, humility, etc. You realise that there are certain topics you feel comfortable talking about with some authority and taking a decisive stance on, and many others (no doubt the majority) you feel unqualified to address, or come to appreciate how complex an issue really is, etc. Hearing yourself, through the voice of your blog posts, can be very useful and is an effective way of fostering intrapersonal continuity and introspection. The blog is a link between your past, present and future selves. And letting all three of these selves interact on one's blog can be very fruitful.

I started thinking about the above comments after I reflected further on yesterday's post. So let me now turn to that....I had one of those little “eureka” moments today as I thought some more about the significance of our evolutionary history and our susceptibility to disease. The significance of our biological history has many important consequences for distributive justice, in particular for the issue of genetic justice.

A central theme in my book-in-progress on genetics and justice is to address the issue of how stringent the duty to directly mitigate genetic disadvantage is (e.g. via gene therapy). And I am interested in exploring how different normative theories (e.g. egalitarianism, sufficiency, priority, etc.) might address this topic.

For example, if one is a “luck egalitarian” then might be inclined to take the view that there is a stringent duty to directly mitigate genetic disadvantage because the natural lottery of life is the paradigm example of an “unchosen” inequality. Those attracted to sufficiency might take the view that justice requires that we implement a genetic decent minimum so that all fall within “normal species functioning”.

Of course one could say a lot more about the central ideas behind these different theories and the principles they will prescribe, but cutting to the chase...I think both frameworks are ill-equipped to help us address the real challenges we face now, and in the decades to come. One of the points we can take away from the insights of Greave’s piece on our intrinsic vulnerability to cancer and disease is that this vulnerability simply *IS* part of normal species functioning. Recall this passage from Greave:

The blind process through which we and other species have emerged carries with it inevitable limitations, compromises and trade-offs. The reality is that for accidental or biologically sound, adaptive reasons, we have historically programmed fallibility. Covert tumours arise constantly, reflecting our intrinsic vulnerability, and each and every one of us harbours mutant clones with malignant potential.

Taking our evolutionary legacies seriously poses, I believe, insurmountable problems for egalitarians and sufficitarians. When in comes to determining how stringent the duty to mitigate genetic disadvantage is we should not be primarily concerned with the choice/chance distinction, or if we fall below “normal species functioning”. The real important questions are: what is the likelihood that we could actually mitigate this disadvantage via genetic intervention? And what would such an intervention cost? And how does the duty to mitigate genetic justice fit into the “big picture” perspective with respect to mitigating disadvantage more generally (e.g. socio-economic disadvantage)?

Only by addressing these tough questions we will be able to ensure that our response to genetic disadvantage is proportionate and fair. This big picture perspective and the concern for proportionality just doesn't seem to fit well within an egalitarian or sufficitarian framework. That is not to suggest that the priority view alone can do all the work. Recall I favour a hybrid or pluralist view that is a second-order, rather than first-order, social theory. But when it comes to genetic justice I think priority (rather than equality or sufficiency) is the value that ought to be doing a good deal of the work in helping us figure out what the demands of genetic justice are in the "here and now", and in the foreseeable future.

So taking our evolutionary legacies seriously reinforces, I believe, the attraction of invoking a prioritarian (rather than egalitarian or sufficitarian) framework to work through these issues. And reading through Greave's article made me realise that one of the skills a political theorist must exercise is not only understanding the history our culture, political institutions, economy, etc., but also our biological history. A theory of genetic justice that is informed by this history is one that is better placed to yield sage prescriptions.


Thursday, March 15, 2007

Why Do We Develop Cancer?

No doubt this is a question we have all asked at some stage in our lives as cancer is a ever constant and present threat to the life prospects of everyone. And the usual answer is one that provides a causal explanation of why a particular person developed a particular kind of cancer. Given that cancer is a multifactorial disease this causal explanation will be one that emphasizes the important role played by our genes, age and environmental influences (like smoking, diet, etc.). Check out this useful site for an informed answer to this question.

But why do we, as a species, develop cancer? That question is a more profound and complex question. And Mel Greaves has a fascinating opinion piece in the latest issue of Nature Reviews Cancer where he offers some answers to this question. The answer, he contends, can be offered by Darwinian science. Here are a few snippets from this insightful piece:

From Mel Greave's "Darwinian medicine: a case for cancer" (Nature Reviews Cancer, March 2007)

A pragmatic focus on immediate, or proximate, causal mechanisms in cancer has been very productive. Epidemiologists identify cause as, for example, chronic exposure to cigarette tar, and molecular biologists indict gene mutations as mechanistic drivers. In turn, these insights provide genuine, practical advances in prevention, screening, differential diagnosis, prognosis and innovative treatments. We should all be happy. But there are two difficulties here, both related to our expectations of what the word 'cause' actually means and what level of understanding we aspire to. Environmental exposures and mutations are self-evidently not autonomous entities, but crucial components of a causal chain of events or components of a causal network. Second, even with a more realistic compound view of risk factors and molecular, biochemical mechanisms that produce cancer, we might still lack a coherent framework that can help us understand vulnerability. Why should potentially lethal cancer be such a common biological phenomenon, and why do we, as a species, seem to be especially vulnerable? Why is the lifetime risk of breast cancer as high as one in ten? And, superimposed on what seems to be a species vulnerability, why are some individuals more at risk of particular cancers than others?

…Overall, these data suggest that cancer risk is underpinned by intrinsic fallibility, and that risk increases with increasing age and is greatly exacerbated by some aspects of human activity.

…Any engineer confronted with a recurring fault in a complex machine or plant would look not only at the immediate source and cause of the fault, but at system design, its compromises and limitations. The engineer will resort to a blueprint; we have evolutionary biology.

The essential tenet of the new discipline of evolutionary or Darwinian medicine is that susceptibility to malfunction and disease must in part reflect historical or evolutionary legacies. The corollary is that we might then benefit from stepping back to take a broader look at human history and our protracted evolutionary trajectory. Even a cursory consideration of human anatomy reveals structural imperfections that are pregnant with potential for malfunction. For example, no intelligent designer would place the optic nerve and retina or prostate and urethra in the anatomical relationships in which we find them. The reality is of course that we have not been 'designed' or 'engineered' at all. The evolutionary processes involved in the diversification of molecules, cells, tissues and physiological processes rely on options generated randomly from previous templates. This is coupled with the selection of beneficial traits, by contingency or chance, or neutral drift. Evolutionary biologists continue to debate the relative importance of the mechanisms of selection, particularly as claims that traits were positively selected (the adaptionist argument) cannot always be substantiated. Irrespective of these uncertainties, the processes involved will inevitably result in 'designs' that have constraints or limitations on board, and trade-offs, collateral damage or negative impacts. Ultimately, inherent flaws are tolerated, at some level, as long as they do not impact deleteriously on reproductive fitness.

…Intrinsic vulnerability to cancer (or other chronic diseases) must be counterintuitive to anyone who views our bodies as the product of purposeful design or engineering. Evolutionary or Darwinian medicine provides the opposite view: the blind process through which we and other species have emerged carries with it inevitable limitations, compromises and trade-offs. The reality is that for accidental or biologically sound, adaptive reasons, we have historically programmed fallibility. Covert tumours arise constantly, reflecting our intrinsic vulnerability, and each and every one of us harbours mutant clones with malignant potential.

The complete article is well worth the read. The link is here (though you will need a subscription to the journal).


Wednesday, March 14, 2007

ARTs and Genetic Integrity

Louise Brown, the first "test-tube baby", was born in 1978. Recent estimates suggest that, since that time, over 3 million babies have been born through some form of assisted reproductive technology (ART).

One ongoing concern about ARTs has been their impact on the health of the child conceived. This article (available online for free) in the latest issue of the Proceedings of the National Academy of Sciences of the United States of America suggests that, when it comes to genetic integrity, artificial reproductive technologies appear to be safe. Here is the abstract.

"Assisted reproductive technologies do not alter mutation frequency or spectrum"
By Lee Caperton, Patricia Murphey, Yukiko Yamazaki, C. Alex McMahan, Christi A. Walter, Ryuzo Yanagimachi,and John R. McCarrey


Assisted reproductive technologies (ARTs) have now contributed to the birth of >3 million babies worldwide, but concerns remain regarding the safety of these methods. We have used a transgenic mouse model to examine the effects of ARTs on the frequency and spectrum of point mutations in midgestation mouse fetuses produced by either natural reproduction or various methods of ART, including preimplantation culture, embryo transfer, in vitro fertilization, intracytoplasmic sperm injection, and round spermatid injection. Our results show that there is no significant difference in the frequency or spectrum of de novo point mutations found in naturally conceived fetuses and fetuses produced by in vitro fertilization, intracytoplasmic sperm injection, or round spermatid injection. These results, based on analyses of a transgenic mouse system, indicate that with respect to maintenance of genetic integrity, ARTs appear to be safe.


Tuesday, March 13, 2007

The Importance of a Good Night's Sleep

The older I get (I just turned 37) the more I have come to value a good night's sleep. No doubt this is linked to the fact that parenthood makes such a sleep more of a rarity than it once was.

This article in Nature Neuroscience suggests that a good sleep is important for forming new memories. Here is the abstract:

"A deficit in the ability to form new human memories without sleep"
Nature Neuroscience - 10, 385 - 392 (2007)
Seung-Schik Yoo1, Peter T Hu, Ninad Gujar, Ferenc A Jolesz & Matthew P Walker

Evidence indicates that sleep after learning is critical for the subsequent consolidation of human memory. Whether sleep before learning is equally essential for the initial formation of new memories, however, remains an open question. We report that a single night of sleep deprivation produces a significant deficit in hippocampal activity during episodic memory encoding, resulting in worse subsequent retention. Furthermore, these hippocampal impairments instantiate a different pattern of functional connectivity in basic alertness networks of the brainstem and thalamus. We also find that unique prefrontal regions predict the success of encoding for sleep-deprived individuals relative to those who have slept normally. These results demonstrate that an absence of prior sleep substantially compromises the neural and behavioral capacity for committing new experiences to memory. It therefore appears that sleep before learning is critical in preparing the human brain for next-day memory formation—a worrying finding considering society's increasing erosion of sleep time.


Thursday, March 08, 2007

Genetics and Justice Conference (update)

Registration and other details for the "Genetics and Justice" Conference at Oxford on July 2nd and 3rd are now available on the CSSJ website here.

As you will see from the list of speakers below, the event will bring scholars from diverse disciplines together to discuss the ethical, social and legal implications of the genetic revolution. It promises to be an excellent event. Here are the speakers on the programme:

Tom Baldwin (Former Deputy Chair of the Human Fertilization and Embryology Authority/Philosophy, York) 'PGD and the Welfare of the Child'

Rebecca Bennett (Bioethics, Manchester) 'The Principle of Procreative Beneficence: A Critique'

Dan Brock (Department of Social Medicine, Harvard) 'Is Selection of Children Wrong?'

Ruth Chadwick (Director of the Center for Economic and Social Aspects of Genomics, Cardiff University) 'The HUGO Principles of Genetic Research: What Has Changed Since 1996?'

Aubrey de Grey (Biogerontology, Cambridge) 'The Duty to Combat Aging'

Colin Farrelly (Politics, Oxford/Waterloo) 'Genetic Justice: Where to Begin?'

Deborah Gill (GeneMedicine, Oxford,) 'Gene Therapy for Cystic Fibrosis Lung Disease - Who Gets Treated?'

Richard Gold (Director of the Centre for Intellectual Property Policy, McGill) 'Myriad Genetics: A Case Study'

Adam Hedgecoe (Sociology, Sussex) 'Justice and Pharmacogenetics: the Example of Herceptin'

Jane Kaye (Ethox, Oxford) 'Biobanks and Benefit Sharing'

Michael Parker (Director of Ethox Centre, Oxford) 'The Ethnography of a Global Malaria Genomics Consortium'

Julian Savulescu (Director of the Program on Ethics of the New Biosciences, Oxford) 'The Case of Performance Enhancement in Sport'


Wednesday, March 07, 2007

Cancer Research Budget Cuts

The latest issue of Science has this News of the Week piece entitled "Tight Budget Takes a Toll on U.S.-Funded Clinical Trials". These budget cuts harm the most vulnerable people in society- children with cancer. Here is an excerpt from the report:

Cancer specialists are reeling from deep cuts now being made in clinical trials, including what they say is the first-ever request from the U.S. National Cancer Institute (NCI) in Bethesda, Maryland, to slash patient enrollment. They are anxiously waiting to learn in the coming weeks precisely how 2007 funding will be divvied up. But already among the 10 U.S. cooperative groups that run large-scale cancer trials, many are implementing an NCI recommendation to trim their costs by 10% because of growing pressure on NCI's budget. Roughly 95 trials are at risk, and the number of open slots for patients is being reduced by 3000.

Trials for children have been hit hard, according to pediatric oncologists. Over several decades, they have built up an efficient network to wring data from a relatively small number of patients. More than 50% of children with cancer enroll in a clinical trial, compared with about 3% of adults, says Gregory Reaman, a pediatric oncologist and head of the Children's Oncology Group (COG) that runs pediatric trials.

ABC News has a video report on the issue here. For an Administration keen on fighting wars, it's tragic that they couldn't take the war on cancer just half as seriously as they do the war on terror. Words defy...


Monday, March 05, 2007

How Sufficient is Sufficiency?

Today was the last CSSJ reading group session this term. We read Paula Casal’s insightful article “Why Sufficiency is Not Enough” from the latest issue of Ethics. Casal distinguishes between a positive and negative thesis of the sufficiency position. The positive thesis stresses the importance of people living above a certain threshold. The negative thesis denies the relevance of certain additional distributive requirements. The article is very useful in bringing to the fore a number of nuanced distinctions one could make to the sufficiency position, as well as to egalitarianism and prioritarianism.

In the end Casal argues that principles of sufficiency can supplement, but not replace, principles of equality and priority. And thus the most tenable position is some version of a hybrid view. I agreed with a good deal of Casal’s arguments in that I think principles of sufficiency alone do not get us very far and that the negative thesis noted above is wrong.

My problem with the sufficiency view is not that it does not go far enough in terms of promoting equality. Rather the real problem is that it (potentially) promises too much (and thus does not offer enough in terms of what a defensible normative theory should offer).

Lets call those who align themselves with sufficiency, rather than equality or priority, as those who invoke what we can call a “big picture” sufficiency account of justice. Such an account maintains that justice requires that all pass a minimum threshold of “X”, where X is a multidimensional index covering not only the distribution of wealth and income, but also opportunities for education and health, and the protection of “negative rights” (e.g. security of the person, etc.), and perhaps other things as well.

So, according to this view, if we want to know how just society A is we need to ask if all pass the minimum threshold we have stipulated for X. The greater the percentage of the population falling under X the more unjust the distribution of that society is. I acknowledge this has some intuitive attraction but I do not think such an account of justice is of much use when we turn to the challenges real non-ideal societies face given the facts of scarcity and pervasive disadvantage (as well as uncertainty, indeterminacy, migration, globalisation, etc.).

So while I think it is interesting and worthwhile to assess how a theoretical framework fares in different hypothetical scenarios (in terms of how intuitive its conclusions are), the ultimate test, for me, is to ask how it fares in the real, non-ideal context. Does invoking the sufficiency theoretical framework (rather than another one that places greater emphasise on priority, for example) enhance our deliberations in useful and appealing ways. Does it bring to the fore (rather than ignore or bracket) the distinct tradeoffs we must make? Does it help us resolve these kinds of issues? Will it leads us to sage, balanced public policies?

This is where I think sufficiency is problematic, because (without invoking a number of provisos) it is a cost-blind distributive principle that is ill-equipped to address the issue of tradeoffs. The complex tradeoffs any society will have to make will not only involve balancing the interests of the advantaged against the disadvantaged, but also the disadvantaged against other disadvantaged persons. This arises, for example, in the case of healthcare provisions. And thus healthcare is perhaps the most compelling example to invoke to reveal the shortcomings of the sufficiency view. When pushed in these kinds of cases I think sufficiency, if it is to be defensible, will collapse into some version of prioritarianism.

This is not to say that the priority view does not itself face a whole host of difficulties. It does, but I think it will do a better job of revealing the diverse challenges we face than will a public ethic that invokes a sufficitarian principle. But it really depends on the context of the goods one is discussing.

I doubt that appealing to any one principle, or serially ordered ranking of principles (e.g. liberty, equality, utility, priority, sufficiency, etc.), will get us very far. I suppose this is why I have, in part, abandoned my search for a “first-order” social theory and am more content to advance the second-order theory of deliberative democracy. Recall my post on the rise of deliberative democracy.

Deliberative democracy is a normative theory that accords weight to both procedural and substantive principles. No doubt a principle of sufficiency could be part of this pluralistic public ethic. But when placed in the context of a second-order social theory one will be primarily concerned with asking how we can reasonably balance this principle with other important principles. And we will adopt a much more provisional stance to this balancing exercise than is typical of most first-order normative theories.

But in any event, I highly recommend Casal’s article. As she notes in the beginning of the piece, a lot of attention has been given to egalitarianism and prioritarianism. And she tries to redress this imbalance by offering a systematic clarification of the sufficiency position. So it is well worth reading and an important contribution to growing literature on these issues.