Luck Egalitarianism, Harshness, and the Rule of Rescue

Luck egalitarianism, harshness, and the rule of rescue

Nir Eyal

Abstract Luck egalitarians consider it somewhat fairer when relative disadvantage results from the disadvantaged party’s own choice or fault—when it is “option luck” not “brute luck”. The most famous objection to luck egalitarianism is the harshness objection. It points out that when someone is at grave risk through their own choice or fault, refusing to rescue them on the ground that they are responsible for their own plight would, intuitively, be too harsh. A strong version of the objection adds that intuitively it is harsh even to weigh her personal responsibility for her plight against rescuing her. In defense of luck egalitarianism, I point out that grave risk is known to bring out the so-called “rule of rescue” mentality, and related biases. These biases incline us to deny that there is any sound reason against rescuing the person identified as at grave risk. That fact, I propose, provides an alternative causal account of our intuition that rescue is mandated and that considerations of personal responsibility against rescue would be harsh and inappropriate. In support of this alternative account, when the propriety of holding people responsible for avoidable risk raking is assessed outside immediate rescue situations, our intuitions are far more accepting of the relevance of personal responsibility for disadvantage, and hence, of luck egalitarianism.

Background: Luck-egalitarianism, the harshness objection, and democratic equality According to luck egalitarianism,i

When deciding whether or not justice (as opposed to charity) requires redistribution, the egalitarian asks if someone with a disadvantage could have

avoided it... If he could have avoided it, he has no claim to compensation, from an egalitarian point of view…ii A paramount objection to luck egalitarianism is that it endorses a harsh allocation of resources. Critics Marc Fleurbaey, Elizabeth Anderson, Dan Wikler, Sam Scheffler, and Norm Daniels accuse luck egalitarianism of supporting the harsh abandonment of reckless drivers who hit trees, of gluttons whose unhealthy diets lead to chronic disease, and of bons vivants whose taste for unprotected sex results in their infection (Fleurbaey 1995, Anderson 1999, Scheffler 2005, Wikler 2006, Daniels 2011). Elizabeth Anderson famously writes,

Consider an uninsured driver who negligently makes an illegal turn that causes an accident with another car. Witnesses call the police, reporting who is at fault; the police transmit this information to emergency medical technicians. When they arrive at the scene and find that the driver at fault is uninsured, they leave him to die by the side of the road...iii The objection is that luck egalitarianism allows society to abandon the negligent (or “imprudent”, or “reckless”, as they are also called in this literature), say, for no special reason or in order to cut costs, to deter others from being negligent, or to stop the negligent from dumping their slack on others. Luck egalitarianism allegedly must say that society would be in its right, at least in terms of justice, if it abandoned them. Anderson and fellow critics of luck egalitarianism preempt some apologies on behalf of luck egalitarianism, according to which luck egalitarianism has the resources to justify rescuing negligent victims of bad option luck. For example, Anderson agrees that it is inexpedient to leave decisions on health coverage to ambulance drivers and emergency physicians. However, the expediency defense fails for harsh decisions made by hospital administrators and insurers. Likewise, the critics judge that abandoning negligent individuals would often penalize patients who have had an underprivileged upbringing, which generally correlates with lower medical compliance. But Fleurbaey, who had raised the harshness objection before Anderson did, was careful to emphasize that the victim he discussed “received a normal and balanced upbringing” (Fleurbaey 1995). Luck egalitarians have proposed a number of responses, most of which seek to clarify why they can consistently endorse a duty to save the imprudent. Pluralist luck egalitarians adduce our many other potential reasons to save the imprudent, such as our complementary (not alternative) reasons to satisfy people’s basic needs. In pluralist luck egalitarian Shlomi Segall’s words, “The

2 concern for basic needs… overrides luck egalitarian distributive justice and mandates meeting the basic medical needs of the prudent and the imprudent alike.”iv However, a sophisticated champion of the harshness objection could respond that intuition rebels against the implications of this position too. For example, an ambulance driver who saved only the prudent when there was a reckless driver and a backseat passenger and only one spot in the ambulance, rather than flip a coin, would intuitively act wrongly (compare Segall 2010, 71-72). Nor is abandoning the imprudent as such something that, intuitively, should even cross the minds of decent ambulance drivers or doctors. Ones who thought that the imprudent had lost their just claim to their services and should be aided out of sheer charitable concern for their basic medical needs would intuitively be guilty, not of making the wrong choice but of flawed background phenomenology. Anderson hints at this “strong version” of the harshness objection (as we may call this version) when she complains that on luck egalitarianism, the post office “can with justice turn away the guide dogs of faulty drivers who lost their sight in a car accident” (Anderson 1999, 296, added italics). Anderson and some other critics of luck-egalitarianism use its alleged harshness to motivate an alternative egalitarian theory, namely, democratic equality. That theory states:

Negatively, egalitarians seek to abolish oppression—that is, forms of social relationship by which some people dominate, exploit, marginalize, demean, and inflict violence upon others… Positively, egalitarians seek a social order in which persons stand in relations of equality. They seek to live together in a democratic community, as opposed to a hierarchical one (Anderson 1999, 313). Democratic equality is said to be immune to the harshness objection because it guarantees “effective access to a package of capabilities sufficient for standing as an equal over the course of an entire life. It is not a starting-gate theory, in which people could lose their access to equal standing through bad option luck” (Anderson 1999, 319, and see also p. 328: “Democratic equality … guarantees a set of capabilities necessary to functioning as a free and equal citizen and avoiding oppression”). Remaining “capable of standing as an equal in civil society requires,” among other things, ambulatory services in the event of a car accident, regardless of the causes of disability; post office disabled access, regardless of its causes (Anderson 1999, 246); lung transplantation to overcome certain lung cancers regardless of their causes; and protection against other very bad brute or option luck. These rights to basic protection are inalienable because society has a duty to protect the standing of each member as a Kantian fundamental

3 equal. This right is as inalienable as are the freedoms from slavery and from any other violation of citizens’ Kantian dignity (Anderson 1999, 319). Put differently, Anderson argues that what is wrong with the alleged luck egalitarian denial of medical care to the neglectful is that it robs them of their capacity for full democratic participation in politics and civil society on equal terms, and that that capacity matters because Kantian dignity does. Daniels and Scheffler espouse the grounding in equal democratic status (Daniels 2011, Scheffler 2005). Daniels adds that such denial of medical care also robs the neglectful of their fair share of opportunity, a related fundamental right (Daniels 2007, 2011). Even Luck egalitarian Shlomi Segall concedes that democratic equality “easily averts the abandonment objection”; he merely insists that, with moral acrobatics, luck egalitarians can avert that objection as well (Segall 2010, but see Segall forthcoming). Like Segall, I am sympathetic to pluralist luck egalitarianism. But I take a more radical stance against the harshness objection than he does. The three sections of this chapter will argue, respectively: 1. Harshness objections arise for democratic equality as well. 2. A central reason why either luck egalitarian recommendations or democratic egalitarian ones seem too harsh may well be the potentially distracting influence of the unrelated and irrelevant “rule of rescue” mentality. That mentality, which I shall lay out, makes us not only prioritize greatly individuals who are identified as being in great danger, but also, crucially, “deeply exclude” (as I shall put it) any reasons to de-prioritize them, sound or unsound. I shall also explain the notion of deep exclusion. 3. Indeed, outside immediate rescue situations, the force of the harshness objection wanes and personal responsibility intuitively feels much more relevant.

I shall conclude that, in truth, personal responsibility always matters somewhat, but that this truth is sometimes too harsh for us to admit—even to ourselves.

1. Harshness objections to democratic equality In its own ways, democratic equality is harsh as well, in some ways more than luck egalitarianism. Elsewhere I laid out several ways in which it is harsh, but let me feature one—its harshness toward identified victims. Anderson cites the protection of a decent democratic

4 minimum as the reason to save the negligent driver. But often it is possible to help more people past the democratic minimum threshold (or any other minimum threshold) by letting another person slip. First, sometimes the fungible resources and the efforts that rescuing the neglectful would take could be diverted to saving more people’s democratic minimum rights elsewhere. Prevention is often more cost-effective than rescue. One reason why resources saved by refusing to rescue could lead to democratic improvements elsewhere is that democratic improvements require giving each some potentially scarce fungibles. In Anderson’s own words, “democratic equality requires that everyone have effective access to enough [divisible] resources to avoid being oppressed by others and to function as an equal in civil society” (Anderson 1999, 320). She also criticizes libertarians’ merely formal definition of freedom because it “neglects the importance of having the means to do what one wants” (Anderson 1999, 315). Many societies are only barely capable of securing these fungibles to all, stably. Rescues of identified individuals from dire straits can be very expensive and not so rare—most dialysis and organ transplantation, intensive care following car accidents and advanced cancer treatments are rescues in that sense, when they seek to rescue an individual identified as at high risk of premature death. Money saved by refusing to provide such rescues to anyone or to some people could often release enough funds for many preventative interventions that are more “cost- democratically effective”, as we may put it. They prevent large democratic deficits in more statistical people. A second way in which abandoning the negligent could improve democratic equality is through deterrence. Sometimes abandoning those identified as both in great danger and negligent would dissuade similar negligent choices by many other statistical people (Tomasi 2013). It would therefore prevent the major democratic deficits that needing rescue, and either getting it on time or not, would cause those who could have made more prudent choices and avoided the trouble in the first place. Refusal to rescue one negligent driver or smoker could turn out to keep more people more careful and safely above any decent minimum of democratic participation and opportunity. It would promote democratic equality and equal opportunity. “Democratic sufficientarians” like Anderson, who prioritize protecting a democratic minimum or a minimum of fair opportunities, may thus be committed to abandoning the neglectful. Abandoning them could move society closer to full democratic participation and

5 opportunity for all. Properly worked out, then, democratic equality may generate the same counterintuitively-harsh recommendations regarding many cases of rescue. Elsewhere I also explain why Anderson’s sufficientarianism and her Kantianism fail to ward off this challenge. Nothing about them, at least as she interprets them, provides reasons to save identified reckless drivers now over merely statistical reckless drivers later. I also find her approach suspect of harshness toward those whose plight is not political (e.g. victims of horrific pain or deafness, when those fail to create social or political impediments or stem from any). In addition, Anderson writes openly of her extreme harshness toward those who make anti-social choices (she actually writes that Van Parijs’s surfers should not be fed). And there are other harshnesses in her system. My provisional conclusion is that there is a lot that’s harsh about democratic equality, at least under Anderson’s seminal interpretation. Luck egalitarianism certainly does not have a monopoly on harshness. Some harshness is built into either of the leading egalitarian theories, and egalitarians of all mettles should examine how much harshness, of which kinds, really poses a problem for an ethical theory.

2. The confounding influence of the rule of rescue Molly Osborne and Timothy Evans have defined the Rule of rescue in healthcare as “the powerful human proclivity to rescue a single identified endangered life, regardless of cost, at the expense of many nameless faces who will therefore be denied health care” (Osborne and Evans 1994, 779). Others have characterized the rule of rescue mentality in additional settings (Cohen, Daniels, and Eyal 2015). It is interesting that Anderson’s negligent driver’s traffic accident is a situation where rescue is needed. So are the often-discussed situations where we must decide whether to give a transplant to a patient who has lost an organ by smoking or by drinking. So are the often- discussed situations in which what we debate is whether to send helicopters to save hikers or yachters who have been warned not to head to remote destinations yet headed there, and got stuck. I am not aware of any version of the harshness objection in which a negligent person did not need rescue. The phenomenology of rescue goes beyond proclivity to rescue threatened identified lives. John McKie and Jeff Richardson add:

Perhaps the most conspicuous feature of the [rule of rescue] is the tendency to disregard opportunity costs when the life of an identifiable individual is visibly threatened. There is a tendency to “act first and ask questions later”. Considerations about costs are pushed in the background (McKie and Richardson 2003). In fact, even this characterization remains partial. McKie and Richardson could have said as much about considerations beyond opportunity cost, all of which are “pushed in the background” in rescue crises. If the person in dire need of rescue were a blameless psychopathic serial killer, we would refrain from and repudiate calculations about the possibility of preempting murder through non-rescue. In the case of rescuing patients living with AIDS or multi-drug resistant tuberculosis, we try not to think about the danger that providing expensive antiretrovirals or second-line antibiotics would exacerbate drug resistance and jeopardize others’ health. We consider it indecent to wonder whether the person lacks the moral desert to be rescued, and whether her death might have taught other negligent people a lesson and saved more lives than it would take. Even writing down these ideas makes me shudder--so powerful is the rule of rescue proclivity. These and other considerations are all typically pushed aside, when human beings rush to the rescue. Morally justified or not, this “pushing in the background” feature of the rule of rescue mentality already causally explains our willingness to rescue and our tendency to repudiate luck egalitarian calculations of personal responsibility, whether or not luck egalitarianism is true. Even if luck-egalitarianism were true, its truth would be pushed in the background. When people need us direly, we are inclined to help them and to dismiss the relevance of virtually any argument against helping them. We dismiss considerations about money and cost effectiveness and about using the money to save more lives later; we dismiss the need to create deterrence against risk taking; we dismiss the legitimacy of sacrificing individuals now as a prophylactic against loss of either future welfare or future democracy; and, among other things, when individuals are responsible for their own plight, we deny that just because they are responsible, that excuses letting them bear the consequences. We are inclined to say that personal responsibility is irrelevant. But that doesn’t show that it is irrelevant, any more than it shows that money or democracy lack any relevance. Let me recap the point. Rescue situations elicit strong tendency not only to weight highly and act on considerations supporting rescue, but also to deny the relevance of considerations that

7 weigh against rescue, even when the latter considerations are perfectly relevant. Harshness objections accuse luck egalitarianism of treating as relevant a factor that may weigh against rescue yet intuitively seems irrelevant in the situation—personal responsibility. But because harshness objections arise only in rescue situations, these objections are very bad tests of any theory that may endorses reasons weighing against non-rescue. Rescues are precisely crises that make us see what is relevant as though it were irrelevant. One way to put this is to say that rescue crises often prompt us to exclude any reasons not to rescue, in a deep way: not only not to take them into consideration in decision making but also to believe and declare that they do not exist, or at least “see them as” non-existent; to hold that somehow, cost or public health or personal responsibility considerations, which are relevant in so many areas of our lives, do not apply there. This “deep exclusion”, as we may call this phenomenon, may itself be justified, or just part of how we are. It may reflect sound deep exclusionary reasons (because rescue crises give us sound second-order reasons to deeply exclude certain first-order reasons) or merely deep exclusionary tendencies (because deep exclusion is just a remnant of our sociobiological heritage, a reflection of our vested interested, or other distractions). But that doesn’t matter. The point is that, justifiably or not, rescue situations systematically make us unreliable judges of which reasons against rescue are relevant and which are irrelevant. Returning to luck egalitarianism, what we need in order to assess luck egalitarianism and its relevance in the health arena more reliably are examples of decisions in which immediate rescue is not a deciding factor. The next section discusses two such examples.

3. The potential plain relevance of personal responsibility for health outside rescue crises

a. Ex ante decision-making For all of her ire about theories that hold people responsible for bad option luck, Anderson actually endorses holding people responsible for many decisions in the health sphere ex ante of luck. At one point her article surprisingly argues for ex ante cigarette taxes—small harms of a financial stripe, which materialize with certainty years before lung cancer or chronic obstructive pulmonary disorder turn out to have materialized or to have not materialized. Anderson clarifies

8 that what she opposes are only ex post reduced benefits. As she explains, democratic capacities are under real threat only when a gamble pans out ill and ex post a person needs an expensive operation and so forth to live and participate democratically. Small ex ante taxes on cigarettes, “just to force smokers to absorb these costs ex ante,” do not jeopardize a person’s standing as a fundamental equal, she believes, so there is nothing wrong with ex ante taxes on cigarettes (Anderson 1999, 328-9). It would seem however that if a large financial loss threatens standing, a small financial loss threatens it some. And a small financial loss that smokers are bound to undergo (as is the case with cigarette taxes) may turn out to threaten it significantly. Daniels’s most recent take on personal responsibility for health likewise starts with long Scanlon-inspired sections dismissing the application of personal responsibility to health of a category mistake of sorts, but then surprisingly states:

Why should others—especially those who may take great care to engage in healthy behaviors—be obliged to pay for meeting health needs that are the result of the imprudent, irresponsible choices of some? It is one thing to respect the self- regarding choices of individuals in order to avoid intrusive forms of paternalism, but it is another to ignore choices that impose externalities on others (Daniels 2011, 276). Daniels then proceeds to express support for forcing all of us to “internalize our externalities”, even in the health arena (so long as society has discharged all of its obligations to us). Unlike Anderson, Daniels does not even clarify whether these pro-personal responsibility for health statements are limited to ex ante resource allocation or apply also ex post. One is left wondering whether Daniels is not committing here to the very same harsh policies of which critical caricatures accuse luck egalitarianism. For consider this. Presumably, Daniels would not propose internalizing of externalities by people who could not avoid making imprudent, irresponsible choices with externalities for others—say, past victims of vicious, forced injection of incurably addictive substances who now desperately seek these substances, with moderate externalities for society. Their present choice to seek them notwithstanding, surely Daniels would endorse compassionate accommodations for such victims, not sheer penalties. His proposal hopefully concerns only those people whose choices are avoidable all the way down. Only they, he hopefully thinks, should be made to internalize social externalities. If so, his proposal seems co-extensive with the sort of luck-egalitarian policies that Anderson’s and Fleurbaey’s harshness objections set out to condemn. Moreover, Daniels’s rationale for these

9 policies seems luck-egalitarian: costs imposed on others by a person’s own wholly avoidable choices are unacceptable, even when these costs are simply what it would take to redress serious disadvantage resulting from the person’s own choice or fault. In fact, unlike luck-egalitarian pluralists, such as Cohen, Temkin, Segall and myself, Daniels may consider such disadvantages permissible or mandatory no matter what, and not only permissible in one respect. Failure to force internalizing of externalities in the care of thoroughly avoidable imprudent choice would unjustly impose on others, and for Daniels, injustice is simply impermissible. However Daniels is to be interpreted, what is clear is that both Anderson and Daniels express here that they have no essential problem with ex ante personal responsibility policies. A possible gloss is that, outside the distracting influence of rescue crises where the human rule of rescue mentality exercises distracting influence, both thinkers find personal responsibility for social externalities in the health sphere perfectly relevant.

b. Ex post decision-making made in advance Consider the following case:

Remotania, a poor and remote island nation, is blessed with beautiful, high mountains, and citizens crave to hike to their summits. All the routes to the top, however, are difficult and dangerous, and there is no way to make the paths safer. Citizens are educated not to attempt hiking, and all approaches to the mountains have prominent signs warning of the dangers. Still, some hikers remain undeterred. On average, 10 hikers a year die of exposure after becoming stranded on the mountainsides. Only a helicopter could have saved them, but in most years in the past, the country had lacked the funds to obtain and operate one. Experience shows that operating one did not motivate additional hiking. This year, the government’s revenues are just high enough to buy and operate a helicopter for the rescue service; but there are competing needs. For example, about 10 adults on this island nation die each year from an unpreventable infection. This infection is completely curable, with no further effects—but only with a critical care device that has been too expensive for this country. The cost for buying and for operating the helicopter and the critical care device are similar, so rescuing the 10 stranded hikers (in an average year) costs about the same as saving and curing the 10 people who (in an average year) will otherwise succumb to this disease. These two groups of 10 are similar in age, general health, and income. If the extra money available this year could be used only for the helicopter rescues (that is, for the 10 stranded hikers who would otherwise die) or for the critical care device (that is, for the 10 patients afflicted with the disease, who

would otherwise die), and the money must be spent this year for one of these, v which would make the better use of these funds?

In this case, I take it that, intuitively, it makes perfect sense to prioritize the drugs for the congenitally ill. While in this case life, limb, and democratic capacities hang in the balance for either group of ten people, our intuitions side with reserving limited resources for the congenitally ill. A natural explanation is that the victims of congenital disease are not at all responsible for avoidable risk-taking. An alternate explanation would have been that rescue might make more people hike, but, as mentioned, that was seen not to be the case. Thus, although grave risks are involved, in the Remotania case, at least, personal responsibility appears perfectly relevant. Let us ask, then: do our intuitions side in that way about Remotania because that case involves unique features that ex nihilo turn what is usually an utterly irrelevant factor, personal responsibility for health, into a sound consideration? More plausibly, personal responsibility was relevant all along, but was masked in discussions of unfolding rescue crises. The negligent driver case, cases where the decision surrounds whether or not to provide rescue for a hiker contemporaneously stuck on a mountain or to a smoker contemporaneously struggling with lung disease, and other standard cases triggered a “rule of rescue” mentality and its resulting distractions. They were badly construed for locating the decision during the rescue crisis. These distractions made us pronounce some potentially relevant considerations to be irrelevant, without proper consideration because deep exclusion of perfectly relevant considerations is part of that mentality. The Remotania case is purer. It blocks these distractions. And, lo and behold, that case strongly suggests that even ex post personal responsibility is, sometimes at least, perfectly relevant. Apparently, luck-egalitarian personal responsibility can count in the health arena. Its relevance may be less apparent because in rescue situations it is deeply excluded, but it remains real. My hunch is that personal responsibility considerations obtain on some level throughout. Even in health contexts and even in rescue contexts. We may have reason, and even all things considered justification, for deep exclusion of such considerations. We may be justified in some sense in having strong intuitions that these considerations do not obtain. But luck-egalitarian considerations of personal responsibility do obtain, even in rescue situations. (They can, of course, be weak or overridden, and often they are.)

Conclusion Luck egalitarianism initially seems to demand an exceedingly harsh allocation of basic health resources—one that is intuitively too hard on those responsible for their own plight. Critics have used the alleged harshness of luck egalitarianism in the health sphere to motivate democratic equality. But I have argued:

1. Harshness objections arise for democratic equality as well. I featured one harsh aspect of democratic equality – its commitment to abandon many identified imprudent victims. 2. A central reason why both luck egalitarian and democratic egalitarian recommendations seem as though they are too harsh is the biasing influence of the unrelated and irrelevant “rule of rescue” mentality. Whether that mentality is justified by what I called “deeply exclusionary reasons” or we have no sound reason for deep exclusion, the reality is that contemporaneous rescue crises make us intentionally blind to perfectly good reasons not to rescue. 3. Indeed, outside contemporaneous rescue crises, the force of the harshness objection wanes and personal responsibility feels more relevant. Even Anderson and Daniels endorse ex ante personal responsibility considerations; and when decisions about ex post personal responsibility are made in advance, as in the case of Remotania, most of us seem to take personal responsibility into account.

References Anderson, Elizabeth S. 1999. "What Is the Point of Equality?" Ethics 109 (2):287-337. Cohen, Gerald A. 1989. "On the Currency of Egalitarian Justice." Ethics 99 (4):906-944. Cohen, I. Glenn, Norman Daniels, and Nir Eyal. 2015. "Introduction." In Identified Vs. Statistical Persons, edited by I. Glenn Cohen, Norman Daniels and Nir Eyal. New York: Oxford University Press. Daniels, Norman. 2007. Just Health: Meeting Health Needs Fairly. Cambridge: Cambridge UP. Daniels, Norman. 2011. "Individual and Social Responsibility for Health." In Responsibility and Distributive Justice edited by Carl Knight and Zofia Stemplowska, 266-86. Oxford: Oxford UP. Fleurbaey, Marc. 1995. "Equal Opportunity or Equal Social Outcome?" Economics and Philosophy 11:25-55. McKie, John, and Jeff Richardson. 2003. "The Rule of Rescue." Social Science & Medicine 56 (12):2407-2419

Osborne, M., and T. W. Evans. 1994. "Allocation of resources in intensive care: a transatlantic perspective." Lancet 343 (8900):778-80. Scheffler, Samuel. 2005. "Choice, circumstance, and the value of equality " Politics, Philosophy & Economics 4 (1):5-28. Segall, Shlomi. 2010. Health, Luck, and Justice. Princeton, NJ: Princeton UP. Segall, Shlomi. forthcoming. "Justice and health." In The Oxford Handbook on Justice, edited by Serena Olsaretti. Oxford: Oxford UP. Tomasi, John. 2013. Free Market Fairness. Princeton NJ: Princeton UP. Wikler, Dan. 2006. "Personal and Social Responsibility for Health." In Public Health, Ethics, and Equity, edited by Sudhir Anand, Fabienne Peter and Amartya K. Sen, 109-134. New York: Oxford University Press.

i This chapter is based on presentations at [blinded]. For comments, I am grateful to the audiences, as well as to [blinded]. ii (Cohen 1989, 920). Obviously, if he could not have avoided it and cannot now overcome it otherwise, then he has a claim to compensation from that point of view. iii (Anderson 1999, 296). See also (Daniels 2011, 466-7). Anderson and other proponents of the harshness objection build on Marc Fleurbaey’s early critique of luck egalitarians’ “equal opportunity” principle: “our moral intuition can run into conflict with the principle of equal opportunity, as Bert’s case should show. Bert has received a normal and balanced upbringing, but he has freely adopted a negligent and reckless character. In particular, he enjoys having his hair blown by the wind when he rides his motorbike on the highway, and he seldom wears a helmet even though he has one and it is compulsory to wear it. One morning … Bert’s careless driving causes an accident, in which he suffers serious head injuries. The hospital diagnoses a trauma which requires a costly operation Bert cannot afford because he has no health insurance. He will die if nothing is done. In this case, the equal opportunity principle would not endorse any transfer of resources to help Bert. He is fully responsible for his injury … a society complying with equal opportunity will quietly let you die” (Fleurbaey 1995, 40–41). iv (Segall 2010, 76-77; my italics). See also pp. 68-72. Elsewhere Segall adds that reasons to promote autonomy and social solidarity can also override the reasons to instill luck-egalitarian justice. v This case is essentially Alex Voorhoeve’s improvement on a case with which I had come up. I am also grateful to I. Glenn Cohen, Leah Price, Andreas Schmidt and Dan Wikler for help in honing it further.