Prioritarianism and Welfare Reductions

Derek Parfit has argued that egalitarianism is exposed to a levelling down objection because it implies, implausibly, that a change, which consists only in the better‐off sinking to the level of the worse‐off, is in one respect better, though it is better for nobody. He claims that, in contrast, the prioritarian view that benefits to the worse‐off have greater moral weight escapes this objection. This article contends, first, that prioritarianism is equally affected by the levelling down objection as is egalitarianism, but that this objection lacks force. Secondly, prioritarianism is less plausible than egalitarianism because it implies that lowering the level of equality by diffusing a quantity of welfare equally over as many recipients as possible is for the better all things considered, and that the outcome of such welfare diffusion would still be better in one respect, even if the quantity of welfare was radically reduced.     

Prioritarianism and the Levelling Down Objection

I discuss Ingmar Persson’s recent argument that the Levelling Down Objection could be worse for prioritarians than for egalitarians. Persson’s argument depends upon the claim that indifference to changes in the average prioritarian value of benefits implies indifference to changes in the overall prioritarian value of a state of affairs. As I show, however, sensible conceptions of prioritarianism have no such implication. Therefore prioritarians have nothing to fear from the Levelling Down Objection.     

Why Levelling Down could be Worse for Prioritarianism than for Egalitarianism

Derek Parfit has argued that, in contrast to prioritarianism, egalitarianism is exposed to the levelling down objection, i.e., the objection that it is absurd that a change which consists merely in the betteroff losing some of their well-being should be in one way for the better. In reply, this paper contends that (1) there is a plausible form of egalitarianism which is equivalent to another form of prioritarianism than the Parfitian one, a relational rather than an absolute form of prioritarianism, and that (2), although this relational or egalitarian form of prioritarianism is hit by the levelling down objection, the Parfitian form is also hit by it, or worse objections, if it is fully worked out.

Prioritarianism for Global Health Investments: Identifying the Worst Off

The available resources for global health assistance are far outstripped by need. In the face of such scarcity, many people endorse a principle according to which highest priority should be given to the worst off. However, in order for this prioritarian principle to be useful for allocation decisions, policy‐makers need to know what it means to be badly off. In this article, we outline a conception of disadvantage suitable for identifying the worst off for the purpose of making health resource allocation decisions. According to our total advantage view: (1) the worst off are those who have the greatest total lifetime disadvantage; (2) advantage foregone due to premature death should be treated in the same way as other ways of being disadvantaged at a time; (3) how badly off someone is depends on the actual outcomes that will befall her without intervention, not her prospects at a time; and (4) all significant forms of disadvantage count for determining who is worst off, not just disadvantage relating to health. We conclude by noting two important implications of the total advantage view: first, that those who die young are among the globally worst off, and second, that the epidemiological shift in the global burden of disease from communicable to non‐communicable diseases should not lead to a corresponding shift in global health spending priorities.     

Prioritarianism, Levelling Down and Welfare Diffusion

I have earlier argued that, like egalitarianism, prioritarianism is exposed to the levelling down objection??which I do not find serious??but also that it faces related, more serious objections that egalitarianism avoids. In this paper I reply to Thomas Porter??s attempt to rebut this argument. I also trace the more serious objections to prioritarianism to the fact that it implies the desirability of welfare diffusion, i.e. that it is better all things considered if a quantity of welfare is distributed over as many recipients as possible, so that each recipient gets a minimal benefit, and that the outcome would still be in one respect better, even if the quantity of welfare was reduced. In contrast to egalitarianism, prioritarianism therefore implies that it is in one respect better if an equality, or a solitary individual, is located at lower rather than a higher level of welfare.     

Ethical Care for Vulnerable Populations Receiving Psychotropic Treatment

The increasing use of pharmacotherapy raises specific ethical concerns for psychologists working with vulnerable populations. Due to a shortage of trained specialists, professionals without training in mental health, such as primary care providers, are increasingly prescribing and monitoring psychotropic medications. Vulnerable populations (e.g., older adults, people currently low in social status, immigrants, and racial/ethnic minorities) face additional barriers to mental health treatment and are at heightened risk when these factors intersect. Hence, these patients experience unique barriers to receiving optimal psychopharmacological care and are differentially vulnerable to deleterious outcomes associated with misdiagnosis and overmedication. Taken together, these factors fuel inequities in the access, quality, and utilization of mental health care. Psychologists working with these patients are ethically mandated to protect patients from harm and ensure equitable care across patient populations. Specifically, psychologists must respond to the dilemma of how to effectively treat patients within these vulnerable populations who have been misdiagnosed or poorly medicated while remaining within the bounds of their competence. This article recommends pathways to address these dilemmas through education, training, research, and advocacy.     

Variable Error

The degree to which blocked (VE) data satisfies the assumptions of compound symmetry required for a repeated measures ANOVA was studied. Monte Carlo procedures were used to study the effect of violation of this assumption, under varying block sizes, on the Type I error rate. Populations of 10,000 subjects for each of two groups, the underlying variance-covariance matrices reflecting a specific condition of violation of the homogeneity of covariance assumptions, were generated based on each of three actual experimental data sets. The data were blocked in various ways, VE calculated, and subsequently analyzed by a repeated measures ANOVA. The complete process was replicated for four covariance homogeneity conditions for each of the three data sets, resulting in a total of 22,000 simulated experiments. Results indicated that the Type I error rate increases as the degree of heterogeneity within the variance-covariance matrices increases when raw (unblocked) data are analyzed. With VE, the effects of within-matrix heterogeneity on the Type I error rate are inconclusive. However, block size does seem to affect the probability of obtaining a significant interaction, but the nature of this relationship is not clear as there does not appear to be any consistent relationship between the size of the block and the probability of obtaining significance. For both raw and VE data there was no inflation in the number of Type I errors when the covariances within a given matrix were homogeneous, regardless of the differences between the group variance-covariance matrices.     

Mean Comparison: Manifest Variable Versus Latent Variable

Mean comparisons are of great importance in the application of statistics. Procedures for mean comparison with manifest variables have been well studied. However, few rigorous studies have been conducted on mean comparisons with latent variables, although the methodology has been widely used and documented. This paper studies the commonly used statistics in latent variable mean modeling and compares them with parallel manifest variable statistics. Our results indicate that, under certain conditions, the likelihood ratio and Wald statistics used for latent mean comparisons do not always have greater power than the Hotelling T² statistics used for manifest mean comparisons. The noncentrality parameter corresponding to the T² statistic can be much greater than those corresponding to the likelihood ratio and Wald statistics, which we find to be different from those provided in the literature. Under a fixed alternative hypothesis, our results also indicate that the likelihood ratio statistic can be stochastically much greater than the corresponding Wald statistic. The robustness property of each statistic is also explored when the model is misspecified or when data are nonnormally distributed. Recommendations and advice are provided for the use of each statistic. The research was supported by NSF grant DMS-0437167 and Grant DA01070 from the National Institute on Drug Abuse. We would like to thank three referees for suggestions that helped in improving the paper.     

A Stabilization Group Approach for Heterogeneous Populations of Trauma Clients

High prevalence and long-lasting implications of human-inflicted trauma call for effective treatment approaches reaching clients in need of trauma-specific treatment. Numerous approaches exist, but often with limited empirical support. There is also a tendency toward segregating treatment approaches depending on type of exposure history and presenting symptoms. This might exclude clients in need of trauma-specific treatment; therefore, treatment approaches that can reach more heterogeneous groups of clients are needed. In this article, a group-based treatment approach adjusted to include clients with a wide range of trauma-related problems and traumatic experiences will be presented. A brief outline of the approach is presented, together with the theoretical and empirical background, to facilitate implementation by practitioners and empirical testing.     

Original Populations and Environmental Rights

ABSTRACT This paper deals with a conflict between our sense of social justice and the need to protect the environment. It is argued that original populations do not own the land and other relevant aspects of their environment. However, immigrant newcomers will work on them and claim them for their own. The original populations are an integral part of the environment. When the newcomers realize that they must protect the vanishing natural environment, they must also control the lives of the original populations. The problem is that the newcomers have brought about the problems which will harm the others, too. In order to analyse this situation I distinguish between different types of rights, the value of nature and our alienation from it. The basic dilemma is described in normative terms and it is suggested that the rights claims of the original populations are quite strong. At the same time it is clear that it is impossible to return to any 'original position'. Some piecemeal solutions are suggested.     

Promoting Wellness in Refugee Populations

Refugee populations experience risk factors that may influence their wellness. As the number of refugees continues to rise, it is important for professional counselors, counselor educators, and counselors‐in‐training to be aware of techniques for supporting wellness in this population. This article addresses risk factors to refugee wellness within the indivisible self model of wellness (Myers & Sweeney, 2004 ) and highlights current wellness trends and the importance of a prevention‐based treatment paradigm for helpers working with refugee populations.