Philosophical justifications of the fair innings criterion and controversies.

Summary The recent advent of innovative and expensive therapies in various therapeutic fields raises important hopes from a public health perspective. However, providing equitable access to these innovations competes with other public investments that are also subject to strong social expectations. It therefore forces actors to define the maximum amount that the community is willing to spend for given health gains. The question then arises as to whether this maximum amount varies according to the circumstances surrounding individuals, such as the rarity of the disease, their lifestyles, and the social inequalities they have experienced throughout their lives. In this article, we focus on a particular priority, that given to the youngest populations, most often referred to, following Harris' work, as fair innings. We ask what might justify such prioritization. In this paper we examine three arguments. First, we propose to justify the fair innings criterion in the name of an objective of equalizing welfare opportunities in the population. Second, we propose to justify it on behalf of an objective of equalizing the time available to individuals to realize their life plans, in accordance with Rawls' theory of justice as fairness. Finally, we propose to justify it in the name of an objective of equalizing the time offered to individuals to accept death. There are, of course, many limitations to these three arguments and we highlight some of them. Our aim in this article is not to convince people of the superiority of one argument over the others. Rather, we seek to contribute to the discussion of prioritization criteria in health care by explaining what might justify one particular criterion: age.