Economic ordeals are allocation mechanisms that impose non-financial ‘deadweight costs to qualify for a transfer’ (Nichols and Zeckhauser 1982: 372). Examples include long waiting times, travel and form-filling as conditions for certain healthcare services. Appropriately designed, ordeals can enhance target efficiency so that the goods being allocated better reach the intended recipients. The logic behind this is simple: ‘Say one welfare eligible would receive 100 utiles from a particular transfer, yet another would receive only 10. Then an ordeal that imposes an 11 utile loss in order to qualify for the transfer will be an effective sorting device’ (Nichols and Zeckhauser 1982: 376). In other words, recipients who would receive smaller benefits are expected to be dissuaded by the ordeal and refrain from requesting the good, whereas recipients who would receive larger benefits from the transfer are expected to seek out the good even if there is a deadweight cost. Moreover, unlike financial participation, which can similarly dissuade users with relatively little to gain from the good in question, ordeals are in no direct way financially regressive: the poor are not necessarily more dissuaded by losing time or by having to fill in a form than the rich are.

Rationing health care by ordeals is likely to have different effects on women and men, and on distinct groups of women. I show how such putative effects of ordeals are relevant to achieving gender justice. I explain why some ordeals may disproportionately set back women’s interest in discretionary time, health and access to health care, and may undermine equality of opportunity for positions of advantage. Some ordeals protect the interests of the worse-off women yet set back the interests of better-off women in equal opportunities. I suggest how we can use ordeal design to advance particular aims of gender justice.

This essay begins by summarizing the reasons why unregulated health-care markets are inefficient. The inefficiencies stem from the asymmetries of information among providers, patients and payers, which give rise to moral hazard and adverse selection. Attempts to ameliorate these inefficiencies by means of risk-adjusted insurance and monetary incentives such as co-pays and deductibles lessen the inefficiencies at the cost of increasing inequalities. Another possibility is to rely on non-monetary incentives, including ordeals. While not a magic bullet, these are feasible methods for addressing the inadequacies of market provision of health care, such as moral hazard.

This paper addresses how to think about the permissibility of introducing deadweight costs (so-called ‘ordeals’) on candidate recipients of goods in order to attain better outcomes. The paper introduces some distinctions between different kinds of value dimensions that should be taken into account when such judgements are made and draws from the literature on comparisons across different value dimensions in order to canvas what sort of situations one might arguably face when evaluating ordeals. In light of the distinctions drawn and the possibilities canvassed, the paper proceeds to outline what circumstances indicate which of the possible situations one is in.

Individuals often face administrative hurdles in attempting to access health care, public programmes, and other legal statuses and entitlements. These ordeals are the products, directly or indirectly, of institutional and policy design choices. I argue that evaluating whether such ordeals are justifiable or desirable instruments of social policy depends on assessing, beyond their targeting effects, the process-related burdens they impose on those attempting to navigate them and these burdens’ distributive effects. I here examine specifically how ordeals that levy time costs reduce and constrain individuals’ free time, and how such time-cost ordeals may thereby create, deepen and compound disadvantages.

Ordeals are burdens placed on individuals that yield no benefits to others; hence they represent a dead-weight loss. Ordeals – the most common is waiting time – play a prominent role in rationing health care. The recipients most willing to bear them are those receiving the greatest benefit from scarce health-care resources. Health care is heavily subsidized; hence, moral hazard leads to excess use. Ordeals are intended to discourage expenditures yielding little benefit while simultaneously avoiding the undesired consequences of rationing methods such as quotas or pricing. This analysis diagnoses the economic underpinnings of ordeals. Subsidies for nursing-home care versus home care illustrate.

This paper considers contractarianism as a method of justification. The analysis accepts the key tenets of contractarianism: expected utility maximization, unanimity as the criteria of acceptance, and social-scientific uncertainty of modelled agents. In addition to these three features, however, the analysis introduces a fourth feature: a criteria of rational belief formation, viz. Bayesian belief updating. Using a formal model, this paper identifies a decisive objection to contractarian justification. Insofar as contractarian projects approximate the Agreement Model, therefore, they fail to justify their conclusions. Insofar as they fail to approximate the Agreement Model, they must explain which modelling assumption they reject.

This paper argues that under conditions of uncertainty, there is frequently a positive option value to staying alive when compared to the alternative of dying right away. This value can make it prudentially rational for you to stay alive even if it appears highly unlikely that you have a bright future ahead of you. Drawing on the real options approach to investment analysis, the paper explores the conditions under which there is a positive option value to staying alive, and it draws out important implications for the problems of suicide and euthanasia.