How to count sore throats

Kamm’s sore throat case gives us a choice: save one life or save a distinct life and cure a sore throat. We defend the fairness explanation of the judgement that one should flip a coin to decide whom to save: it is disrespectful to let a sore throat act as a tie-breaker, because an individual would be forced to forgo a 50% fair chance of living (given to them by a coin flip), which cannot be outweighed by any number of sore throats. We show that this explanation of when and why claims can permissibly break ties generates new problem cases for theories of aggregation, including theories that have been thought to accommodate the judgement that one should flip a coin in Kamm’s sore throat case. We then generalize the fairness explanation to cases involving multiple groups.