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Nisan comments on Non-personal preferences of never-existed people - Less Wrong
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If I understand correctly, you're saying that if you had Down Syndrome and your neighbor were healthy then you would want your neighbor to help you; so therefore in reality you are healthy and help your neighbor who has Down Syndrome; and this constitutes your obligation to them.
Is this correct?
Yes. Roughly speaking, a Nash bargain could-have/should-have been made to that effect in the "Original Position" when we were both operating under Rawls's "Veil of Ignorance". I don't completely buy Rawls's "Theory of Justice", but it makes a lot more sense to me than straight utilitarianism.