Health incentive schemes aim to produce healthier behaviors in target populations. They may do so both by making incentivized options more salient and by making them less costly. Changes in costs only result in healthier behavior if the individual rationally assesses the cost change and acts accordingly. Not all people do this well. Those that fail to respond rationally to incentives will typically include those who are least able to make prudent choices more generally. This group will typically include (...) the least advantaged more generally, since disadvantage inhibits one's effective ability to choose well and since poor choices tend to cause or aggravate disadvantage. Therefore, within the target population, health benefits to the better off may come at the cost of aggravated inequity. This is one instance of a problem I name the Able Chooser Problem, previously emphasized by Richard Arneson in relation to coercive paternalism. I describe and discuss this problem by distinguishing between policy options and their effects on the choice situation of individuals. Both positive and negative incentives, as well as mandates that are less than perfectly effective, require some sort of rational deliberation and action and so face the Able Chooser Problem. In contrast, effective restriction of what options are physically available, as well as choice context design that makes some options more salient or appealing, do not demand rational agency. These considerations provide an equity-based argument for preferring smart design of our choice and living environment to incentives and mandates. (shrink)

In this paper I propose to shed new light on the role of feeling in Kant’s psychology of moral motivation by focusing on the concept of an incentive (Triebfeder), a term he borrowed from one of his most important rationalist predecessors, Alexander Gottlieb Baumgarten. I argue that, similar to Baumgarten, Kant understands an incentive to refer to the ground of desire and that feelings function as a specific kind of ground within Kant’s psychology of moral action, namely as the ‘impelling (...) cause’ of desire. I claim that this interpretation has several advantages over the alternatives currently on offer in the literature. (shrink)

This paper examines the relationship between CEO incentives and strong and weak corporate social performance. Using the KLD database we find that incentives have no significant relationship with strong social performance. Salary and long-term incentives have a positive association with weak social performance.

Background Policies to use financial incentives to encourage healthy behaviour are controversial. Much of this controversy is played out in the mass media, both reflecting and shaping public opinion. Objective To describe UK mass media coverage of incentive schemes, comparing schemes targeted at different client groups and assessing the relative prominence of the views of different interest groups. Design Thematic content analysis. Subjects National and local news coverage in newspapers, news media targeted at health-care providers and popular websites between (...) January 2005 and February 2010. Setting UK mass media. Results The study included 210 articles. Fifteen separate arguments favourable towards schemes, and 19 unfavourable, were identified. Overall, coverage was more favourable than unfavourable, although most articles reported a mix of views. Arguments about the prevalence and seriousness of the health problems targeted by incentive schemes were uncontested. Moral and ethical objections to such schemes were common, focused in particular on recipients such as drug users or the overweight who were already stereotyped as morally deficient, and these arguments were largely uncontested. Arguments about the effectiveness of schemes and their potential for benefit or harm were areas of greater contestation. Government, public health and other health-care provider interests dominated favourable coverage; oppo- sition came from rival politicians, taxpayersÕ representatives, certain charities and from some journalists themselves. Conclusions Those promoting incentive schemes for people who might be regarded as ÔundeservingÕ should plan a media strategy that anticipates their public reception. (shrink)

Rawls argues that ‘Parties in the original position would wish to avoid at almost any cost the social conditions that undermine self-respect’. But what are these social conditions that we should so urgently avoid? One evident candidate might be conditions of material inequality. Yet Rawls seems confident that his account of justice can endorse such inequalities without jeopardising citizens’ self-respect. In this article I argue that this confidence is misplaced. Unequalising incentives, I claim, jeopardise the self-respect of those least (...) advantaged—at least under a Rawlsian schema—by undermining the very processes by which Rawls hopes to make distributional inequalities and self-respect compatible. I begin by setting out Rawls’s distinct account of self-respect before moving to describe how Rawls expects the difference principle to support citizens’ in this regard. I then draw upon GA Cohen’s distinction between ‘strict’ and ‘lax’ interpretations of the difference principle to argue that the presence of unequalising incentives undermines both the direct and indirect support that the difference principle can offer to citizens’ self-respect. As such, I claim that Rawls must either weaken his endorsement of unequalising incentives, or risk violating his ‘prior commitment’ to avoiding social conditions harmful to citizens’ self-respect. (shrink)

In Rescuing Justice and Equality, G.A. Cohen argues that the incentive inequalities permitted by John Rawls's difference principle are unjust since people cannot justify them to their fellow citizens. I argue that citizens of a Rawlsian society can justify their acceptance of a wide range of incentive inequalities to their fellow citizens. They can do so because they possess the right to freedom of occupational choice, and are permitted – as a matter of justice – to exercise this right by (...) making occupational decisions on the basis of a wide range of values and preferences. (shrink)

Introduction Financial incentive schemes have been commonly used by the hearing aid industry as a way of encouraging device sales. These schemes can lead to a conflict of interest as the hearing device dispenser is torn between personal reward over the best interests of their client. This conflict of interest has the potential for the dispenser to develop “moral distress”, a negative state of mind when an individual’s ethical values contrast with those of the employing organization. The purpose of this (...) study was to investigate if there was a relationship between financial incentives and moral distress in Australian audiologists and audiometrists. Methods An online survey was distributed to all members of Audiology Australia and the Australian College of Audiology via email. Participants rated their perceived moral distress from 0 to 10 on the Moral Distress Thermometer and answered four questions about financial incentives in their respective workplace. Results A total of 65 participants, 42 females and 23 males, completed the online survey. A quarter of participants rated their moral distress corresponding to levels of uncomfortable or above. A statistically significant association was found between financial incentives, sales target setting, and higher perceived moral distress in participants. Conclusions For our sample, the implementation of financial incentives created ethical challenges for practicing audiologists and audiometrists. Modifications to employee rewards programs as well as a regulation of device sales are recommended. (shrink)

This book, first published in 2006, examines the incentives at work in a wide range of institutions to see how and how well coordination is achieved by informing and motivating individual decision makers. The book examines the performance of agents hired to carry out specific tasks, from taxi drivers to CEOs. It investigates the performance of institutions, from voting schemes to kidney transplants, to see if they enhance general well being. The book examines a broad range of market transactions, (...) from auctions to labor markets, to the entire economy. The analysis is conducted using specific worked examples, lucid general theory, and illustrations drawn from news stories. Of the seventy different topics and sections, only twelve require a knowledge of calculus. The second edition offers new chapters on auctions, matching and assignment problems, and corporate governance. Boxed examples are used to highlight points of theory and are separated from the main text. (shrink)

In a recent article, Seana Valentine Shiffrin offers a distinctive egalitarian critique of the types of incentive inequalities that are permitted by John Rawls's difference principle. She argues that citizens of a well-ordered society, who publicly accept Rawls's two principles of justice and their justifications, may not demand incentives to employ their talents in productive ways since such demands are inconsistent with a major justification for the difference principle: the moral arbitrariness of talent. I argue that there is no (...) such inconsistency. Citizens can publicly accept the claim that talent is morally arbitrary and accept incentives to employ their talents productively without inconsistency. In the standard case that Rawls envisions, citizens who do so take their preferences to be a reason for a higher salary, not their talents. (shrink)

In Utopophobia Estlund offers a prominent version of a conditional account of feasibility. I think the account is too permissive. I defend an alternative incentives account of feasibility. The incentives account preserves the spirit of the conditional account but qualifies fewer actions as feasible. Simplified, the account holds that an action is feasible if there is an incentive such that, given the incentive, the agent is likely to perform the action successfully. If we accept that ought implies feasible, (...) then we should reject some normative requirements on agents that Estlund would accept in light of his more permissive conditional account. But we can still recognise normative requirements on individual and collective agents that, if complied with, would result in a world that is radically better than our own. (shrink)

An egalitarian interpretation and defence of Rawls's principles of justice and their institutional and policy implications in response to G. A. Cohen's criticisms of Rawls's alleged justification of unequalizing incentives. Keywords Applied Philosophy Social and Political Philosophy Rawls G.A. Cohen difference priciple incentives justice property-owning democracy.

An egalitarian interpretation and defence of Rawls's principles of justice and their institutional and policy implications in response to G. A. Cohen's criticisms of Rawls's alleged justification of unequalizing incentives.

Monetary incentives to increase COVID-19 vaccinations are widely used. Even if they work, whether such payments are ethical is contested. This paper reviews ethical arguments for and against using monetary incentives that appeal to utility, liberty, civic responsibility, equity, exploitation, and autonomy. It concludes that in low-income nations and nations with meagre safety nets and income inequality, policy-makers should proceed with caution.

Financial incentives and disincentives are fundamental to a category of proposals, usually characterised as forms of managed care, whereby the pecuniary interests of health care providers are directly affected by their clinical decision-making. Presently, Australian health care administrators and private insurers are adopting financial incentives as a means of ensuring provider compliance with ‘health outcome ’ and cost-constraint objectives. To the extent that this has occurred, health-care relationships are transformed to emulate, more closely, a commercial transaction.This paper questions (...) the ideological assumptions which inform the use of financial incentives in the health care domain and raises concerns with regard to the potential for financial incentives to undermine the moral integrity of clinical decision-making. It also challenges the legitimacy of rationing health care resources through the use of this measure, particularly when adopted by private insurers of health care. (shrink)

In Rescuing Justice and Equality , G. A. Cohen reiterates his critique of John Rawls's difference principle as a justification for inequality-generating incentives, and also argues that Rawls's ambition to provide a constructivist defence of the first principles of justice is doomed. Cohen's arguments also suggest a natural response to my earlier attempt to defend the basic structure objection to Cohen's critique, which I term the alien factors reply. This paper criticises the reply, and Cohen's more general argument against (...) Rawls's constructivism. 1. (shrink)

This paper explores how managers’ and supervisors’ equity incentives impact the likelihood of committing corporate fraud in Chinese-listed firms. Previous research has shown that corporate fraud in China is a widespread phenomenon and has severe consequences for affected firms and executives. However, our understanding of the reasons that fraud is committed in a Chinese setting has been very limited thus far. This is an increasingly important topic, because corporate governance is rapidly changing in China, and it is unclear whether (...) adopting the executive compensation practices of the West is appropriate for Chinese firms. We show that managers’ equity incentives increase their propensity to commit corporate fraud. We also find that this effect is more pronounced for state-owned firms. However, we find a negative but not significant relationship between the equity incentives of the supervisory board and the incidence of fraud. (shrink)

ABSTRACTThe disadvantaged have incentives to commit crime, and to develop criminogenic dispositions, that limit the extent to which their co-citizens can blame them for breaking the law. This is true regardless of whether the causes of criminality are mainly “structural” or “cultural.” We need not assume that society as a whole is unjust in order to accept this conclusion. And doing so would neither stigmatize nor otherwise disrespect the disadvantaged.

Contemporary debates about scientific institutions and practice feature many proposed reforms. Most of these require increased efforts from scientists. But how do scientists’ incentives for effort interact? How can scientific institutions encourage scientists to invest effort in research? We explore these questions using a game-theoretic model of publication markets. We employ a base game between authors and reviewers, before assessing some of its tendencies by means of analysis and simulations. We compare how the effort expenditures of these groups interact (...) in our model under a variety of settings, such as double-blind and open review systems. We make a number of findings, including that open review can increase the effort of authors in a range of circumstances and that these effects can manifest in a policy-relevant period of time. However, we find that open review’s impact on authors’ efforts is sensitive to the strength of several other influences. (shrink)

Hertwig and Ortmann suggest paying participants contingent upon performance in order to increase the thoroughness they devote to a decision task. We argue that monetary incentives can yield a number of unintended effects including distortions of the subjective representation of the task and impaired performance. Therefore, we conclude that performance-contingent payment should not be generally employed in judgment and decision research.

Given the constraints of human partiality and the possible social benefits of widespread genetic technology, allowing for incentive-based inequalities in access in order to boost innovation and diffusion may be the only feasible option available to the post-genomics egalitarian planner. In light of the prevailing ethos that exists in the non-ideal circumstances of society, an initial post-genomics egalitarian goal for all to have equivalent access to comparable genetic interventions seems very unlikely to succeed.While I outline how the initial egalitarian goal (...) can entail either overly prohibitive or overly idealistic prescriptions, I argue that the more recent non-ideal focus has not given adequate attention to how different distributions in genetic access may not only be constrained by, but may also affect the prevailing ethos for better or worse, in turn affecting the range of feasible options into the future. I analyse Farrelly’s Lax Genetic Difference Principle , as an exemplar of a non-ideal post-genomics theorising, and evaluate it in terms of its anticipated effects on the egalitarian ethos. I argue that achieving a more just distribution of access to genetic technologies, by principles that take into account genuine non-ideal considerations, requires a greater awareness of such effects.Finally, I briefly sketch a framework for ‘ethos-proofing’ non-ideal principles, in terms of access to genetic technologies, particularly enhancements, with regard to maintaining and fostering such an egalitarian ethos. (shrink)

The paper by Lynch et al. argues that payments to research participants in biomedical research can be divided into three different categories, reimbursement, compensation, and incentive and...

This 1992 book examines alternative methods for achieving optimality without all the apparatus of economic planning, or a vain reliance on sufficiently 'perfect' competition. All rely entirely on the self-interest of economic agents and voluntary contract. The author considers methods involving feedback iterative controls which require the prior selection of a 'criterion function', but no prior calculation of optimal quantities. The target is adjusted as the results for each step become data for the criterion function. Implementation is built in by (...) the incentive structure, and all controls rely on consistency with the self-interest of individuals. The applicability of all the methods is shown to be independent of the form of ownership of enterprises: examples are given for industries which are wholly privately owned, wholly nationalized, mixed and labour-managed. (shrink)

The ethics of health incentive research—a form of public health research—are not well developed, and concerns of justice have been least examined. In this paper, we explore what potential long term harms in relation to justice may occur as a result of such research and whether they should be considered as part of its ethical evaluation. ‘Long term harms’ are defined as harms that contribute to existing systematic patterns of disadvantage for groups. Their effects are experienced on a long term (...) basis, persisting even once an incentive research project ends. We will first establish that three categories of such harms potentially arise as a result of health incentive interventions. We then argue that the risk of these harms also constitutes a morally relevant consideration for health incentive research and suggest who may be responsible for assessing and mitigating these risks. We propose that responsibility should be assigned on the basis of who initiates health incentive research projects. Finally, we briefly describe possible strategies to prevent or mitigate the risk of long term harms to members of disadvantaged groups, which can be employed during the design, conduct and dissemination of research projects. (shrink)

Philippe van Parijs (2003) has argued that an egalitarian ethos cannot be part of a post- Political Liberalism Rawlsian view of justice, because the demands of political justice are confined to principles for institutions of the basic structure alone. This paper argues, by contrast, that certain principles for individual conduct—including a principle requiring relatively advantaged individuals to sometimes make their economic choices with the aim of maximising the prospects of the least advantaged—are an integral part of a Rawlsian political conception (...) of justice. It concludes that incentive payments will have a clearly limited role in a Rawlsian theory of justice. (shrink)

This paper documents for the first time tournament incentives of pension fund managers and their preferences for social and environmental security characteristics. Using a comprehensive data set on pension fund security holdings, differences in manager tournaments are distinguished by sorting pension funds into portfolios based on the number of concurrent managers each pension fund employs. Results indicate that the way pension schemes structure portfolio manager tournament incentives is important in explaining the social and environmental portfolio firm characteristics of (...) pension fund held stock. (shrink)

In Cohen’s vision of the just society, there would be no need for unequalizing incentives so as to benefit the least well-off; instead, people would be motivated by an egalitarian ethos to work hard and in the most socially productive jobs. As such, Cohen appears to offer a way to mitigate the trade-off of equality for efficiency that often characterizes theorizing about distributive justice. This article presents an egalitarian challenge to Cohen’s vision of the just society. I argue that (...) a society where all internalized the egalitarian ethos would be one lacking equal respect among its members, in which certain groups lacked the grounds of self-respect. Section 1 defends equal respect and a form of equality of self-respect as values with broad-based appeal to egalitarians, and argues that a particular form of hierarchy would undermine both equal respect and the grounds of self-respect. Sections 2 and 3 reveal that just such a hierarchy would emerge in a society in which all had internalized the egalitarian ethos, in the case of both carers and the untalented. Thus, Cohen’s proposed society is shown to fail to unite equality and efficiency. Instead, Cohen’s society would be characterized by a lack of equality. (shrink)

Philippe van Parijs (2003) has argued that an egalitarian ethos cannot be part of a post- Political Liberalism Rawlsian view of justice, because the demands of political justice are confined to principles for institutions of the basic structure alone. This paper argues, by contrast, that certain principles for individual conduct—including a principle requiring relatively advantaged individuals to sometimes make their economic choices with the aim of maximising the prospects of the least advantaged—are an integral part of a Rawlsian political conception (...) of justice. It concludes that incentive payments will have a clearly limited role in a Rawlsian theory of justice. (shrink)

Bonuses, as incentives or rewards for health -related behavior, feature prominently in German social health insurance. Their goal is centered around promoting personal responsibility, but reducing overall health -care expenditure and enabling competition between sickness funds also play a role. The central position of personal responsibility in German health -care policy is described, and a framework is offered for an analysis of the ethical issues raised by policies seeking to promote responsibility. The framework entails seven tests relating to: solidarity; (...) equality and equity; intrusiveness; attributability and opportunity of choice; evidence, rationale, and feasibility; affected third parties; and coherence. It is contended that a focus on tests, in particular from within contractualism, is the most appropriate way of addressing the question of health responsibility in pluralistic societies. However, taken by themselves, the tests also allow an identification of the key ethical issues by particular policies, which are illustrated by applying the framework to particular bonus polices. (shrink)

Philippe van Parijs (2003) has argued that an egalitarian ethos cannot be part of a post- Political Liberalism Rawlsian view of justice, because the demands of political justice are confined to principles for institutions of the basic structure alone. This paper argues, by contrast, that certain principles for individual conduct—including a principle requiring relatively advantaged individuals to sometimes make their economic choices with the aim of maximising the prospects of the least advantaged—are an integral part of a Rawlsian political conception (...) of justice. It concludes that incentive payments will have a clearly limited role in a Rawlsian theory of justice. (shrink)

Over the past decade the welfare state has come under sustained attack not only from quarters which never approved of its policies, but also from political theorists who used to support it. With the collapse of communism, the policy of comprehensive welfare provision came under renewed scrutiny. It was argued that its impact on work incentives is most detrimental. Examining in detail current unemployment debates within Western welfare states, this book seeks to verify or refute the view that non-work (...) is increasingly chosen by work shy individuals - the 'pathological' theory of unemployment. Drawing from a range of disciplinary perspectives - from social philosophy and the history of philosophy, to occupational psychology and feminist economics - this interdisciplinary analysis reveals that the "pathological" theory of unemployment, with its reliance on a deficient depiction of human nature and its disregard of non-pecuniary work incentives and empirical evidence on benefit fraud, cannot be upheld. (shrink)

Chronic shortage in organs for transplantation worldwide is leading many policy-makers to consider various incentives that may increase donation rates.1 These range from giving holders of donor cards some priority on the transplant waiting list or a discount on health insurance premiums, to giving families who consent to donation a medal of honour, reimbursement of funeral expenses, tax incentives or even financial compensation.2–4 Of the various proposed incentive mechanisms, the one that has consistently garnered the most criticism and (...) objection in the literature is that of paying families who consent to donate the organs of a deceased loved one.Arguments against such a policy abound: it could exploit the poor, influence the family to prematurely withdraw care, encourage families to withhold medical information that would result in transplant-transmission of disease, and finally, it would commercialise the value of human life and result in the perception of human organs as commodities. Indeed, to date no Western country has adopted a policy of financial compensation to families for consenting to organ donation.2Recently, a country suffering from severe shortage in organs has implemented a policy of financial incentives that uses cash payments. Wu and Fang5 describe a recent pilot programme in China that compensates families for postmortem donation, through an independent third party and based on consent or presumed consent of the deceased. The particular context within which this programme is implemented validates and even exacerbates some ethical concerns that have been voiced in the Western medical and bioethics …. (shrink)

In order to assess to the degree to which the provision of economic incentives can result in justified inequalities, we need to distinguish between compensatory incentive payments and non-compensatory incentive payments. From a liberal egalitarian perspective, economic inequalities traceable to the provision of compensatory incentive payments are generally justifiable. However, economic inequalities created by the provision of non-compensatory incentive payments are more problematic. I argue that in non-ideal circumstances justice may permit and even require the provision of non-compensatory (...) class='Hi'>incentives despite the fact that those who receive non-compensatory payments are not entitled to them. In some circumstances, justice may require us to accede to unreasonable demands for incentive payments by hard bargainers. This leads to a kind of paradox: from a systemic point of view, non-compensatory incentive payments can be justified even though those who receive them have no just claim to them. (shrink)

:A common justification offered for unequal pay is that it encourages socially beneficial productivity. G. A. Cohen famously criticizes this argument for not questioning the behaviour and attitudes that make those incentives necessary. I defend the communal status of incentives against Cohen's challenge. I argue that Cohen's criticism fails to appreciate two different contexts in which we might grant incentives. We might grant unequal payment to someone because they demand it. However, unequal payment might be an offer (...) instead. I claim that incentives as offers promote the ideal of society as a cooperative venture for mutual advantage. (shrink)

I discuss a game-theoretic model in which scientists compete to finish the intermediate stages of some research project. Banerjee et al. have previously shown that if the credit awarded for intermediate results is proportional to their difficulty, then the strategy profile in which scientists share each intermediate stage as soon as they complete it is a Nash equilibrium. I show that the equilibrium is both unique and strict. Thus rational credit-maximizing scientists have an incentive to share their intermediate results, as (...) long as this is sufficiently rewarded. (shrink)

Richard Penny argues that Rawls’s commitment to self-respect puts him at odds with his endorsement of unequalizing incentives. Penny draws on G.A. Cohen’s distinction between ‘lax’ and ‘strict’ readings of the difference principle to make this point. Given this, Penny concludes that Rawls faces a dilemma: either Rawls weakens his endorsement of unequalizing incentives or weakens his commitment to self-respect. By taking the difference principle in isolation, Penny creates a false dilemma. I will argue that once we place (...) the difference principle in the context of Rawls’s theory as a whole, we find that unequalizing incentives pose no danger to the self-respect of the least advantaged. Moreover, I will argue that a strict reading of the difference principle is incompatible with the self-respect of all citizens in a well-ordered society given the fact of reasonable pluralism. My arguments reveal the importance of seeing self-respect as a threshold good, rather than a relative one. (shrink)

This article presents an overview of traditional legal and regulatory incentives directed at achieving lawful corporate behavior, together with examples of more recent governmental incentives aimed at encouraging self regulation activities by corporations. These incentives have been differentiated into positive incentives that benefit corporations for actions that encourage or assist lawful behavior, and punitive incentives that only punish corporations for violations of legal or regulatory standards. This analysis indicates that traditional legal and regulatory incentives (...) for lawful corporate behavior are overwhelmingly punitive in their intended effects, while more recent governmental incentives to encourage voluntary corporate self regulation are much more positive in their intended effects.A prototype private compliance system containing typical features specified in governmental incentives for corporate self regulation was then analyzed applying the same positive/punitive analysis that was performed with the governmental incentives. This analysis suggests that corporate compliance programs that are structured to comply with Department of Defense regulations for defense contractors or the new Federal Organizational Sentencing Guidelines will reflect the same overwhelmingly punitive balance of incentives for lawful and ethical employee conduct as do the traditional legal and regulatory incentive systems for lawful corporate behavior. (shrink)

The rapid development of credit default swap market has changed the manner of credit risk management of banks to some extent and has had a new influence on the bank-enterprise credit model. In this study, the credit financing process of credit risk in small- and medium-sized enterprises gathers within a bank, which makes it difficult for SMEs to raise funds. On the basis of the perspective of CDS, we construct an incentive game model of bank-enterprise credit behavior and analyze the (...) influence mechanism of the credit financing of SMEs on CDS contract coupon rate, CDS payout ratio, bank-enterprise credit effort, and loan recovery rate when considering CDS. The result shows that the CDS contract leads to insufficient supervision after a bank loan, the moral hazard of the SMEs rises, and the probability of credit default events increases. In addition, in view of CDS, the SMEs can access more credit funds. (shrink)

The paper examines one of the considerations that determines the extent to which policymakers pursue the objec- tives demanded by constituents. The nature and extent of their ignorance serve to determine the incentives confronted by policymakers to pursue their constituents’ demands. The paper also considers several other consequences of policymaker ig- norance and its relationship to expert failure.

Poor medication adherence in patients with a psychosis is associated with relapse. It has been proposed that outcomes might be improved by using financial incentives for treatment adherence (FITA). However, a strong moral intuition against this practice has been found. This paper examines the ethics of FITA. Three arguments are presented, which if accepted would severely restrict or even prohibit the practice. These are based on (1) “incommensurable values”, where FITA denigrates an aspect of “respect for the person”, (2) (...) “exploitation”, where unfair advantage is taken of the patient, and (3) “fairness”, where it is difficult to draw a line between those who should and should not be offered payment. A number of practical impediments are also considered. (shrink)

According to the incentives argument, inequalities in material goods are justifiable if they are to the benefit of the worst off members of society. In this paper, I point out what is easily overlooked, namely that inequalities are justifiable only if they are to the overall benefit of the worst off, that is, in terms of both material and social goods. I then address the question how gains in material goods can be weighed against probable losses in social goods. (...) The ultimate criterion, so my idea, is how these gains and losses affect a person’s ability to reach her goals in life. Based on the idea that goals in life cannot be taken as given, I conclude that the absolute material gains are negligible compared to the losses of social goods and the disadvantage in the relative position caused by material inequalities. (shrink)

Incentives are typically conceived as a form of trade, and so voluntariness appears to be the only ethical concern. As a consequence, incentives are often considered ethically superior to regulations because they are voluntary rather than coercive. But incentives can also be viewed as one way to get others to do what they otherwise would not; that is, as a form of power. When incentives are viewed in this light, many ethical questions arise in addition to (...) voluntariness: What are the responsibilities of the powerful in using incentives? Can incentives be manipulative or exploitative, even if people are free to refuse them? Like all other forms of power, incentives can be abused. This paper develops criteria for distinguishing their legitimate from their illegitimate uses, viz. legitimacy of purpose, voluntariness, and effect on character. The criteria are then applied to three cases: plea bargaining, recruiting medical research subjects, and motivating children to learn. Thinking of incentives in terms of.. (shrink)

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This paper studies whether incentivizing performance with competition and cooperation-based incentive schemes, rather than individual compensation, affects peer effects on subsequent risk behaviour. We run a laboratory experiment in which we introduce three different compensation schemes—piece rate, the equal-split-sharing-rule and a tournament—associated with a real effort task and we measure risk behaviour both before and after the effort task. We find that competition more than halves peer influence on risk behaviour compared with piece-rate compensation and in some specifications produces negative (...) peer effects. Competition also significantly reduces an individual’s feeling of attachment to their peers and self-reported peer influence. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Kennedy Institute of Ethics Journal 13.1 (2003) 53-64 [Access article in PDF] Incentives for Providing Organs Patricia Milmoe McCarrick and Martina Darragh After a contentious debate at its 2002 annual meeting, the American Medical Association's House of Delegates voted to endorse the opinion of its Council on Ethical and Judicial Affairs that the impact of financial incentives on organ donation should be studied (Josefson 2002). The shortage (...) of organs for transplantation has been an ongoing problem for more than 20 years. In June1981, Representative Philip Crane (R-IL) introduced legislation in the U.S. House of Representatives proposing a $25,000 income tax deduction and a $25,000 estate tax exclusion for donating an organ (Tax Incentives 1981). Still the National Organ Transplant Act enacted in October 1984 prohibited the offering of any "valuable consideration" in return for organs (United States 1984).The developments of a legal market for tissues in the United States and a black market for organs around the world have raised the question of whether donation without compensation is the only ethically viable option. Some critics of the current system claim reliance on donation actually promotes a black market in organs (Kaserman and Barnett 2002, p. 38; Palmer 1999, p. 36). In addition, a new set of compensation issues has arisen as living kidney donor transplantations begin to rival those performed with cadaveric organs (United States 2001).As a result, current suggestions for incentives go far beyond the traditional death benefit payment to include such ideas as medals of honor for donors, reimbursement for funeral expenses, exchange programs for organ donation, and special medical insurance for living organ donors. Numerous bills introduced into the 107th Congress have proposed such incentives (Delmonico et al. 2002.) In October 2002, the U.S. Department of Health and Human Services awarded $5.2 million in grants to study both clinical and behavioral interventions for increasing organ donations that do not involve incentives. The inspiration for some of the funded proposals comes from the successes of Spain's social services and the United Kingdom's clinical administration of organ procurement programs (Robeznieks 2002). [End Page 53]With a nod to evidence-based medicine, the underlying concern expressed in much of the current literature is that no idea for increasing the supply of organs should be discounted before it is studied. This bibliography provides a short introduction to the range of opinions expressed on the issue of incentives for providing organs.al-Mousawi, M.; Samhan, M.; al-Mezairee I.; Razzak, M.A.; and Khawari, F. Cadaver Organ Procurement in Kuwait. Transplantation Proceedings 31 (8): 3375-76, 1999.The authors describe a protocol that significantly increased cadaveric organ donation and credit it with fostering the expansion of an organ sharing program among the Arab Gulf states. Developed by Kuwaiti neurologists and anesthetists after a continuing education course on transplantation, the protocol places a special emphasis on the role of local transplant coordinators who facilitate the investigation of brain death cases by neurologists.Arnold, Robert; Bartlett, Steven; Bernat, James; et al. [Ethics Committee of the American Society of Transplant Surgeons] Financial Incentives for Cadaver Organ Donation: an Ethical Reappraisal. Transplantation 73 (8): 1361-67, 27 April 2002.To prepare for proposed studies of financial incentives for organ donation, the American Society of Transplant Surgeons convened a panel to develop a methodology for evaluating the ethics of such research. Comprised of organ procurement organization executives, physicians, surgeons, and ethicists, the panel generated a list of nine criteria for use in judging any incentives proposal. While opposed to direct payment or tax incentives for organ donation, a majority of the members support funeral expense reimbursement or charitable contributions as incentives that would not violate or undermine the ideal of altruism.Cameron, J. Stewart, and Hoffenberg, Raymond. The Ethics of Organ Transplantation Reconsidered: Paid Organ Donation and the Use of Executed Prisoners as Donors. Kidney International 55 (2): 724-32, February 1999.After reviewing arguments for and against payment for organ procurement, the authors apply these arguments to the specific case of obtaining organs from executed... (shrink)