ABSTRACT: BACKGROUND: The governments and citizens of the developed nations are increasingly called upon to contribute financially to health initiatives outside their borders. Although international development assistance for health has grown rapidly over the last two decades, austerity measures related to the 2008 and 2011 global financial crises may impact negatively on aid expenditures. The competition between national priorities and foreign aid commitments raises important ethical questions for donor nations. This paper aims to foster individual reflection and public debate on (...) donor responsibilities for global health. METHODS: We undertook a critical review of contemporary accounts of justice. We selected theories that: (i) articulate important and widely held moral intuitions; (ii) have had extensive impact on debates about global justice; (iii) represent diverse approaches to moral reasoning; and (iv) present distinct stances on the normative importance of national borders. Due to space limitations we limit the discussion to four frameworks. RESULTS: Consequentialist, relational, human rights, and social contract approaches were considered. Responsibilities to provide international assistance were seen as significant by all four theories and place limits on the scope of acceptable national autonomy. Among the range of potential aid foci, interventions for health enjoyed consistent prominence. The four theories concur that there are important ethical responsibilities to support initiatives to improve the health of the worst off worldwide, but offer different rationales for intervention and suggest different implicit limits on responsibilities. CONCLUSIONS: Despite significant theoretical disagreements, four influential accounts of justice offer important reasons to support many current initiatives to promote global health. Ethical argumentation can complement pragmatic reasons to support global health interventions and provide an important foundation to strengthen collective action. (shrink)

In a recent global survey commissioned for the Millennium Summit of the United Nations, people around the world consistently mentioned good health as what they most desired.

Objective: To determine whether a moral reasoning exercise can improve response quality to surveys of healthcare priorities Methods: A randomised internet survey focussing on patient age in healthcare allocation was repeated twice. From 2574 internet panel members from the USA and Canada, 2020 (79%) completed the baseline survey and 1247 (62%) completed the follow-up. We elicited respondent preferences for age via five allocation scenarios. In each scenario, a hypothetical health planner made a decision to fund one of two programmes identical (...) except for average patient age (35 vs 65 years). Half of the respondents (intervention group) were randomly assigned to receive an additional moral reasoning exercise. Responses were elicited again 7 weeks later. Numerical scores ranging from –5 (strongest preference for younger patients) to +5 (strongest preference for older patients); 0 indicates no age preference. Response quality was assessed by propensity to choose extreme or neutral values, internal consistency, temporal stability and appeal to prejudicial factors. Results: With the exception of a scenario offering palliative care, respondents preferred offering scarce resources to younger patients in all clinical contexts. This preference for younger patients was weaker in the intervention group. Indicators of response quality favoured the intervention group. Conclusions: Although people generally prefer allocating scarce resources to young patients over older ones, these preferences are significantly reduced when participants are encouraged to reflect carefully on a wide range of moral principles. A moral reasoning exercise is a promising strategy to improve response quality to surveys of healthcare priorities. (shrink)

This thesis investigates Habermas's attempt to establish a credible form of universalism in moral and political philosophy by means of the theoretical approach which he terms "discourse ethics." The central question motivating this study is whether Habermas succeeds in this ambition. Discourse ethics specifies a procedure which purports to enable all agents involved in a conflict of interest in which issues of justice are at stake to come to a rational and cooperative resolution. It proposes a position unique among contemporary (...) approaches to justice in the strength and character of its anti-relativist stance: the plurality of human cultures and the situated character of human understanding do not, according to this theory, bar the way to arriving at a minimal form of moral universalism. Although the procedure specified in communicative ethics elucidates only a narrow range of concerns--those pertaining to justice in the strict sense--it aims to do so in a way valid across all human cultures. ;Habermas's strategy for the defence of a species-wide moral universalism is, I argue, both the key feature of his position, and the least well understood. Discussion of discourse ethics to date has focussed almost exclusively on the question of its appropriateness to the context of modern, Western pluralism. An important reason for this focus has been the intricacy of Habermas's argumentative strategy, which links the recent work on discourse ethics to his longstanding project of developing a theory of communicative action. ;The principle aim of this thesis is to clarify Habermas's position by explicating his programme of justification. In so doing, I draw attention to several problems in his approach as a mechanism for cross-cultural conflict adjudication, and endeavour to provide a more perspicuous account of the relation of Habermas's theory to its main philosophical competitors, especially Rawlsian deontology, and contextualism. (shrink)