This paper introduces this mini-series on vertical equity in health care. It reflects on the fact that by and large equity policies in health care have failed and that there is a need for positive discriminationto promote equity better in future. This positive discrimination is examined under the heading of`vertical equity'. The paper considers Varian's notion of 'envy' as a basis for equity in health care but concludes that this is not a helpful (...) route to go down. Better it would seem to pursue the idea from Sen of 'freedoms' and 'communitarian claims' (as raised previously by this author). While it is argued that procedural justice is to be preferred in the longer run as a basis for equity there are gains in adopting a short run goal of promoting distributive justice. Some preliminary evidence is presented on the weighting of health gains to reflect such vertical equity concerns. (shrink)

This paper represents the first attempt to apply vertical equity principles to the South African health sector. A vertical equity approach, which recognises that different groups have different starting points and therefore require differential treatment, appears to offer an appropriate basis for considering how best to redress the vast inequities which exist in post-Apartheid South Africa. Vertical equity principles are applied in critically analysing two areas of recent policy action which are particularlyrelevant to health (...) sector equity in South Africa, namely public-private sector cross-subsidies and the allocation of government resources between provinces. Despite a strong political commitment to redressing historical inequities, recent government policy actions in these two areas appear to fall short of desirable goals when viewed through a vertical equity lens. In particular, policies since the first democratic elections in 1994 have done little to reduce the extent of government subsidies to the private health sector, which serves a minority of the population. In addition, recent proposals for a Social Health Insurance will allow minimal cross-subsidies between high- and low-income earners and would not adequately redress the currently inequitable public-private cross-subsidies. With respect to the allocation of government resources between provinces, a vertical equity approach would suggest that the most historically dis-advantaged provinces have an even greater claim on government resources than reflected in the current formula, as developed by the Department of Finance. This paper also considers the potential benefits of engaging with societal views in determining what constitutes dis-advantage in the South African context, in order to identify those who should receive priority in resource allocation decisions. It concludes with a review of a number of practical steps that can be taken to draw vertical equity principles into policy action. (shrink)

Since taking office, the President of the United States has consistently refused to make his tax returns available for public scrutiny. In so doing, he has broken with presidential tradition and kept people guessing about what his tax returns would show if they were disclosed. Interestingly enough, in the absence of concrete knowledge about the President’s tax circumstances, some taxpayers perceive that he did not pay his fair share and others perceive that he did. This situation presents an opportunity for (...) us to consider how vertical equity perceptions about the President’s fair share of taxes, and identification with the President via voting behavior, are jointly associated with taxpayers’ compliance. Using insights from equity theory as reported in Adams Advances in experimental social psychology, Academic Press, New York, 1965) and social learning theory as reported in Bandura, we anticipate and find that those taxpayers who perceive that the President did not pay his fair share of taxes and who most closely socially identify with him have the lowest tax compliance. We use a survey of 600 American taxpayers to capture their perceptions of vertical equity, voting behavior, and tax compliance intentions. Our results may reflect that taxpayers who identify with the President will tend to model his tax-related actions, or may also indicate that some taxpayers vote for a president whose actions are similar to their own. Insights and implications for ethics and tax researchers and tax policy makers are discussed. (shrink)

Given the significant disparities in health and health related disadvantage between Aboriginal andnon-Aboriginal Australians, the application of somenotion of equity has a role to play in the formulationof policy with respect to Aboriginal health. Aboriginal andTorres Strait Islander has been abbreviated to Aboriginal. There has been considerable debate in Australia as to what the principles of equity should be. This paper discussesthe relevance of the principle of vertical equity (theunequal, but equitable, treatment of unequals) toAboriginal health (...) funding. In particular, the paperadvocates pursuing procedural justice as the basis forvertical equity where the focus is on the fairness ofhow things are done rather than on the distribution ofoutcomes per se (i.e. distributive justice).Particular attention is paid to how the principle ofvertical equity might be handled at a practical level.Details of the approach used in a number of Australianindigenous communities are discussed. It is concludedthat there are strong arguments for pursuingprocedural justice under vertical equity particularlywhen there are cultural differences in the ways healthis defined and when there is importance attached toindigenous involvement in the health care decisionmaking process. (shrink)

This essay seeks to characterise the essential features of an equitable health care system in terms of the classical Aristotelian concepts of horizontal and vertical equity, the common language of “need” and the economic notion of cost-effectiveness as a prelude to identifying some of the more important issues of value that policy-makers will have to decide for themselves; the characteristics of health that can cause policy to be ineffective ; the information base that is required to support a (...) policy directed at securing greater equity, and the kinds of research that are needed to underpin such a policy. (shrink)

ABSTRACT Following Rawls' seminal work, political philosophers and economists have recently shown great interest in different conceptions of equity or justice. Apart from Rawls' own principles, these have included utilitarianism, need and desert, horizontal and vertical equity and envy‐free distributions. None of these conceptions, however, seem to command general consensus; and this paper is an attempt to find out why. The conclusion is reached that they all fail because they do not take account of an essential element (...) of equity: its relationship to the existence or otherwise of choice. An alternative conception is offered, based explicitly on that relationship; it is argued that this conception comes closer to capturing the essence of what is generally meant by the term equity than any of the others considered. (shrink)

Conscience rests within the heart of equity, yet it is a manifestly nebulous and contradictory concept. In particular, equity has never been clear about exactly whose conscience we are concerned with: the Chancellor or judge, or the court, or the defendant? Furthermore, in some lights conscience appears to compel obedience to the authority of law, whilst in others it gives expression to ethical drives that escape the formal strictures of legal rules. Contextualised within the broader history of ideas (...) of Western modernity, this article sets out to understand the rhetorical significance of conscience in equity, making the argument that its disparate and contradictory modes of expression do not undermine its significance, and instead are essential to its construction of juridical obligations. By invoking conscience as a contradictory expression of both vertical state authority and personal ethical autonomy, equity asserts not only a unique normative structure, but also a distinct mode of power. (shrink)

There has been much discussion about how to obtain legitimacy at macro-level priority setting in health care by use of fair procedures, but how should we consider priority setting by individual clinicians or health workers at the micro-level? Despite the fact that just health care totally hinges upon their decisions, surprisingly little attention seems being paid to the legitimacy of these decisions. This paper addresses the following question: what are the conditions that have to be met in order to ensure (...) that individual claims on health care are well aligned with an overall concept of just health care? Drawing upon a distinction between individual and aggregated needs, I argue that even though we assume the legitimacy of macro-level guidelines, this legitimacy is not directly transferable to decisions at micro-level simply by adherence to the guidelines’ recommendation. Further, I argue that individual claims are subject to the formal principle of equality and the demands of vertical and horizontal equity in a way that gives context- and patient-related equity concerns precedence over equity concerns captured at the macro-level. I conclude that if we aim to achieve just health care, we need to develop a complementary framework for legitimising individual judgment of patients’ claims on health care resources. Moreover, I suggest the basic structure of such a framework. (shrink)

Photo ID 72893750 © Rawpixelimages|Dreamstime.com ABSTRACT Solidarity is a concept increasingly employed in bioethics whose application merits further clarity and explanation. Given how vital cooperation and community-level care are to mitigating communicable disease transmission, we use lessons from the COVID-19 pandemic to reveal how solidarity is a useful descriptive and analytical tool for public health scholars, practitioners, and policymakers. Drawing upon an influential framework of solidarity that highlights how solidarity arises from the ground up, we reveal how structural forces can (...) impact the cultivation of solidarity from the top down, particularly through ensuring robust access to important social determinants of health. Public health institutions can support solidarity movements among individuals and communities by adopting a lens of social justice when considering public health priorities and, in turn, promote health equity. INTRODUCTION Over the past two decades, scholars have invoked the concept of solidarity when assessing a wide range of topics in bioethics, from CRISPR-Cas9 technology to organ donation to structural racism.[1] However, the growing literature on solidarity has not fully examined the roles and responsibilities of institutions and governments in fostering solidarity, especially regarding public health measures that implicate entire populations. We argue that it remains unclear how public health institutions should engage with solidarity and how their engagement will affect public health and its ethics. We first take Prainsack and Buyx’ three-tiered framework as an analytical starting point.[2] We then explore how public health institutions can foster solidarity by carefully considering factors that may bolster it on an interpersonal, community, and national scale. We conclude that public health institutions should adopt a lens of social justice to promote solidarity at the interpersonal and community levels, thereby promoting equity in future public health efforts. BACKGROUND Calls for solidarity in bioethics raise longstanding normative questions about the nature and limits of our duties to one another and how to weigh autonomy over considerations of justice.[3] Though the term is diversely applied, Prainsack and Buyx propose a potentially unifying definition in the 2011 Nuffield Council report, “Solidarity: Reflections On An Emerging Concept in Bioethics.” The report defines solidarity as an activity involving “shared practices reflecting a collective commitment to carry financial, social, emotional, and or other ‘costs’ to assist others.” Their conceptualization also includes important features that distinguish solidarity from other values like empathy or altruism: solidarity emphasizes action rather than mere internal feeling and recognition of connection as motivation.[4] Bioethicists have since applied this conceptualization when analyzing issues in public and global health, given that population-level efforts need cooperation from individuals and communities. Prainsack and Buyx further note that solidarity is relevant in bioethics discourses about justice and equity, in support of providing aid to low- and middle-income countries, and as a value exemplified by European welfare states.[5] Other bioethicists have argued that promoting solidarity can contribute to community engagement, partnership with Tribal communities, and global health equity.[6] Most recently, scholars have applied solidarity as a lens to assess the COVID-19 pandemic, highlighting the pitfalls of national mitigation efforts and global disparities in disease outcomes.[7] I. Solidarity at Three Levels It seems impossible to foster solidarity in public health if we cannot identify it in general contexts. Prainsack and Buyx articulate three levels of solidarity: interpersonal solidarity, group solidarity, and legal or contractual codifications of solidarity.[8] They argue that each level inherently informs the one ‘above’ it in a unilateral direction. In other words, solidarity is fundamentally a bottom-up phenomenon. Solidarity among individuals influences group norms, which then have the potential to shape policy and institutional practice.[9] Within the Prainsack and Buyx framework, it would seem nonsensical to posit how solidarity might be expressed vertically or from the “top down.” It appears intuitively odd to imagine how a government entity might ‘be’ in solidarity with a person or group if solidarity requires some cognition about their condition per Prainsack and Buyx’ definition. Some have argued that solidarity does not seem like something that one can impose, as instances of it arise from agents recognizing and acting upon some bond rather than in response to a command. Indeed, people may be rightfully hesitant to engage in solidarity if the official messaging is overly paternalistic or coercive.[10] However, some authors have countered that governments can express solidarity through enacting structural and policy changes, though it is ambiguous how these actions are distinct from a justice-driven approach.[11] If a bottom-up approach is thus the most practical means of achieving policy that reflects solidarity, then it does not add much to public health. Institutions would be ineffective without the population’s initiation of the corresponding social norms. However, we find this conclusion overly pessimistic. Fostering a culture of solidarity to improve public health has potential merit. Prainsack and Buyx’ framework overlooks how public health actors can influence solidarity between individuals and across communities. To clarify, we agree with the view that solidarity is a bottom-up phenomenon. Solidarity may not be able to originate in a top-down fashion, but we suggest that public health institutions can take a more active role in providing the public with accurate information, promoting social justice, and intervening in the social determinants of health. II. The COVID-19 Pandemic as a Case Study Lessons learned from the ongoing COVID-19 pandemic support our argument. The pandemic deepened socioeconomic disparities in the US and hindered access to vital resources such as food, housing, and healthcare.[12] Prainsack recently noted: “[n]ext to the immediate health effects of the virus, poverty and grave inequalities have been the root causes of human suffering during the pandemic.”[13] Prior to the pandemic, many rural and low-income populations lacked reliable access to the internet and devices like laptops or smartphones. This continued lack of access restricts the flow of information and prevents people from accessing telemedicine services.[14] Preexisting social, political, and health inequities worsened health outcomes among many marginalized racial and ethnic groups. It is well-documented that communities of color, including Black, American Indian or Alaska Native, and Latinx populations, had greater COVID-related mortality and morbidity due to the effects of structural racism.[15] Although federal US agencies such as the Centers for Disease Control and Prevention enacted laws that provided safety nets (e.g., the Federal Eviction Moratorium), the majority of such programs have ended, leaving many with little assistance and the threat of further hardship.[16] These disparities are relevant because Prainsack, Buyx, and others note that solidarity arises from agents recognizing and acting on some perceived attainable collective goal(s). Income inequality and disparate access to food, education, and health care may lead people to consider public health goals unattainable. This could limit the desire to work toward those goals collectively.[17] The existing literature on collective action theory supports this intuition. It emphasizes that structural conditions, such as an absence of perceived hope for social change among a group, can lead to low ‘group efficacy’ and little willingness to cooperate, both within and across socioeconomic strata.[18] The pandemic spurred countless messages from public health agencies. The messaging did not recognize or attend to the different material realities and circumstances of the US population. How can people feel comfortable getting vaccinated if they deeply distrust the government, including public health institutions? How can people remain motivated to wear masks and distance themselves if they cannot afford basic necessities and work jobs without adequate pay and leave policies? We ask these questions to illustrate how socioeconomic disparities can marginalize people if they feel ignored, apathetic, or resentful of those better off or those in power whom they perceive to “not be doing enough.” This marginalization precludes the formation of solidarity. There are instances when a population has disparate access to resources and social capital, but solidarity may still emerge from a shared goal or vision for the future. For example, a heterogeneous population living in the same town may come together to protest an environmental injustice that impacts their water supply with the common goal of securing access to safe drinking water. However, many populations in the US failed to recognize shared goals of this kind during the COVID-19 pandemic. A significant minority of the US population was reluctant to acknowledge the severity of COVID-19 infection and thus refused to participate in efforts to mitigate its spread. Even between groups who shared the goal of slowing COVID-19 transmission, the methods were widely debated. Approximately 20 percent of the adult population eligible for vaccination remains unvaccinated.[19] Governmental bodies responsible for disseminating information, coordinating the allocation of resources, and establishing guidelines have a large role in mediating these disagreements and intervening in socioeconomic conditions that impact people's ability and willingness to engage in solidarity. III. Solidarity, Social Justice, and the Role of Public Health Institutions Adopting a lens of social justice provides further insights into how public health actors impact solidarity. Powers and Faden argue that the “foundational moral justification for the social institution of public health is social justice.”[20] Their theory of social justice has two aims. First, it ensures that everyone has a sufficient amount of the six core elements of well-being and that public health institutions are responsible for “adopting policies and creating environments” where all can flourish.[21] Second, public health institutions should distribute resources meant to promote well-being and focus on the “needs of those who are the most disadvantaged.”[22] Public health institutions should enact policies that address injustice. In doing so, public health institutions can seed the opportunity to build solidarity from the bottom up. Equipping individuals and communities with resources will foster cooperation and adherence to policies that require solidarity, such as masking and vaccination. This is consistent with arguments illustrating how institutions such as Tribal governments promote the conditions needed for their group, and especially its most vulnerable members, to flourish.[23] Addressing social determinants of health with a social justice lens will create the circumstances under which more individuals and groups can find common causes and foster solidarity. In the long run, such efforts may result in the establishment of values and practices from the bottom up. There are societal and public health preconditions required before institutions can expect their audience to act in solidarity with one another. Through their great influence over information and resources, public institutions do have the power to impact what values are most widespread. Furthermore, public health may foster trust and hope, which are important psychosocial factors that influence collective action,[24] if policies increase access to resources that promote well-being. Messaging efficacy also depends on the context of public trust, education, and whether the institutions meet one’s basic needs. Disparate messaging across different public institutions may confuse or disillusion individuals. To apply our theory of solidarity to the decision to vaccinate, a policy would be to foster conditions that facilitate access to vaccines and information about vaccine efficacy instead of imposing a top-down mandate without first eliciting public trust. IV. Counterargument Some argue that discordant public health messaging, ineffective government, and inadequate social programs can also bring people together under pressure and foster solidarity. One may argue that the most powerful motivators towards solidarity are strife and disparity, as evidenced throughout history. During the pandemic alone, political struggle and personal hardship inspired solidarity in the US, from individual neighbors helping each other to mutual aid groups forming across communities. We thus do not claim that solidarity is possible only when our government programs and public health institutions are most effective. We instead point out that solidarity can be further hindered when people feel alienated, hopeless, and pitted against each other. CONCLUSION Many competing conceptualizations of solidarity persist in the bioethics literature, and Prainsack and Buyx offer one compelling framework that public health ethicists continue to draw upon.[25] However, their framework fails to acknowledge how public health institutions impact interpersonal and group solidarity. Public health institutions can foster solidarity through actions other than mere messaging, invoking catchphrases like “we are all in this together.” Efforts to address socioeconomic preconditions and alleviate health disparities can cultivate group solidarity. As we saw during the pandemic, cooperation and solidarity go hand-in-hand with disease mitigation efforts; solidarity has clear intrinsic value.[26] As this relationship becomes more apparent, we will continue to see attempts from public health institutions to foster or invoke solidarity. Therefore, public health institutions would be remiss to ignore their role in addressing the social determinants of health. Adopting a social justice lens when planning public health interventions will clarify and strengthen their role in facilitating solidarity. Ultimately, if health disparities continue to persist or widen, it is very hard to imagine how group solidarity can ever be achieved. The widescale adoption of many public health measures needed to promote health and well-being would be conducive to solidarity. - Disclaimer: The opinions expressed are the authors’ and do not represent the views of the NIH, DHHS, or the U.S. government. Funding Disclosure: This work was supported in part by the Intramural Program of the National Institutes of Health Clinical Center. - [1] John J Mulvihill et al., “Ethical Issues of CRISPR Technology and Gene Editing through the Lens of Solidarity,” British Medical Bulletin 122 (2017): 17–29, https://doi.org/10.1093/bmb/ldx002; Ben Saunders, “Altruism or Solidarity? The Motives for Organ Donation and Two Proposals,” Bioethics 26, no. 7 (September 2012): 376–81, https://doi.org/10.1111/j.1467-8519.2012.01989.x; -Vanessa Y Hiratsuka, “SPECIAL REPORT: A Critical Moment in Bioethics: Reckoning with Anti-Black Racism through Intergenerational Dialogue A Call for Solidarity in Bioethics: Confronting Anti-Black Racism Together,” 2022, https://doi.org/10.1002/hast.1380. [2] Prainsack and Buyx, Solidarity: Reflections on an Emerging Concept in Bioethics London: Nuffield Council on Bioethics, 2011; Prainsack and Buyx, “Solidarity in Contemporary Bioethics--towards a New Approach.” Bioethics 26, no. 7 (September 2012): 343–50. https://doi.org/10.1111/J.1467-8519.2012.01987.X. [3] Bob Simpson, “A ‘We’ Problem for Bioethics and the Social Sciences: A Response to Barbara Prainsack,” Science, Technology, & Human Values 43, no. 1 (January 12, 2018): 45–55, https://doi.org/10.1177/0162243917735899. [4] Barbara Prainsack and Alena Buyx, Solidarity: Reflections on an Emerging Concept in Bioethics (London: Nuffield Council on Bioethics, 2011). [5] Barbara Prainsack and Alena Buyx, “Solidarity in Contemporary Bioethics--towards a New Approach,” Bioethics 26, no. 7 (September 2012): 343–50, https://doi.org/10.1111/J.1467-8519.2012.01987.X. [6] Bridget Pratt, Phaik Yeong Cheah, and Vicki Marsh, “Solidarity and Community Engagement in Global Health Research,” The American Journal of Bioethics : AJOB 20, no. 5 (May 3, 2020): 43–56, https://doi.org/10.1080/15265161.2020.1745930; Sara Chandros Hull, F. Leah Nez (Diné), and Juliana M. Blome, “Solidarity as an Aspirational Basis for Partnership with Tribal Communities,” The American Journal of Bioethics 21, no. 10 (October 3, 2021): 14–17, https://doi.org/10.1080/15265161.2021.1965258; Mbih J. Tosam et al., “Global Health Inequalities and the Need for Solidarity: A View from the Global South,” Developing World Bioethics 18, no. 3 (September 1, 2018): 241–49, https://doi.org/10.1111/DEWB.12182. [7] Peter West-Oram, “Solidarity Is for Other People: Identifying Derelictions of Solidarity in Responses to COVID-19,” Journal of Medical Ethics 47, no. 2 (February 1, 2021): 65–68, https://doi.org/10.1136/MEDETHICS-2020-106522; Barbara Prainsack, “Solidarity in Times of Pandemics,” Democratic Theory 7, no. 2 (December 1, 2020): 124–33, https://doi.org/10.3167/DT.2020.070215; F. Marijn Stok et al., “Social Inequality and Solidarity in Times of COVID-19,” International Journal of Environmental Research and Public Health 18, no. 12 (June 2, 2021), https://doi.org/10.3390/IJERPH18126339; Ming Jui Yeh, “Solidarity in Pandemics, Mandatory Vaccination, and Public Health Ethics,” American Journal of Public Health 112, no. 2 (February 1, 2022): 255–61, https://doi.org/10.2105/AJPH.2021.306578; Barbara Prainsack, “Beyond Vaccination Mandates: Solidarity and Freedom During COVID-19.,” Am J Public Health 112, no. 2 (February 1, 2022): 232–33, https://doi.org/10.2105/AJPH.2021.306619. [8] Prainsack and Buyx, Solidarity: Reflections on an Emerging Concept in Bioethics London: Nuffield Council on Bioethics, 2011; Prainsack and Buyx, “Solidarity in Contemporary Bioethics--towards a New Approach.” Bioethics 26, no. 7 (September 2012): 343–50. https://doi.org/10.1111/J.1467-8519.2012.01987.X. [9] Prainsack and Buyx, Solidarity: Reflections on an Emerging Concept in Bioethics London: Nuffield Council on Bioethics, 2011; Prainsack and Buyx, “Solidarity in Contemporary Bioethics--towards a New Approach.” Bioethics 26, no. 7 (September 2012): 343–50. https://doi.org/10.1111/J.1467-8519.2012.01987.X. [10] Yeh, “Solidarity in Pandemics, Mandatory Vaccination, and Public Health Ethics”; Prainsack, “Beyond Vaccination Mandates: Solidarity and Freedom During COVID-19.” [11] Ho, Anita, and Iulia Dascalu. "Relational solidarity and COVID-19: an ethical approach to disrupt the global health disparity pathway." Global Bioethics 32, no. 1 (2021): 34-50; West-Oram, Peter. "Solidarity is for other people: identifying derelictions of solidarity in responses to COVID-19." Journal of Medical Ethics 47, no. 2 (2021): 65-68. [12] Monica Webb Hooper, Anna María Nápoles, and Eliseo J. Pérez-Stable, “COVID-19 and Racial/Ethnic Disparities,” JAMA 323, no. 24 (June 23, 2020): 2466, https://doi.org/10.1001/jama.2020.8598. [13] Prainsack, Barbara. “Beyond Vaccination Mandates: Solidarity and Freedom During COVID-19.” Am J Public Health 112, no. 2 (February 1, 2022): 232–33. https://doi.org/10.2105/AJPH.2021.306619. [14] Camille A Clare, “Telehealth and the Digital Divide as a Social Determinant of Health during the COVID-19 Pandemic,” Network Modeling Analysis in Health Informatics and Bioinformatics 10 (2021): 26, https://doi.org/10.1007/s13721-021-00300-y. [15] Patrick Nana-Sinkam et al., “Health Disparities and Equity in the Era of COVID-19,” Journal of Clinical and Translational Science 5, no. 1 (March 16, 2021): e99, https://doi.org/10.1017/cts.2021.23. [16] Kathryn M Leifheit et al., “Expiring Eviction Moratoriums and COVID-19 Incidence and Mortality,” American Journal of Epidemiology 190, no. 12 (December 1, 2021): 2503–10, https://doi.org/10.1093/aje/kwab196. [17] Barbara Prainsack, “Solidarity in Times of Pandemics,” Democratic Theory 7, no. 2 (December 1, 2020): 124–33, https://doi.org/10.3167/DT.2020.070215 [18] Maximilian Agostini and Martijn van Zomeren, “Toward a Comprehensive and Potentially Cross-Cultural Model of Why People Engage in Collective Action: A Quantitative Research Synthesis of Four Motivations and Structural Constraints.,” Psychological Bulletin 147, no. 7 (July 2021): 667–700, https://doi.org/10.1037/bul0000256. [19] Department of Health and Human Services (HHS) Centers for Disease Control and Prevention (HHS/CDC), “COVID Data Tracker,” 2023, https://covid.cdc.gov/covid-data-tracker. [20] Powers, Madison, and Ruth Faden. Social Justice: The Moral Foundation of Public Health and Health Policy. 1st editio. New York: Oxford Press, 2006, p. 9 and Chapter 4 [21] Powers and Faden, Social Justice: The Moral Foundation of Public Health and Health Policy; Madison Powers and Ruth Faden, Structural Injustice: Power, Advantage, and Human Rights (New York: Oxford University Press, 2019). [22] Powers, Madison, and Ruth Faden. Social Justice: The Moral Foundation of Public Health and Health Policy. 1st editio. New York: Oxford Press, 2006, p. 10 [23] Bobby Saunkeah et al., “Extending Research Protections to Tribal Communities,” The American Journal of Bioethics 21, no. 10 (October 3, 2021): 5–12, https://doi.org/10.1080/15265161.2020.1865477. [24] Agostini and van Zomeren, “Toward a Comprehensive and Potentially Cross-Cultural Model of Why People Engage in Collective Action: A Quantitative Research Synthesis of Four Motivations and Structural Constraints.” [25] Prainsack and Buyx, Solidarity: Reflections on an Emerging Concept in Bioethics. [26] Ruth Chadwick, “COVID‐19 and the Possibility of Solidarity,” Bioethics 34, no. 7 (September 8, 2020): 637–637, https://doi.org/10.1111/bioe.12813. (shrink)

The maternal‐fetal HIV transmission trials, conducted in developing countries in the 1990s, undoubtedly generated one of the most intense, high profile controversies in international research ethics. They sparked off a prolonged acrimonious and public debate and deeply divided the scientific community. They also provided an impetus for the revision of the Declaration of Helsinki – the most widely known guideline for international research. In this paper, I provide a brief summary of the context, outline the arguments for and against the (...) controversial use of placebo controls, and focus on particular areas that I believe merit further discussion or clarification. On balance, I argue that the researchers failed in their duties to protect the best interests of their research subjects, and to promote distributive justice. I discuss the difficulties of obtaining valid consent in this research context, and argue that it is unethical to inform women of their HIV status without at least offering them prophylactic treatment for their unborn children. A global view of justice, which endorses international equity, cannot be squared with international research guidelines that allow ‘local conditions’ to define the scope of duty to the control group. Finally, I suggest that the heated debate reflects a tension, if not an outright war, between two conflicting meta‐ethical systems, or incommensurable paradigms, that underpin scientific research involving human subjects. (shrink)

The history of climate research in the 20th century has been characterised by a crucial shift from a geography-oriented, two-dimensional approach towards a physics-based, three-dimensional concept of climate. In the 1930s, the introduction of new technology, such as radiosondes, enabled climatologists to investigate the high atmosphere, which had previously been out of reach. This “conquest of the third dimension” challenged the surface-oriented, geographical notion of climate patterns and opened up climatology to a three-dimensional approach, which deeply changed the character of (...) climate research. Two decades later, by drilling deep into polar glaciers and using the downward vertical dimension as an archive of the earth's history, ice core scientists began to reconstruct past climates layer by layer. The data retrieved in deep glacial layers contributed crucially to a temporal expansion of climate history far beyond human timescales. However, the inaccessibility of glaciers and the practical challenges of bringing fragile fragments of ice into transnational networks of scientific exchange meant that this vertical extension of climate knowledge production proceeded through a range of new scientific practices, and was shaped by new forms of international collaboration. Furthermore, this vertical approach to glaciers also asked for a new understanding of glacier volume. Drawing on archival and printed sources, I argue that ice core research represented a second discovery of the third dimension, this time downwards into the depth of the earth's surface, but again with decisive consequences for the research practice, for collaboration politics, and for understandings of climate, spatially as well as temporally. (shrink)

Access to education for undocumented migrant children in South Africa remains a significant challenge. While the difficulties related to their inability to access education within the country have been highlighted elsewhere, there remains a lack of clarity on an approach to how this basic human right can be achieved. In this conceptual paper, we draw on the distinction between equality and equity, and describe the various ways in which education has been conceptualised in the South African Constitution – which (...) in part contributes to the existing confusion on education for various groups, including undocumented migrant children. In this paper, we critically reflects on the need to develop an integrated approach for creating a platform that allows all undocumented migrant children access to education in South Africa. We argue that an integrated approach – which entails ways through which access to education can be delivered through the lens of equity – will enhance the right to education for undocumented migrant children in South Africa. We conclude that the South African government must urgently consider this integrated approach to enable access to education for undocumented migrant children, so that they can achieve their full educational potential. (shrink)

The dominance of agency theory can reduce our collective scope to analyse private equity in all its diversity and depth. We contribute to theorisation of private equity by developing a contrasting perspective that draws on a rich tradition of virtue ethics. In doing so, we juxtapose 'private equity' with 'public good' to develop points of rhetorical and analytical contrast. We develop a typology differentiating various forms of private equity, and focus on the 'take private' form. These (...) takeovers are where private equity funds are used to buy all a firm's publicly listed shares. Take private deals reduce reporting requirements and lessen the amount of public scrutiny a firm comes under. They allow greater control of a firm's assets and resources but also have effects in terms of the wider social fabric. The 'public good' and virtue ethics offer an alternative basis for theorisation of these deals. This provides a needed contrast to accounts of private equity based on agency theory. (shrink)

We report the results of a vignette study with an online sample of the German adult population in which we analyze the interplay between need, equity, and accountability in third-party distribution decisions. We asked participants to divide firewood between two hypothetical persons who either differ in their need for heat or in their productivity in terms of their ability to chop wood. The study systematically varies the persons’ accountability for their neediness as well as for their productivity. We find (...) that participants distribute significantly fewer logs of wood to persons who are held accountable for their disadvantage. Independently of being held accountable or not, the needier person is partially compensated with a share of logs that exceeds her contribution, while the person who contributes less is given a share of logs smaller than her need share. Moreover, there is a domain effect in terms of participants being more sensitive to lower contributions than to greater need. (shrink)

Equity in Early Modern Legal Scholarship takes the reader through the vast amount of legal writings on equity that were published in continental Europe in early modern times. The book offers the first comprehensive overview of the development of the legal concept of equity through the sixteenth and seventeenth century. During this time, equity scholarship broke with its medieval past and entered a lively debate on the nature and function of the concept. Lorenzo Maniscalco links these (...) developments to the early modern identification of equity with Aristotelian epieikeia, a conceptual shift that brought down the barrier that divided theological and legal writings on equity and led to its development as a tool for the interpretation and amendment of legal rules. (shrink)

The sustainable development issue is mainly focused on questions of intergenerational equity. The study of intragenerational equity is less common. In this article, I am interested in a particular kind of intragenerational equity, territorial equity. As well as exposing the various territorial inequalities, the literature on SD comprehends territorial equity through possible territorial transfers of sustainability. The reality of these transfers and how to measure them are however, very directly dependent on general conceptions of SD. (...) The text examines analyses that may be inferred from these different ideas. It attempts to reveal the respective limits and to propose a synthesis, which incorporates operational objectives. (shrink)

Both intertemporal and intratemporal equity are central to the examination of policy towards climate change. However, many discussions of intertemporal issues have been marred by serious analytical errors, particularly in applying standard approaches to discounting; the errors arise, in part, from paying insufficient attention to the magnitude of potential damages, and in part from overlooking problems with market information. Some of the philosophical concepts and principles of Paper 1 are applied to the analytics and ethics of pure-time discounting and (...) infinite-horizon models, providing helpful insights into orderings of welfare streams and obligations towards future generations. Such principles give little support for the idea of discrimination by date of birth. Intratemporal issues are central to problematic and slow-moving international discussions and are the second focus of this paper. A way forward is to cast the policy issues and analyses in a way that keeps equity issues central and embeds them in the challenge of fostering the dynamic transition to the low-carbon economy in both developed and developing countries. This avoids the trap of seeing issues primarily in terms of burden-sharing and zero-sum games – that leads to inaction and the most inequitable outcome of all. (shrink)

This paper argues that the direct, vertical toleration of certain types of citizen by the Rawlsian liberal state is appropriate and required in circumstances in which these types of citizen pose a threat to the stability of the state. By countering the claim that vertical toleration is redundant given a commitment to the Rawlsian version of the liberal democratic ideal, and by articulating a version of that ideal that shows this claim to be false, the paper reaffirms the (...) centrality of vertical toleration in the Rawlsian liberal account of state-citizen relations. (shrink)

This paper focuses on the potential of “equitech”—AI technology that improves equity. Recently, interventions have been developed to reduce the harm of implicit bias, the automatic form of stereotype or prejudice that contributes to injustice. However, these interventions—some of which are assisted by AI-related technology—have significant limitations, including unintended negative consequences and general inefficacy. To overcome these limitations, we propose a two-dimensional framework to assess current AI-assisted interventions and explore promising new ones. We begin by using the case of (...) human resource recruitment as a focal point to show that existing approaches have exploited only a subset of the available solution space. We then demonstrate how our framework facilitates the discovery of new approaches. The first dimension of this framework helps us systematically consider the analytic information, intervention implementation, and modes of human-machine interaction made available by advancements in AI-related technology. The second dimension enables the identification and incorporation of insights from recent research on implicit bias intervention. We argue that a design strategy that combines complementary interventions can further enhance the effectiveness of interventions by targeting the various interacting cognitive systems that underlie implicit bias. We end with a discussion of how our cognitive interventions framework can have positive downstream effects for structural problems. (shrink)

ABSTRACT:In this response, I reiterate my argument that price gouging undercuts the goal of equity in access to essential goods whereas Zwolinski emphasizes the importance of the efficient provision of essential goods above all other goals. I agree that the efficient provision of essential goods is important as I argue for the goal of equitable access to sufficient of the goods essential to living a minimally flourishing human life. However, efficiency is a means to this goal rather than the (...) end itself. Finally, I offer additional arguments against the non-worseness claim. (shrink)

We report the results of a vignette experiment with a quota sample of the German population in which we analyze the interplay between need, equity, and accountability in third-party distributive decisions. We asked subjects to divide firewood between two hypothetical persons who either differ in their need for heat or in their productivity in terms of their ability to chop wood. The experiment systematically varies the persons’ accountability for their neediness as well as for their productivity. We find that (...) subjects distribute significantly fewer logs of wood to persons who are held accountable for their disadvantage. Independently of being held accountable or not, the needier person is always compensated with a share of logs that exceeds her contribution, while the person who contributes less is punished in terms of receiving a share of logs smaller than her need share. Moreover, there is a domain effect in terms of subjects being more sensitive to lower contributions than to greater need. (shrink)

behaviour from the rival manufacturer. We consider the case where franchise fees can be used to extract retailers' surplus. We show that vertical separation is in the collective, as well as individual, interest of manufacturers, and hence facilitates some collusion in the simple setting..

I outline two ways of reading what is at issue in the exclusion problem faced by non-reductive physicalism, the “vertical” versus “horizontal”, and argue that the vertical reading is to be preferred to the horizontal. I discuss the implications: that those who have pursued solutions to the horizontal reading of the problem have taken a wrong turn.

Organs for transplantation are a scarce resource. Markedly, the transplant community’s primary challenge is the stark disparity between the number of patients awaiting deceased donor organ transplants and the rate at which organs become available. However, the allocation of a limited number of organs poses another constant challenge: maintaining an equilibrium between renal transplant utility and equity, that is, striking a balance between the utilitarian argument of medical efficiency and the principle of equity. In this comprehensive overview, the (...) authors delve into the challenge of maintaining an acceptable balance between equity and efficiency and elaborate on some of the factors that might inform a decisionmaker’s evaluation of the extent to which a given allocation scheme is efficient or equitable. (shrink)

I outline two ways of reading what is at issue in the exclusion problem faced by non-reductive physicalism, the “vertical” versus “horizontal”, and argue that the vertical reading is to be preferred to the horizontal. I discuss the implications: that those who have pursued solutions to the horizontal reading of the problem have taken a wrong turn.

Solutions to the urban problems of the future must assume the new reality of megacities. The inevitable technological progress must find a balance with the ‘bio-ecological' recovery of the natural environment. In the vertical bionic city, all these occur; bio intelligence and giant structures of the city are merged into a single. These structures try to survive by relying on working together as a single organism alive, as ants work in their nest. What makes them so efficient? What makes (...) them work all together? What will be the future form of our building environment? Our future habitable environment is more likely to be in a vertical built form, against the horizontal city form. There are many reasons to believe that the new vertical cities will be more sustainable than the conventional horizontal cities. If this logic is accepted as the future scenario, then the question facing all planners and architects today is: Should we take this built form and make it more socially accepted, physically habitable, and human? This paper examines some of the key implications of this scenario, and the criteria for the design and planning of our future sustainable built environment as the vertical cities in the sky. (shrink)

The tension between equity and excellence is fundamental in science policy. This tension might appear to be resolved through the use of merit-based evaluation as a criterion for research funding. This is not the case. Merit-based decision making alone is insufficient because of inequality aversion, a fundamental tendency of people to avoid extremely unequal distributions. The distribution of performance in science is extremely unequal, and no decision maker with the power to establish a distribution of public money would dare (...) to match the level of inequality in research performance. We argue that decision makers who increase concentration of resources because they accept that research resources should be distributed according to merit probably implement less inequality than would be justified by differences in research performance. Here we show that the consequences are likely to be suppression of incentives for the very best scientists. The consequences for the performance of a national research system may be substantial. Decision makers are unaware of the issue, as they operate with distributional assumptions of normality that guide our everyday intuitions. (shrink)

In this response, I reiterate my argument that price gouging undercuts the goal of equity in access to essential goods whereas Zwolinski emphasizes the importance of the efficient provision of essential goods above all other goals. I agree that the efficient provision of essential goods is important as I argue for the goal of equitable access to sufficient of the goods essential to living a minimally flourishing human life. However, efficiency is a means to this goal rather than the (...) end itself. Finally, I offer additional arguments against the non-worseness claim. (shrink)

We wholeheartedly agree with Schmidt and colleagues’ efforts to promote equity in intensive care unit triage. We also take issue with their characterisation of the New Jersey allocation framework for ICU beds and ventilators, which is modelled after the multi-principle allocation framework we developed early in the pandemic. They characterise it as a two-criterion allocation framework and claim—without evidence—that it will ‘compound disadvantage for black patients’. However, the NJ triage framework—like the model allocation policy we developed—actually contains four allocation (...) criteria: the two criteria that the authors mentioned and two criteria that they failed to mention which we included to promote equity: giving priority to frontline essential workers and giving priority to younger patients. These omissions are problematic both for reasons of factual accuracy and because the two criteria they failed to acknowledge would likely mitigate rather than exacerbate racial disparities during triage. (shrink)

Obesity is often considered a public health crisis in rich countries that might be alleviated by preventive regulations such as a sugar tax or limiting the density of fast food outlets. This paper evaluates these regulations from the point of view of equity. Obesity is in many countries correlated with socioeconomic status and some believe that preventive regulations would reduce inequity. The puzzle is this: how could policies that reduce the options of the badly off be more equitable? Suppose (...) we distinguish: (1) the badly off have poor options from (2) the badly off are poor at choosing between their options (ie, have a choosing problem). If obesity is due to a poverty of options, it would be perverse to reduce them further. Some people in public health say that preventive regulations do not reduce options but, I shall argue, they are largely wrong. So the equity case for regulations depends on the worst off having a choosing problem. It also depends on their having a choosing problem that makes their choices against their interests. Perhaps they do. I ask, briefly, what the evidence has to say about whether the badly off choose against their interests. The evidence is thin but implies that introducing preventive regulations for the sake of equity would be at least premature. (shrink)

Offering a new answer to an age-old problem: the meaning of a just or equitable distribution of resources, Julian Le Grand examines the principal interpretations of equity used by economists and political philosophers. He argues that none captures the essence of the term as well as an alternative conception relating equity to the existence or otherwise of individual choice. Le Grand shows that this conception is not only philosophically well-grounded but is also directly relevant to key areas of (...) distributional policy. His theoretical argument is complemented by detailed discussion of the application of the central idea to specific areas of policy, including the distribution of health and health care, central government grants to local governments and the measurement of income for tax purposes. Equity and Choice is written by an economist, but is intended for political philosophers and social policy analysts as well as economists. Hence the key chapters are written in a non-technical fashion, with specialized material relegated to appendices. This book is a unique combination of philosophical, economic and policy analysis and represents a major contribution in all three areas. (shrink)

The standard model of precedential constraint holds that a court is equally free to modify a precedent of its own and a precedent of a superior court—overruling aside, it does not differentiate horizontal and vertical precedents. This paper shows that no model can capture the U.S. doctrine of precedent without making that distinction. A precise model is then developed that does just that. This requires situating precedent cases in a formal representation of a hierarchical legal structure, and adjusting the (...) constraint that a precedent imposes based on the relationship of the precedent court and the instant court. The paper closes with suggestions for further improvements of the model. (shrink)

In this paper I explore consciousness and intelligence in the setting of conventional neuroscience and cognitive science. To be conscious is to be aware but awareness is not always intelligence. Intelligence is task driven, and comes at a later stage in development than consciousness. Consciousness and intelligence are sometimes interdependent on each other, but have always been known as separate entities; an attempt to associate them, results in a lot of debate. This paper hypothesises the growth of consciousness to be (...) horizontal, while the growth of intelligence to be vertical during the progression of development. The horizontal growth of consciousness is completely dependent on cell division and cell differentiation, while the vertical growth of intelligence depends on the horizontal growth of consciousness and enhancement of neural systems. Consciousness is computed within the microtubular network of a single cell, which amplifies with multicellularity, while intelligence is related to the nervous system which matures with complexity. (shrink)

This book sets out to defend the claim that Equity ought to remain a separate body of law; the temptation to iron-out the differences between neighbouring doctrines on the two sides of the Equity/Common Law divide should, in most cases, be resisted. The theoretical part of the book is argues that the characteristics of Equity, namely, appeal to conscience, flexibility, retroactivity and the use of morally-freighted jargon, are essential for the implementation of a legal ideal that has (...) been neglected by the Common Law: 'Accountability Correspondence'. According to this fundamental legal ideal, liability imposed by legal rules should correspond to the pattern of moral duty in the circumstances to which the rules apply. Equity promotes this ideal in the fields of property and obligations by disallowing parties to exploit the rule-like nature of Common Law norms in a way that breaches their moral duty to the other party. By reference to various equitable doctrines, it is argued that the faults identified by critics of Equity, especially from the perspective of the Rule of Law, are highly exaggerated, and that the criticism often reflects a political belief in the supremacy of individualism and free market over empathy and social justice. The theoretical part is followed by three chapters, each dedicated to an in-depth analysis of the equitable doctrines of fiduciary duties, proprietary estoppel, and clean hands. For each doctrine, it is shown how their equitable characteristics are indispensable for achieving their social, ethical and economic purpose. (shrink)

Aristotelian equity has often been relegated to scholarly discussions of retributive justice. Recently, however, political theorists have recast equity as the virtue of a sympathetic democratic citizen. I build on this literature by offering a more precise explanation of equity’s internal structure and political significance. In particular, I reveal equity’s deliberative dimension. For Aristotle, equitable citizens, statesmen, and legislators correct or go beyond the law, as appropriate, not only when they render retrospective judgments about matters of (...) punishment or distribution, but also when they deliberate about future-oriented questions of legislation or political action. In addition, I show, more concretely, the role of equity in democratic citizenship. Drawing upon the Aristotelian Constitution of the Athenians, I argue that the Athenian demos exemplified equity when it brought about the reconciliation and the amnesty of 403 BC. Attention to this episode clarifies the conceptual linkages between equity, deliberation, sympathy, and democracy. (shrink)

The fusion of law and equity in common law systems was a crucial moment in the development of the modern law. In this volume leading scholars assess the significance of the fusion of law and equity from comparative, doctrinal, historical and theoretical perspectives.

This book presents a clear, carefully-analysed picture of the operation of equity today, across the common law world. Rather than revisit the abstract debate as to whether or not equity has 'fused' with the common law, it focuses on specific equitable principles and doctrines. Expert contributors step back and take a wider view of those doctrines, examining how they can best be understood today, and how they might develop in the future. This will prove invaluable to practitioners and (...) courts (at first instance as well as appellate level), allowing them to navigate the constantly-growing mass of case law. Drawing on expertise from across the worlds of academia, practice and the bench, this seminal collection provides the most illuminating picture available of how equity operates. (shrink)

Achieving equity in international research is one of the pressing concerns of the twenty-first century. In this era of progressive globalization, there are many opportunities for the deliberate or accidental export of unethical research practices from high-income regions to low- and middle-income countries and emerging economies. The export of unethical practices, termed “ethics dumping,” may occur through all forms of research and can affect individuals, communities, countries, animals, and the environment. Ethics dumping may be the result of purposeful exploitation (...) but often arises from lack of awareness of good ethical and governance practice. This chapter describes the work of the TRUST project toward counteracting the practice of ethics dumping through the development of tools for the improvement of research governance structures. Multi-stakeholder consultation informs all of TRUST’s developments. Most importantly, this gives voice to marginalized vulnerable groups and indigenous people, who have been equal and active partners throughout the project. At the heart of the TRUST project is an ambitious aim to develop a Global Code of Conduct for Research in Resource-Poor Settings. Uniquely, the Code provides guidance across all research disciplines in clear, short statements, focusing on research collaborations that entail considerable imbalances of power, resources and knowledge and using a new framework based on the values of fairness, respect, care, and honesty. The code was recently adopted by the European Commission as a reference document for Horizon 2020 and Horizon Europe. (shrink)

In the present world order unbridled forces of free market capitalism are frequently cited for much of the social injustice, inequity, and disparity of wealth between the rich and the poor. Although history''s verdict in favor of the free markets could hardly be harsher or clearer, it is clear that after the initial wave of triumph, the free market paradigm has developed some cracks in its façade. What marks the trail of such sustained and pronounced move toward free markets in (...) terms of ethics, morality, social welfare and social justice? How does one keep a social score in this seemingly relentless and irreversible move all over the world toward free market capitalism?In this paper we shall attempt to address these and related questions. Drawing on concepts from organization theory and social philosophy and using publicly available financial information, we shall illustrate how, amidst the myriad and mixed noises, some sense of order and signal can be discerned in addressing issues of equity and social justice. Toward this end, first, we provide a broad contrast between two models of financial markets: the command model and the free market model and proceed to examine publicly available financial information and analyze the trends and patterns with graphical representations using publicly available data from Handbook of International Economic Statistics. Next, we explore the implications of financial performance measures for social welfare and social justice and discuss the social perils of free markets using the Mexican and Asian Financial crises as the focal points. Finally, we present a set of recommendations for smoother structural transition. (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)

There are growing bodies of evidence demonstrating the benefits of equity, diversity, and inclusion on academic and organizational excellence. In turn, some editors have stated their desire to improve the EDI of their journals and of the wider scientific community. The Royal Society of Chemistry established a minimum set of requirements aimed at improving EDI in scholarly publishing. Additionally, several resources were reported to have the potential to improve EDI, but their effectiveness and feasibility are yet to be determined. (...) In this commentary we suggest six approaches, based on the Royal Society of Chemistry set of requirements, that journals could implement to improve EDI. They are: adopt a journal EDI statement with clear, actionable steps to achieve it; promote the use of inclusive and bias-free language; appoint a journal’s EDI director or lead; establish a EDI mentoring approach; monitor adherence to EDI principles; and publish reports on EDI actions and achievements. We also provide examples of journals that have implemented some of these strategies, and discuss the roles of peer reviewers, authors, researchers, academic institutes, and funders in improving EDI. (shrink)

By excavating the ambiguities of the helicopter’s machinic-prosthetic view, a perspective which may be distant and abstract, while also near and viscerally present, this article will explore how megacity security is increasingly waged and consumed. The article argues that megacity security marches to the rotator-beat of the police helicopter, fuelled by military technophilia and in a context of the biopolitical desertion of the megacities’ most vulnerable. The article takes three aspects, visually expressed and constituted through aerial-helicopter security. Drawing from several (...) megacity examples including Mumbai, Lagos, São Paulo and Rio de Janeiro, the first resolves megacity confusion with legibility. In the following section the article examines the mobilization of the security gaze, and the final section explores how helicopter visuality may hold or territorialize megacity space. (shrink)

BackgroundUnder COVID-19 pandemic, many organizations developed guidelines to deal with the ethical aspects of resources allocation. This study describes the results of an argument-based review of ethical guidelines developed at the European level. It aims to increase knowledge and awareness about the moral relevance of the outbreak, especially as regards the balance of equity and dignity in clinical practice and patient’s care. MethodAccording to the argument-based review framework, we started our research from the following two questions: what are the (...) ethical principles adopted by the ethical guidelines produced at the beginning of the COVID-19 outbreak related to resource allocation? And what are the practical consequences in terms of 'priority' of access, access criteria, management of the decision-making process and patient care?ResultsTwenty-two ethical guidelines met our inclusion criteria and the results of our analysis are organized into 4 ethical concepts and related arguments: the equity principle and emerging ethical theories; triage criteria; respecting patient’s dignity, and decision making and quality of care.ConclusionFurther studies can investigate the practical consequences of the application of the guidelines described, in terms of quality of care and health care professionals’ moral distress. (shrink)