Alternative allocations of a fixed bundle of healthcare resources often involve significantly different indirect, non-health effects. The question arises whether these effects must figure in accounts of the conditions under which a distribution of healthcare resources is morally justifiable. In this article we defend a Scanlonian, affirmative answer to this question: healthcare resource managers should sometimes select an allocation which has worse direct, health-related effects but better indirect, nonhealth effects; they should do this when the interests served by (...) such a policy are more urgent than the healthcare interests better served by an alternative allocation. We note that there is a prima facie case for the claim that such benefits (and costs) are relevant—i.e. they are real benefits, and in other contexts our decisions can permissibly be guided by them. We then proceed to rebut three lines of argument that might be thought to defeat this prima facie case: they appeal to fairness, the Kantian Formula of Humanity as an End in Itself, and the equal moral worth of persons, respectively. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Catholic Social Teaching and the Allocation of Scarce ResourcesJohn Langan S.J. (bio)I shall approach the issue of justice in the allocation of scarce resources from the viewpoint of Catholic social teaching, as developed over the last century. This teaching is found primarily in the social encyclicals issued by popes from Leo XIII (1878–1903) to John Paul II (1978- ), but also in the (...) pastoral letters of the various bishops’ conferences, especially in the United States and in Latin America. These documents, which enjoy a high standing in Catholic teaching but which are not taken as binding in all their particulars, form part of a tradition of moral and social theorizing that a contemporary American would regard as “communitarian.” On social questions, this tradition also has shown itself to be historicist in that it is capable of modifying itself in significant ways in response to changing political and economic situations. It normally approaches issues from a universalist perspective, though it has shifted from a preoccupation with the concerns of the industrial societies of Europe to an advocacy of much of the reform agenda of the Third World.Rooted in classical and biblical sources and modified in the course of the last [End Page 401] century to include a principled acceptance of religious freedom, of human rights, and of democratic political institutions, the Catholic social tradition proposes a number of ideas that can serve as the basis for significant criticism of currently dominant liberal modes of organizing and interpreting advanced industrial societies. These ideas do not form a countertheory to liberalism so much as they indicate ways in which a religious organization that includes both hierarchical and egalitarian elements in its structure and that has both moral commitments and practical responsibilities with regard to health care can draw on its intellectual resources to develop alternative strategies for the reform of health care.I shall survey six ideas that figure prominently in Catholic social teaching and that are relevant to the allocation of scare resources in American health care. Space constraints require that I present them in a very condensed fashion, without tracing the complex development they have undergone in the internal Catholic debate or subjecting them to much criticism.First, Catholic social teaching, especially the great encyclical of John XXIII, Pacem In Terris (PT 1963), affirms the full range of human rights recognized in such modern documents as the Universal Declaration of Human Rights (1949). In addition to the civil and political rights enumerated in the Bill of Rights added to the original U.S. Constitution (1791), the Universal Declaration includes rights “to life, to bodily integrity, and to the means which are suitable for the proper development of life; these are primarily food, clothing, shelter, rest, medical care, and finally the necessary social services” (PT 11). Catholic social teaching has not committed itself to one particular way of institutionalizing these rights, but it effectively endorses the comprehensive West European welfare states that the Christian Democratic political parties helped to construct in the period after 1945.Second, Catholic social teaching has accorded a central organizing role to the notion of the common good, the realization of which “is the whole reason for the existence of civil authorities” (PT 54). The common good, however, is not to be understood as identical with the interest or the power of the state; rather, it “embraces the sum total of those conditions of social living whereby men are enabled to achieve their own integral perfection more fully and more easily” (PT 58; quoting Mater et Magistra). John XXIII is particularly anxious to affirm that the common good cannot be construed so as to exclude some groups or to violate the rights of individuals and that it must include both physical and spiritual goods (PT 55–61). The notion of the common good has both an inherent attractiveness and a vagueness that cries out for specification and clarification. But in the contemporary situation it serves to remind us that “individual citizens and intermediate groups are obliged to make their specific contributions to the common welfare” (PT 53).Third, while an insistence on the primacy of the common good and on the [End Page 402... (shrink)

Around the world, the population is ageing in ways that pose new challenges for healthcare providers. To date these have mostly been formulated in terms of challenges created by increasing costs, and the focus has been squarely on life-prolonging treatments. However, this focus ignores the ways in which many older people require life-enhancing treatments to counteract the effects of physical and mental decline. This paper argues that in doing so it misses important aspects of what justice requires when it (...) comes to older people. (shrink)

This paper describes the present resource allocation problems in the Danish tax-based public health care system and presents an analysis of the two policy options put forward as a solution to these problems: (1) explicit rationing of services, and (2) the introduction of two-tiered health care. It is argued that a two-tiered system with a private second tier is unlikely to be acceptable and viable in Denmark, whereas an introduction of a second tier within the public system may (...) be more acceptable. It is further argued that present implicit rationing methods may be unethical and ought to be replaced by explicit rationing. Keywords: justice, resource allocation, two-tiered health care CiteULike Connotea Del.icio.us What's this? (shrink)

This paper maps the different levels of the problem of healthcare resource allocation — micro, macro and international — with reference to three cases. It is argued that two standard approaches to the issue of distributive justice in healthcare, the QALY (quality-adjusted life year) approach and the social-contract approach developed by Norman Daniels, are fundamentally unsatisfactory for reasons identified by Alasdair MacIntyre. Although the virtue theory articulated by MacIntyre and others has been influential in many areas (...) of healthcare ethics, there seems to have been relatively little discussion of the difference it might make to the problems of resource allocation. The potential of such an approach is explored in the later sections of the paper. Two apparently promising ways of bringing virtue ethics to bear on resource allocation are examined and found wanting to greater or lesser extents. Firstly, Beauchamp and Childress’s account of the virtues as a supplement to their ‘Four Principles’ is found to have little or no substantive contribution to make to this issue. Secondly, the ‘liberal communitarian’ system of resource allocation proposed by Ezekiel Emanuel, while a considerable improvement on the account of Beauchamp and Childress, remains problematic in some respects. An alternative Christian account is developed by identifying significant influences that might shape the ‘political prudence’ which would enable Christian communities to form sound judgments about distributive justice in healthcare. The paper concludes with some remarks about the relationship between this tradition-constituted account and the wider public sphere of policy-making and practice. (shrink)

This article draws attention to the limited amount of scholarship on what constitutes fairness and equity in resource allocation to health research by individual funders. It identifies three key decisions of ethical significance about resource allocation that research funders make regularly and calls for prioritizing scholarship on those topics – namely, how health resources should be fairly apportioned amongst public health and health care delivery versus health research, how health research resources should be fairly allocated between (...) health problems experienced domestically versus other health problems typically experienced by disadvantaged populations outside the funder's country, and how domestic and non-domestic health research funding should be further apportioned to different areas, e.g. types of research and recipients. These three topics should be priorities for bioethics research because their outcomes have a substantial bearing on the achievement of health justice. The proposed agenda aims to move discussion on the ethics of health research funding beyond its current focus on the mismatch between worldwide basic and clinical research investment and the global burden of disease. Individual funders’ decision-making on whether and to what extent to allocate resources to non-domestic health research, health systems research, research on the social determinants of health, capacity development, and recipients in certain countries should also be the focus of ethical scrutiny. (shrink)

More and more cities develop urban food strategies to guide their efforts and practices towards more sustainable food systems. An emerging theme shaping these food policy endeavours, especially prominent in North and South America, concerns the enhancement of social justice within food systems. To operationalise this theme in a European urban food governance context we adopt Nancy Fraser’s three-dimensional theory of justice: economic redistribution, cultural recognition and political representation. In this paper, we discuss the findings of an (...) exploratory document analysis of the social justice-oriented ambitions, motivations, current practices and policy trajectories articulated in sixteen European UFSs. We reflect on the food-related resource allocations, value patterns and decision rules these cities propose to alter and the target groups they propose to support, empower or include. Overall, we find that UFSs make little explicit reference to social justice and justice-oriented food concepts, such as food security, food justice, food democracy and food sovereignty. Nevertheless, the identified resources, services and target groups indicate that the three dimensions of Fraser are at the heart of many of the measures described. We argue that implicit, fragmentary and unspecified adoption of social justice in European UFSs is problematic, as it may hold back public consciousness, debate and collective action regarding food system inequalities and may be easily disregarded in policy budgeting, implementation and evaluation trajectories. As a path forward, we present our plans for the RE-ADJUSTool that would enable UFS stakeholders to reflect on how their UFS can incorporate social justice and who to involve in this pursuit. (shrink)

This essay argues that considerations of justice that govern the morality of self-defense are also relevant in some cases in which organs are allocated for transplantation in conditions of scarcity. The essay's main substantive claim is that in general alcoholics are morally liable to be assigned a lower priority in the distribution of livers for transplantation because of their own responsibility for their need for a transplant. There are, however, practical obstacles to giving lower priority in the distribution of (...) medical resources generally to those who are responsible for their own illnesses, and it may seem unfair to single out alcoholics but not others for lower priority. (shrink)

The question of resource allocation is particularly pertinent to the realisation of socioeconomic rights. Perceptions of the place of resource allocation impact the adjudication of these rights. This article departs from the premise that with the adoption of the Optional Protocol to the International Covenant on Economic, Social and Cultural rights allowing individual communications and the establishment of the African Court on Human and Peoples’ Rights, there will be an increase in resource allocation (...) questions for adjudication. The article interrogates the experience of national courts and examines potential lessons that can be adopted at the international level to overcome the reluctance that supra-national tribunals may have when adjudicating on states obligations to fulfil. (shrink)

In ethics and political philosophy, the concepts of equity, equality, need satisfaction, and justice are significant for the fulfilment of underlying requirements of human rights, and the attainment of peace in societies. Studies show these as potential frames for defining processes, distributing resources, sharing responsibilities, allocating rewards, demonstrating respect and dispensing with unequal treatments. Justice, as the ideal that impels us to impartially adjudicate between competent claims, is linked to equality. But as the moral force that propels actions (...) for needs’ satisfaction, it is linked to equity. Hence, equality and equity are two elements of the theory of justice: both are grounded on the principles of distributive justice. This ‘common grounding’ apparently obfuscates their distinctive features, and over time, has elicited their equiparation. This essay highlights the archetypal frames of the notions of equity and equality as indispensable principles of social justice. It identifies the skewed distribution of resources in Nigeria as arising from a legal framework that removes the power of personal/group autonomy from the people. The essay notes the misleading tendency in the insulated use of equality for justice, and accepts the primacy of distributive justice amongst rival pathways to national cohesive living. (shrink)

Hennie Lötter, in his book Poverty, Ethics, and Justice, contends that we have a moral obligation to eradicate global poverty, but does so under the assumption that eradicating poverty is possible under current political and economic policy. Roughly 1.8 billion people (the consuming class) currently consume the majority of the world’s economic production. About 5.2 billion poor people (the non-consuming class) would like to consume at similar levels. Is it possible for the non-consuming class to approach levels of material (...) welfare similar to that of the consuming class? What would be the impact on the global environment if the billions of the non-consuming class started to consume at a reasonable standard? The answers to these questions are rather bleak for the cause of eradicating poverty: discussions on global poverty like Lötter’s fail to cohere with data on the environment and regarding resources constraints. Without radical transformation of current economic and political philosophy, the assumption that the eradication of poverty is possible is a false assumption. (shrink)

Hennie Lötter, in his book Poverty, Ethics, and Justice, contends that we have a moral obligation to eradicate global poverty, but does so under the assumption that eradicating poverty is possible under current political and economic policy. Roughly 1.8 billion people currently consume the majority of the world’s economic production. About 5.2 billion poor people would like to consume at similar levels. Is it possible for the non-consuming class to approach levels of material welfare similar to that of the (...) consuming class? What would be the impact on the global environment if the billions of the non-consuming class started to consume at a reasonable standard? The answers to these questions are rather bleak for the cause of eradicating poverty: discussions on global poverty like Lötter’s fail to cohere with data on the environment and regarding resources constraints. Without radical transformation of current economic and political philosophy, the assumption that the eradication of poverty is possible is a false assumption. (shrink)

The COVID‐19 pandemic has raised important universal public health challenges. Conceiving ethical responses to these challenges is a public health imperative but must take context into account. This is particularly important in sub‐Saharan Africa (SSA). In this paper, we examine how some of the ethical recommendations offered so far in high‐income countries might appear from a SSA perspective. We also reflect on some of the key ethical challenges raised by the COVID‐19 pandemic in low‐income countries suffering from chronic shortages in (...) health care resources, and chronic high morbidity and mortality from non‐COVID‐19 causes. A parallel is drawn between the distribution of severity of COVID‐19 disease and the classic “Fortune at the bottom of the pyramid” model that is relevant in SSA. Focusing allocation of resources during COVID‐19 on the ‘thick’ part of the pyramid in Low‐to‐Middle Income Countries (LMICs) could be ethically justified on utilitarian and social justice grounds, since it prioritizes a large number of persons who have been economically and socially marginalized. During the pandemic, importing allocation frameworks focused on the apex of the pyramid from the global north may therefore not always be appropriate. In a post‐COVID‐19 world, we need to think strategically about how health care systems can be financed and structured to ensure broad access to adequate health care for all who need it. The root problems underlying health inequity, exposed by COVID‐19, must be addressed, not just to prepare for the next pandemic, but to care for people in resource poor settings in non‐pandemic times. (shrink)

Considerations of social justice pertain to universities with respect to reserved spaces for applicants from disadvantaged groups, targeted hiring, differential student fees or faculty workloads and salaries, and similarly contested matters. This paper displaces debates over what constitutes just allocation of university resources from those over theories of justice in general to those about alternative visions of the proper goal of universities. To this end, educational and democratic theories of John Dewey are drawn on as an (...) alternative to elitist conceptions and the implications of these competing viewpoints for specific justice-related issues are explicated. (shrink)

The allocation of healthcare resources takes place at two distinct levels. At the macroeconomic level, policymakers decide on budgets, staffing, cost‐effectiveness thresholds, clinical guidelines and insurance payments; at the microeconomic level, healthcare professionals decide on whom to treat, what the appropriate treatment is, how much time and effort should each patient receive and how urgent the need for care is. At both levels, there is a constant social need for just allocation. Policymakers are mostly guided by abstract (...) principles of justice, thinking in terms of groups of patients, epidemiological data, impersonal statistics and economic costs. On the other hand, healthcare professionals understand the need for justice at a more personal level, as they interact with patients and, in a sense, put theory into practice. Nurses hold a unique position in healthcare systems, as, traditionally, they are closer to patients than other health professionals. This means that they have a firsthand view of the effect that their decisions have on specific patients and, therefore, nurses tend to get more influenced by their personal feelings, values and beliefs at the microeconomic level. This presentation shall examine the gap between abstract macroeconomic and concrete microeconomic health resources allocation decisions, with a particular emphasis on the role of the nurse. (shrink)

Equipoise is widely regarded to be an essential prerequisite for the ethical conduct of a randomised controlled trial. There are some circumstances however, under which it is acceptable to conduct a randomised controlled trial in the absence of equipoise. Limited access to the preferred intervention is one such circumstance. In this paper we present an example of a randomised trial in which access to the preferred intervention, preschool education, was severely limited by resource constraints. The ethical issues that arise (...) when conducting randomised trials in health care are considered in the context of trials of social interventions. In health, education and social welfare, effective interventions are frequently limited due to budgetary constraints. Explicit acknowledgement of the need to ration interventions, and the use of random allocation to do this even in the absence of equipoise, would facilitate learning more about the effects of these interventions. (shrink)

Shortages of life-saving medical resources caused by COVID-19 have prompted hospitals, healthcare systems, and governmentsto develop crisis standards of care, including 'triage protocols' to potentially ration medical supplies during the public health emergency. At the same time, the pandemic has highlighted and exacerbated racial, ethnic, and socioeconomic health disparities that together constitute a form of structural racism. These disparities pose a critical ethical challenge in developing fair triage systems that will maximize lives saved without perpetuating systemic inequities. Here we review (...) alternatives to 'utilitarian' triage, including first-come first-served, egalitarian, and prioritarian systems of allocating scarce medical resources. We assess the comparative advantages and disadvantages of these allocation schemes. Ultimately, we argue that while triage protocols should not exacerbate disparities, they are not an adequate mechanism for redressing systemic health inequities. Entrenched health disparities must be addressed through broader social change. (shrink)

Over many years, different theories have been developed to guide the social practices and policies of institutions so that they demonstrate equal concern and respect for all, and satisfy the requirements of justice. Although the normative principles described in a theory may support just institutions, whether this results in just outcomes will depend on how the decisions that implement the principles are made and actioned. As a societal institution charged with caring for people, ensuring just outcomes is a (...) distinct concern in healthcare. Relationships within this institution are constitutive of human flourishing and are also important to justice. Yet, it is not possible to create, maintain or evaluate interpersonal relationships in the same manner as institutions because rather than being universal and impartial, they are particular and partial. Consequently, the link between theories of justice that guide decision-making in relation to structures or institutions, and the relationships that influence those with a proximate effect on individuals, is not explicit. To address this gap, this article argues that a focus on human flourishing provides a nexus between the decision-making for just institutions and just outcomes for individuals. (shrink)

The debate about justice and health care has occurred largely at a remove from the institutions it concerns; it has been about our most general moral principles, and about what things we value. This debate has foundered. But if the debate is turned in another direction, toward some moral principles that are widely accepted within those institutions, and toward principles that have to do with control over allocation decisions rather than with actually how to make those decisions, agreement (...) may be nearer at hand. (shrink)

In this engaging and provocative book, Sher explores the normative moral and social problems that arise from living in a decidedly non-ideal world_a world that contains immorality, evil, and injustice, and in which resources are often inadequate. Sher confronts difficult issues surrounding preferential treatment and equal opportunity, compensatory justice and punishment, the allocation of goods, and moral compromise.

Inequities in health and health care are one of the greatest challenges facing the international community today. This problem raises serious questions for health care planners, politicians and ethicists alike. The major world religions can play an important role in this discussion. Therefore, interreligious dialogue on this topic between ethicists and health care professionals is of increasing relevance and urgency. This article gives an overview on the positions of Islam and Christianity on equity and the distribution of resources in health (...) care. It has been written in close collaboration and constant dialogue between the two authors coming from the two religions. Although there is no specific concept for the modern term equity in either of the two religions, several areas of agreement have been identified: All human beings share the same values and status, which constitutes the basis for an equitable distribution of rights and benefits. Special provisions need to be made for the most needy and disadvantaged. The obligation to provide equitable health services extends beyond national and religious boundaries. Several areas require intensified research and further dialogue: the relationship between the individual and the community interms of rights and responsibilities, how to operationalize the moral duty to decrease global inequalities in health, and the understanding and interpretation of human rights in regard to social services. (shrink)

Withholding or withdrawing life-saving ventilators can become necessary when resources are insufficient. In the USA, such rationing has unique social justice dimensions. Structural elements of dominant allocation frameworks simultaneously advantage white communities, and disadvantage Black communities—who already experience a disproportionate burden of COVID-19-related job losses, hospitalisations and mortality. Using the example of New Jersey’s Crisis Standard of Care policy, we describe how dominant rationing guidance compounds for many Black patients prior unfair structural disadvantage, chiefly due to the (...) way creatinine and life expectancy are typically considered.We outline six possible policy options towards a more just approach: improving diversity in decision processes, adjusting creatinine scores, replacing creatinine, dropping creatinine, finding alternative measures, adding equity weights and rejecting the dominant model altogether. We also contrast these options with making no changes, which is not a neutral default, but in separate need of justification, despite a prominent claim that it is simply based on ‘objective medical knowledge’. In the regrettable absence of fair federal guidance, hospital and state-level policymakers should reflect on which of these, or further options, seem feasible and justifiable.Irrespective of which approach is taken, all guidance should be supplemented with a monitoring and reporting requirement on possible disparate impacts. The hope that we will be able to continue to avoid rationing ventilators must not stand in the way of revising guidance in a way that better promotes health equity and racial justice, both to be prepared, and given the significant expressive value of ventilator guidance. (shrink)

Evidence-Based Medicine (EBM) is defined as the conscious, and judicious use of current best evidence in making decisions about the care of individual patients. The greater the level of evidence the greater the grade of recommendation. This pioneering explicit concept of EBM is embedded in a particular view of medical practice namely the singular nature of the patient-physician relation and the commitment of the latter towards a specific goal: the treatment and the well being of his or her client. Nevertheless, (...) in many European countries as well as the United States, this integration of the best evidence from systematic research with clinical expertise and patient values appears to be re-interpreted in light of the scarcity of healthcare resources. The purpose of this paper is double. First, to claim that from an ethical perspective EBM should be a guideline to clinical practice; and second, that in specific circumstances EBM might be a useful tool in macro-allocation of healthcare resources. Methodologically the author follows Norman Daniels' theory of democratic accountability to justify this assumption. That is, choices in healthcare must be accountable by democratic procedures. This perspective of distributive justice is responsible for the scope and limits of healthcare services. It follows that particular entitlements to healthcare — namely expensive innovative treatments and medicines —may be fairly restricted as long as this decision is socially and democratically accountable and imposed by financial restrictions of the system. In conclusion, the implementation of EBM, as long as it limits the access to drugs and treatments of unproven scientific results is in accordance with this perspective. The use of EBM is regarded as an instrument to facilitate the access of all citizens to a reasonable level of healthcare and to promote the efficiency of the system. (shrink)

According to a common view, in a case involving an indivisible good and several potential beneficiaries, who are equal in every relevant respect, there is a non-instrumental reason to allocate the benefit in a way that gives each an equal chance to receive the benefit. In this paper, I argue that this view is incompatible with several plausible and widely held assumptions. I emphasize especially the assumption that the distributive role of chances is secondary to that of benefits in an (...) important sense: the value of allocating chances is related to the ways in which it is possible to allocate the relevant benefits. Specifically, chances should be allocated only when it is impossible or too costly to allocate benefits in accordance with the relative importance of the reasons in favor of allocating the relevant benefit to each potential beneficiary. Given this assumption, I argue that the fact that there is no relation between the distributive concern for chances and other distributive concerns suggests that we should reject the view that chances have a distributive role that is not merely instrumental. (shrink)

This article contributes to the debate on automation and justice by discussing two under-represented concerns: labour justice and equality. Since automation involves both winners and losers, and given that there is no ‘end of work’ on the horizon, it is argued that most normative views on the subject – i.e. the ‘allocative’ view of basic income, and the ‘desirability’ views of post-work and workist ethics – do not provide many resources with which to address unjustly unequal divisions of (...) labour involved in technological innovation. This article problematises these common responses reframing the problem from the perspective of labour justice. While the allocative view assumes that labour justice follows ‘spontaneously’ from income redistribution, the desirability views are chiefly interested in either defining or contesting the meanings of work for individuals, overlooking the interdependent nature of work and concerns of equality other than autonomy. Two conceptions of labour justice are thus applied to the problem: Paul Gomberg’s contributive justice, and Iris Young’s democratic division of labour. Instead of deciding between them, the normative core of ‘contributive parity’ is suggested as a critical standard for assessing unequal labour structures, and for envisaging a future in which technology can be an ally in making social cooperation fair. (shrink)

The Infectious Diseases Act entered into force officially on 14 November 2018 in Bangladesh. The Act is designed to raise awareness of, prevent, control, and eradicate infectious or communicable diseases to address public health emergencies and reduce health risks. A novel coronavirus disease was first identified in Bangladesh on 8 March 2020, and the Ministry of Health and Family Welfare issued a gazette on 23 March, listing COVID-19 as an infectious disease and addressing COVID-19 as a public health emergency. The (...) gazette empowers the government to monitor the spread of infection. Despite there being an infrastructure of research ethics committees in almost all hospitals in Bangladesh, a lack of such committees in the clinical setting often forces healthcare professionals to allocate scarce healthcare resources to the task. These personnel are often either influenced by materialistic matters or guided by the emergency policies, without reaching a consensus on how to allocate scarce resources in times of need, especially in the time of the COVID-19 pandemic. Ethical dilemmas often arise when a number of patients with COVID-19, especially in poor and middle-class areas, are denied care while elites are prioritized to receive such scarce resources. Resource allocation in healthcare during the COVID-19 pandemic in Bangladesh appears to be unethical and in direct conflict with the biomedical principles of non-maleficence and procedural justice. The findings of this study suggest that the Act needs substantive changes in the stipulation of policy directing hospitals in the provision of resource allocation framework. Furthermore, parliament should produce guidance outlining how to successfully implement the law with the aim of protecting public health in times of emergency, especially the COVID-19 pandemic. (shrink)

Even though considerable resources have been allocated to the study of obesity, there is no consensus on its definition, causes, or solutions. Amidst ongoing debates over understandings of obesity, Obesity Canada (OC) was established to enhance the quality of life of Canadians with obesity through the advancement of anti-discrimination, policy change, and obesity prevention and treatment. Drawing upon a transdisciplinary social justice framework, we use critical thematic analysis to examine the OC website, which is the organization’s primary knowledge (...) mobilization platform. We will address the following research question: To what extent does OC serve social justice goals that promote the best interests of larger people? We argue that the social justice potential of OC ultimately falls short and conclude with some recommendations on how the site content could be enhanced with social justice principles. (shrink)

This article examines the inherently ethical nature of resource allocation in policing. Decision-makers must make trade-offs between values such as efficiency vs. equity, individual vs. collective benefit, and adopt principles of distribution which allocate limited resources fairly. While resource allocation in healthcare has been the subject of extensive discussion in both practitioner and academic literature, ethical resource allocation in policing has received almost no attention. We first consider whether approaches used in healthcare settings would (...) be suitable for policing. Whilst there are some high-level similarities in the relevant ethical considerations and processes—such as aiming for efficient and equitable resource deployment—there are also fundamental differences between the two settings, which we argue necessitate a different approach. These differences include: (1) greater diversity and incommensurability of the benefits of policing, (2) more frequent non-linearity in returns on policing investment, (3) greater “ethical divisibility” (permissible scaling down) of programs in policing, (4) a requirement to assess “need” for policing resources at the collective (rather than individual) level, and (5) clearer primacy of equity considerations in policing. Having drawn out the implications of these differences, we sketch some tentative proposals for ethical resource allocation in policing. (shrink)

Should there be a female age limit on public funding for assisted reproductive technology (ART)? The question bears significant economic and sociopolitical implications and has been contentious in many countries. We conceptualise the question as one of justice in resource allocation, using three much-debated substantive principles of justice—the capacity to benefit, personal responsibility, and need—to structure and then explore a complex of arguments. Capacity-to-benefit arguments are not decisive: There are no clear cost-effectiveness grounds to restrict funding (...) to those older women who still bear some capacity to benefit from ART. Personal responsibility arguments are challenged by structural determinants of delayed motherhood. Nor are need arguments decisive: They can speak either for or against a female age limit, depending on the conception of need used. We demonstrate how these principles can differ not only in content but also in the relative importance they are accorded by governments. Wide variation in ART public funding policy might be better understood in this light. We conclude with some inter-country comparison. New Zealand and Swedish policies are uncommonly transparent and thus demonstrate particularly well how the arguments we explore have been put into practice. (shrink)

If one is committed to a “Rawlsian” conception of justice, is one not also necessarily committed to a “Christian” personal ethics? MOE explicitly, if one believes that social justice requires the maximinning of material conditions, should one not use one's time and resources as well as one can in order to assist the poorest? The paper offers a very partial answer to these questions by arguing for the following two claims: (1) Contrary to what is implied by (...) some egalitarian critics of Rawls, the idea of a well‐ordered society does not require maximin‐guided choices at the individual level, and hence leaves room for legitimate incentive payments.(2) Despite Rawls's own neglect of this fact, a limited form of patriotism does constitute an individual “natural duty” following from a commitment to maximin social justice. (shrink)

If ‘community’ is the answer, what is the problem? While questions undoubtedly arise in allocating resources to public health, such as ‘how much?’ and ‘to whom?’, we already have answers based on (i) the observation that disease and illness are bad, (ii) views of justice and fairness and (iii) an appreciation of market failure. What does the concept of community add to the existing answers? Not nothing, I shall argue, but not much either. In some cases, health providers should (...) take advantage of ties of community to deliver services more effectively. The desire to preserve communities may have some minor implications for devolved health care funding. The value of community may set some limits to inequalities in access to health care. That’s about it. I do consider some other claims of behalf of the concept, e.g. that people would not support justice in health care without a sense of community; but I don’t find these claims very plausible. Finally, I point out some ways in which communities can be damaged by the promotion of public health understood as population health. (shrink)

It has been observed that some groups in society tend to report their health to be better than would be expected through more objective measures. The available evidence suggests that while variations in self-assessed measures of health may act as good proxies of mortality and morbidity in homogeneous populations, in some groups, such as the Aboriginal and Torres Strait Islander communities of Australia, these subjective measures may provide a misleading picture. Useful insights into the formation of health perceptions can be (...) drawn from a range of disciplines, in particular, from social comparison theories, models of illness behaviour, survey literature and linguistics. These theories and models help to provide an understanding of the different ways in which illness may be perceived, evaluated and acted upon by different kinds of people. Such considerations can have very direct implications for those planning and evaluating public health programs as well as those responsible for funding such programs. (shrink)

Hastings Center Report, Volume 51, Issue 5, Page 51-53, September‐October 2021.

If one is committed to a “Rawlsian” conception of justice, is one not also necessarily committed to a “Christian” personal ethics? MOE explicitly, if one believes that social justice requires the maximinning of material conditions, should one not use one's time and resources as well as one can in order to assist the poorest? The paper offers a very partial answer to these questions by arguing for the following two claims: (1) Contrary to what is implied by (...) some egalitarian critics of Rawls, the idea of a well‐ordered society does not require maximin‐guided choices at the individual level, and hence leaves room for legitimate incentive payments.(2) Despite Rawls's own neglect of this fact, a limited form of patriotism does constitute an individual “natural duty” following from a commitment to maximin social justice. (shrink)

This article proposes that all psychologists-and all psychologies-are innately concerned with justice, and yet there is no consensually defined discipline of psychology, and no consensual understanding of social justice. Adopting an intergroup and identitybased model of what is and what should be, we will describe the mechanisms whereby identities and perceptions of justice are formed, contested, and changed over time. We will argue that psychological research and practice have implications for social justice even where-and (...) perhaps especially when-these are not made explicit. Psychology is considered as the product of diverse groups with distinct and evolving identities, and with differential access to resources and power, which dynamically contest different normative perceptions of justice. (shrink)

Regulation is often applied to business behavior to ensure that the social costs of doing business are included in the cost and pricing structures of the firm. Because the consumer benefits from the transaction that generated the social costs, asking the consumer to bear the burden imposed by the transaction is fair. However, there may be a lack of Justice m the internal and external distribution of the social costs of doing business if consumers are the (...) only party bearing that burden, or if the costs are being shifted to employees or taxpayers when a closer stakeholder is also benefiting from the transaction – the stockowner. A social justice perspective requires that those benefiting from a transaction share in the burdens of it. We propose that a Tobin-like tax on stock transactions might be a just means of achieving greater justice in the distribution of the social cost burden. (shrink)

. If one is committed to a “Rawlsian” conception of justice, is one not also necessarily committed to a “Christian” personal ethics? MOE explicitly, if one believes that social justice requires the maximinning of material conditions, should one not use one's time and resources as well as one can in order to assist the poorest? The paper offers a very partial answer to these questions by arguing for the following two claims: Contrary to what is implied by (...) some egalitarian critics of Rawls, the idea of a well‐ordered society does not require maximin‐guided choices at the individual level, and hence leaves room for legitimate incentive payments. Despite Rawls's own neglect of this fact, a limited form of patriotism does constitute an individual “natural duty” following from a commitment to maximin social justice. (shrink)

rally best suited’. One would ordinarily suppose social justice to concern not only the allocation of duties but also the distribution of benefits. I argue that this expectation is fulfilled not by Plato’s conception of social justice, but by the normative basis for it, Plato’s requirement of aiming at the happiness of all the citizens. I argue that Plato treats social justice as a necessary but not sufficient means to happiness that guarantees only (...) the production of the greatest goods; ensuring that these goods are distributed so as to maximize the happiness of the whole city.. (shrink)

This article will examine the Catholic concept of global justice within a health care framework as it relates to women's needs for delivery doctors in the developing world and women's demands for assisted reproduction in the developed world. I will first discuss justice as a theory, situating it within Catholic social teachings. The Catholic perspective on global justice in health care demands that everyone have access to basic needs before elective treatments are offered to the wealthy. (...) After exploring specific discrepancies in global health care justice, I will point to the need for delivery doctors in the developing world to provide basic assistance to women who hazard many pregnancies as a priority before offering assisted reproduction to women in the developed world. The wide disparities between maternal health in the developing world and elective fertility treatments in the developed world are clearly unjust within Catholic social teachings. I conclude this article by offering policy suggestions for moving closer to health care justice via doctor distribution. (shrink)

The coronavirus disease 2019 (COVID-19) pandemic has motivated medical ethicists and several task forces to revisit or issue new guidelines on allocating scarce medical resources. Such guidelines are relevant for the allocation of scarce therapeutics and vaccines and for allocation of ICU beds, ventilators, and other life-sustaining treatments or potentially scarce interventions. Principles underlying these guidelines, like saving the most lives, mitigating disparities, reciprocity to those who assume additional risk (eg, essential workers and clinical trial participants), and equal (...) access may compete with one another. We propose the use of a “categorized priority system” (also known as a “reserve system”) as an improvement over existing allocation methods, particularly because it may be able to achieve disparity mitigation better than other methods. (shrink)

This chapter contains sections titled: Determinants of Health Who, If Anyone, Allocates Health Resources? Determining the Share of the Overall Budget To Be Devoted to Health Allocation Within the Budget for Health Health Needs and Benefits Ethical Issues in Measuring Health Benefits: Quantity and Quality of Life Ethical Issues in the Distribution of Health Benefits Other Principles of Allocation Allocation and Social Justice Democratic Choice Conclusion References Further reading.

This paper stems from the current global worsening of the scarcity of resources for healthcare, which will deepen even more in future public emergencies. This justifies strengthening the reflection on the allocation of resources which, in addition to considering technical issues, should also involve ethical concerns. The two plans in which the allocation of resources develops—macro and micro—are then systematized, both requiring the identification of ethical criteria for the respective complex decision-making. Then, we describe how the complexity at (...) the macro level focuses on the joint consideration of the rectitude of the principles, the goodness of the ends, and the integrity—respectively the deontological, teleological, and procedural perspectives; and at the micro level, it focuses in prioritizing people, which can result in the exclusion of some, as happened with the elderly during peaks of COVID-19. The main objective of this article is to show that, in public health emergency situations, in which the daily criteria for prioritizing access to health care are not efficient, it is possible not only to ration the available means but also to rationalize them. We argue that rationing and rationalization are different concepts, entail different consequences, have different ethical foundations, and draw different guidelines for patient care. We apply them to the distribution of intensive care and vaccines to the elderly thus demonstrating the ethically legitimate domain of implementation of each of these two prioritization criteria. We conclude that rationalization respects more strictly the core ethical principles of our common morality. (shrink)

Some ethicists assert that there is a consensus that maximising medical outcomes takes precedence as a principle of resource allocation in emergency triage of absolutely scarce resources. But the nature of the current severe acute respiratory syndrome-related coronavirus 2 pandemic and the history of debate about balancing equity and efficiency in resource allocation do not support this assertion. I distinguish a number of concerns with justice and balancing considerations that should play a role in critical (...) care triage policy, focusing on discrimination and on fundamental egalitarian and social justice concerns. (shrink)

The debate over the host of moral issues that genetic enhancement technology (GET) raises has been significant. One argument that has been advanced to impugn its moral legitimacy is the ‘unfair advantage argument’ (UAA), which states: allowing access to GET to be determined by socio-economic status would lead to unjust outcomes, namely, create a genetic caste system, and with it the exacerbation and perpetuation of existing socio-economic inequalities. Fritz Allhoff has recently objected to the argument, the kernel of which is (...) that it conflates the use of the technology with its distribution. GET, he argues, would generate unjust outcomes only if it is distributed according to principles of an unjust pattern of distribution; for if we can determine what constitutes a ‘just’ distributive scheme, then the technology can be allocated according to the principles of that scheme. In this paper I argue the following cluster of related claims: (1) both UAA and Allhoff's proposed distributive schemes ignore the importance of non-genetic factors in the development of an individual's characteristics and capacities; (2) if we accept the view that it is good to prevent unjust outcomes that arise because some have exclusive access to GET, then we have to accept wide-ranging distributive schemes; (3) by tracking genetic and non-genetic factors wide-ranging schemes do violate in some sense the widely shared value of neutrality in liberal democracies. (shrink)

Through its adoption of the biomedical model of disease which promotes medical individualism and its reliance on the individual-based anthropology, mainstream bioethics has predominantly focused on respect for autonomy in the clinical setting and respect for person in the research site, emphasizing self-determination and freedom of choice. However, the emphasis on the individual has often led to moral vacuum, exaggeration of human agency, and a thin (liberal?) conception of justice. Applied to resource-poor countries and communities within developed countries, (...) autonomy-based bioethics fails to address the root causes of diseases and public health crises with which individuals or communities are confronted. A sociological explanation of disease causation is needed to broaden principles of biomedical ethics and provides a renewed understanding of disease, freedom, medical practice, patient-physician relationship, risk and benefit of research and treatment, research priorities, and health policy. (shrink)

The question of how to allocate scarce medical resources has become an important public policy issue in recent decades. Cost-Utility Analysis is the most commonly used method for determining the allocation of these resources, but this book counters the argument that overcoming its inherent imbalances is simply a question of implementing methodological changes. The Economics of Resource-Allocation in Healthcare represents the first comprehensive analysis of equity weighting in health care resource allocation that offers a fundamental (...) critique of its basic framework. It offers a heterodox account of health economics, putting the discourse on economic evaluation into it broader socio-political context. Such an approach broadens the debate on fairness in health economics and ties it in with deeper rooted problems in moral philosophy. Ultimately, this interdisciplinary study calls for the adoption of a fundamentally different paradigm to address the distribution of scarce medical resources. This book will be of interest to policy makers, health care professionals or Post-Graduate students looking to broaden their understanding of the economics of the healthcare system. (shrink)