Bioethics - basics of bioethics, scarcity resource allocation, battisti

Good Bioethics McMillan 2008: What is the central question of McMillan's paper?

The central question is what makes bioethics "good" and how bioethics can be characterized as a discipline, focusing on its values, methods, and goals.

Good Bioethics McMillan 2008: What is McMillan’s general definition of bioethics?

Bioethics is an interdisciplinary inquiry into ethical issues arising in the life sciences and biomedicine, where moral reasoning is brought to bear on these issues.

Good Bioethics McMillan 2008: How do John Harris and Art Caplan characterize good bioethics?

Harris and Caplan argue that good bioethics aims at "doing good." It must contribute to improving the world, ensuring life flourishes, and promoting beneficial outcomes.

Good Bioethics McMillan 2008: What concern does McMillan raise about prioritizing 'doing good' in bioethics?

McMillan argues that prioritizing "doing good" may undermine the importance of truth in scholarly work, as not all good bioethics directly promotes "the good" (e.g., uncovering ethical failings).

Good Bioethics McMillan 2008: How does McMillan refine Harris and Caplan’s 'doing good' requirement?

McMillan refines it by suggesting bioethics should be "practically normative," meaning it should contribute to resolving or understanding ethical issues, even indirectly.

Good Bioethics McMillan 2008: What are Alastair Campbell's two principles of good bioethics?

1. No special pleading: No philosophical or theological view should dominate.
   2) Engagement with experience: Bioethics must connect with the realities faced by patients, practitioners, and policymakers.

Good Bioethics McMillan 2008: What does 'no special pleading' mean in the context of bioethics?

It means that no single theoretical, philosophical, or theological perspective should claim priority or privilege in ethical discussions within bioethics.

Good Bioethics McMillan 2008: Why was 'no special pleading' emphasized in early bioethics journals like JME?

It was a response to concerns about theology or utilitarianism dominating bioethics and aimed to ensure openness to diverse perspectives for credibility and inclusivity.

Good Bioethics McMillan 2008: What role does interdisciplinarity play in good bioethics, according to Dan Callahan?

Callahan argues that bioethics should incorporate insights from literature, history, and social sciences, reflecting the full range of human life, individual and social.

Good Bioethics McMillan 2008: What is Campbell and Callahan’s idea of 'engagement with experience'?

It is the principle that good bioethics must stay attuned to the experiences of healthcare providers, patients, and policymakers, addressing practical realities rather than abstract theory.

Good Bioethics McMillan 2008: How does McMillan critique 'engagement with experience' using thought experiments?

McMillan notes that thought experiments (e.g., Thomson's abortion violinist case) may not engage with real-life experiences but still contribute indirectly to practical ethical understanding.

Good Bioethics McMillan 2008: How does McMillan modify the principle of 'engagement with experience'?

He broadens it to include 'practical normativity,' meaning good bioethics contributes to ethical understanding or practical resolution, even if indirectly.

Good Bioethics McMillan 2008: What is an example of bioethics that indirectly engages with experience?

Judith Jarvis Thomson’s thought experiments on abortion and James Rachels’ euthanasia scenarios challenge assumptions and clarify moral concepts, indirectly impacting practical ethics.

Good Bioethics McMillan 2008: Why does McMillan say sound moral reasoning is essential for good bioethics?

Sound moral reasoning distinguishes bioethics from medical sociology or law. Without it, bioethics would fail to address ethical dimensions and instead become purely empirical.

Good Bioethics McMillan 2008: How does Julian Savulescu view the role of philosophy in bioethics?

Savulescu argues that good bioethics requires "good philosophy," where philosophical rigor helps clarify ethical concepts like coercion, exploitation, and moral obligations.

Good Bioethics McMillan 2008: What does Dan Brock claim is a problem in bioethics?

Brock points out that much bioethics lacks careful, rigorous argumentation, leading to weak analysis that does not effectively support moral conclusions.

Good Bioethics McMillan 2008: How does McMillan conclude what makes bioethics 'good'?

Good bioethics involves: 1) practical normativity (contributing to ethical understanding or resolution), 2) sound moral reasoning, and 3) avoiding theoretical dominance through 'no special pleading.'

Good Bioethics McMillan 2008: What is the central stance of McMillan’s argument on good bioethics?

Good bioethics promotes ethical understanding,
engages with real-world practical issues (directly or indirectly), and
upholds rigorous moral reasoning while avoiding theoretical dominance. (no special pleading)

Good Bioethics McMillan 2008: How does McMillan respond to the balance between truth and doing good in bioethics?

He argues that prioritizing "doing good" should not overshadow the importance of truth, as bioethics must critically engage with moral concepts to maintain integrity.

Intro McMillan 2008: What is McMillan’s motivation for writing the book?

McMillan wrote the book for two reasons: 1) to clarify what bioethics aims to do and how it should be done, addressing fragmentation in the field, and 2) to help newcomers understand bioethics without getting lost in moral theories like Kant or Aristotle.

Intro McMillan 2008: What does McMillan believe is the core method of bioethics?

The core method of bioethics is bringing moral reason to bear on practical ethical issues, rather than focusing solely on philosophical theories or favoring one discipline.

Intro McMillan 2008: How does McMillan describe the central tension in bioethics?

McMillan argues that bioethics struggles between overemphasizing normative moral theory and engaging practically with real-world ethical issues. This tension leads to unnecessary fragmentation.

Intro McMillan 2008: How does McMillan adapt Battin’s three activities of bioethics?

Battin identifies three activities in bioethics:

Theoretical reflection: Focused on philosophical inquiry.
Clinical consultation: Addressing practical ethical issues in clinical settings.
Policy development: Shaped by law and aimed at crafting feasible policies.

McMillan adapts these by refining their scope:

Theoretical reflection becomes scholarly bioethics: A broader activity that includes ethical speculation, not just theory.
Clinical consultation becomes biomedical case consultation: Includes clinical ethics, research ethics, and public health ethics.
Policy development incorporates moral consequentialism, where bioethicists must consider the moral implications of advocating policies that are impractical or harmful if enacted.

Intro McMillan 2008: How does McMillan justify the connection between bioethics and law?

McMillan argues that ethics and law have overlapping but distinct forms of normativity:

Law derives normativity from statutes, common law, or legal precedent. Ethics derives normativity from morally compelling reasoning. He uses Hart’s argument in The Concept of Law to highlight the distinction: law has primary rules (conduct-based) and secondary rules (procedural). Similarly, ethics involves moral rules (like obligations) and processes for reasoning about moral conclusions.

Examples from the text:

Confidentiality: It’s both a legal and ethical duty, but law provides conditions where breaching it is warranted (e.g., reporting serious crimes). Informed consent: Law establishes a minimum standard for information disclosure, which also defines part of the ethical obligation. Thus, McMillan concludes that bioethics must account for legal standards while maintaining its distinct focus on moral reasoning.

Intro McMillan 2008: How does McMillan differentiate bioethics from applied ethics?

Applied ethics is a branch of philosophy that uses moral theory to address practical issues, whereas bioethics is interdisciplinary. Bioethics is issue-driven and not “owned” by any one discipline, integrating philosophy, law, sociology, and empirical methods.

Intro McMillan 2008: How does McMillan redefine 'moral reason' in bioethics?

Moral reason is not about applying pre-existing moral frameworks but a process of:

Identifying and clarifying practical and moral considerations in an issue.
Critically testing claims for truth and inferences for validity.
Forming a reflective, justified normative conclusion.

This process is central across scholarly bioethics, biomedical case consultation, and public policy work.

Intro McMillan 2008: What is the relationship between missionary bioethics and philosophical bioethics?

Missionary bioethics: Exposes wrongdoing and advocates reforms (e.g., Beecher’s Ethics and Clinical Research exposing unethical research). Philosophical bioethics: Tests assumptions, explores counterintuitive ideas, and follows moral arguments wherever they lead (e.g., Harris’s Survival Lottery proposing organ lotteries). Both approaches are valid, but philosophical bioethics more often employs formal methods of reasoning, which McMillan addresses in Part III.

Intro McMillan 2008: What role does moral consequentialism play in public policy bioethics?

Moral consequentialism in public policy means considering the practical implications of advocating certain policies.

Example: A bioethicist might prefer a costly bowel cancer screening program with fewer false positives, but advocating for it could result in no program being funded. Instead, they may ethically argue for a cheaper, practical alternative to maximize overall benefit.

This shows that bioethicists must balance ideal ethical recommendations with realistic outcomes.

Intro McMillan 2008: How does McMillan view the role of empirical bioethics?

Empirical bioethics uses methods from disciplines like sociology to ground ethical analysis in real-world experiences. While empirical bioethics is useful, McMillan emphasizes that all bioethics—whether philosophical or empirical—should connect conceptual analysis with issues that matter practically.

Intro McMillan 2008: What distinguishes bioethics from medical ethics?

Medical ethics focuses on the roles, responsibilities, and duties of healthcare providers within professional settings. Bioethics is broader, addressing issues of public morality, such as environmental ethics and animal experimentation. McMillan accepts that bioethics includes medical ethics but argues for a broader, global scope.

Intro McMillan 2008: Provide a substantive schematization of McMillan’s argument in Chapter 1.

Motivation: McMillan critiques bioethics for overemphasizing moral theory and creating unnecessary fragmentation.
Core concept: Bioethics involves bringing moral reason to bear on practical ethical issues.
Adaptation of Battin: McMillan refines Battin’s three activities:
Theoretical reflection → Scholarly bioethics
Clinical consultation → Biomedical case consultation
Policy development → Incorporates moral consequentialism.
Moral reason: Defined as clarifying, testing, and reasoning through moral considerations to form justified conclusions.
Key distinctions: Bioethics is interdisciplinary, distinct from law, applied ethics, and medical ethics.

Spectrum of approaches: Includes missionary bioethics (advocacy) and philosophical bioethics (rigorous argumentation).

Conclusion: Bioethics must connect normative reasoning with practical engagement to address real-world ethical issues effectively. (best justified moral stance - bringing moral reason 2 bear

Persad, Wertheimer, Emanuel 2009: What are the key objections to the Complete Lives System, and how do the authors address them?

1. Discrimination against older people: Critics argue that age-based allocation is a form of ageism. The authors counter that treating people differently based on their age is not discriminatory because everyone progresses through life stages. Prioritizing younger individuals reflects the moral value of enabling people to live through all life stages. Importantly, they argue, it is worse for someone to die young having lived few years than for someone who has already lived many years.

2. Non-medical criterion objection: Age is sometimes viewed as an inappropriate, non-medical basis for allocation. The authors respond that a complete life is itself a health outcome. Long-term survival and delaying disease onset are central goals of healthcare.

3. Insensitivity to lifespan differences: Critics claim that prioritizing based on age ignores global disparities in lifespan. The authors acknowledge that implementation can differ across contexts but argue that the principle of prioritizing a "complete life" remains universally valid.

4. Balancing principles lexically: Some object that principles like saving the most lives or prognosis should take strict precedence over others. The authors reject strict lexical ordering in allocation systems, arguing that balancing multiple relevant principles reflects fairness better than rigid hierarchies.

5. System-wide implementation: Critics claim that applying the Complete Lives System broadly, rather than only in scarcity situations, is premature. The authors clarify that the system is designed specifically for persistently scarce life-saving interventions, such as organs or vaccines, where trade-offs are unavoidable.

Persad, Wertheimer, Emanuel 2009: How do the authors justify prioritizing younger individuals in the Complete Lives System?

The authors argue that younger individuals are the worst off because they have lived the fewest life-years and thus have the greatest potential to benefit from life-saving interventions. Unlike infants, adolescents and young adults have received substantial societal and personal investment, such as education, and have developed a personality capable of valuing long-term plans. This prioritization ensures that people have a chance to live through all life stages.

Persad, Wertheimer, Emanuel 2009: How does the Complete Lives System incorporate multiple ethical principles?

The Complete Lives System combines five principles:

Youngest-first: Prioritizes individuals who have lived fewer years. Prognosis: Considers life expectancy post-treatment to ensure interventions provide significant benefit.
Saving the most lives: A utilitarian principle that maximizes the number of people saved.
Lottery: Used to break ties between roughly equal candidates, ensuring fairness and resistance to corruption.
Instrumental value: Included only in public health emergencies to prioritize those whose survival benefits others (e.g., vaccine producers). By integrating these principles, the system balances fairness, efficiency, and ethical relevance while avoiding the flaws of single-principle approaches.

Persad, Wertheimer, Emanuel 2009: How does the Complete Lives System respond to concerns about corruption and fairness?

The Complete Lives System minimizes corruption and ensures fairness through clear and verifiable criteria. For example:

Age-based prioritization can be quickly established using official identity documents, reducing opportunities for fraud. Prognosis-based allocation incentivizes physicians to improve patients' health instead of manipulating health conditions, which happens under sickest-first allocation systems. Lotteries for tied candidates further reduce bias and ensure transparency. By incorporating multiple principles and clear implementation criteria, the system avoids the corruption and unfairness seen in approaches like first-come, first-served or UNOS points systems.

Persad, Wertheimer, Emanuel 2009: What is the central ethical challenge addressed in this paper?

The central ethical challenge is the just allocation of very scarce medical interventions, such as organs, vaccines, and intensive care beds.

Persad, Wertheimer, Emanuel 2009: What are the four categories of ethical principles for allocation of scarce medical resources?

The four categories are: (1) Treating people equally, (2) Favouring the worst-off (prioritarianism), (3) Maximizing total benefits (utilitarianism), and (4) Promoting and rewarding social usefulness.

Persad, Wertheimer, Emanuel 2009: How does the principle of treating people equally manifest in allocation systems?

Treating people equally manifests through allocation methods like lotteries (random selection) and first-come, first-served systems.

Persad, Wertheimer, Emanuel 2009: What are the advantages and disadvantages of using a lottery system for allocation?

Advantages: Lotteries are quick, resist corruption, and treat all individuals equally. Disadvantages: They are blind to relevant moral factors like prognosis or life-years saved.

Persad, Wertheimer, Emanuel 2009: Why do the authors reject the first-come, first-served principle?

First-come, first-served is rejected because it unfairly favors the wealthy, powerful, and well-connected, and can be corrupted by those who are better informed or able to wait longer.

Persad, Wertheimer, Emanuel 2009: What does the principle of "favouring the worst-off" prioritize, and how is it flawed?

It prioritizes those who are sickest (sickest-first) or youngest (youngest-first). Sickest-first ignores prognosis and is inherently flawed in persistent scarcity. Youngest-first, while prioritizing life-years, can undesirably favor infants over adolescents.

Persad, Wertheimer, Emanuel 2009: How does the principle of "saving the most lives" align with utilitarianism?

It aligns with utilitarianism by maximizing the number of lives saved without making comparative judgments about the quality or length of those lives.

Persad, Wertheimer, Emanuel 2009: What is the prognosis principle, and how does it differ from saving the most lives?

The prognosis principle aims to maximize life-years saved rather than just the number of lives. It considers post-treatment survival and life expectancy.

Persad, Wertheimer, Emanuel 2009: How do the authors view the principle of instrumental value?

Instrumental value prioritizes individuals who are essential to promoting other values, like saving lives during public health emergencies. It should be applied sparingly and only in public health crises.

Persad, Wertheimer, Emanuel 2009: What is the principle of reciprocity, and when is it appropriate?

Reciprocity rewards individuals who have made past contributions or sacrifices, such as organ donors or healthcare workers. It is appropriate only when individuals are irreplaceable and have made significant sacrifices.

Persad, Wertheimer, Emanuel 2009: What are the three existing allocation systems evaluated in the paper?

The three systems are: (1) UNOS points systems for organ allocation, (2) Quality-Adjusted Life Years (QALYs), and (3) Disability-Adjusted Life Years (DALYs).

Persad, Wertheimer, Emanuel 2009: What are the key criticisms of the UNOS points system for organ allocation?

The system includes flawed principles like first-come, first-served and sickest-first, is vulnerable to manipulation (e.g., multiple listings), and does not adequately prioritize prognosis or saving the most lives.

Persad, Wertheimer, Emanuel 2009: Why do the authors criticize QALY-based allocation systems?

QALY systems are criticized for disadvantaging disabled individuals, focusing on maximizing QALYs rather than treating people equally, and ignoring distributive justice considerations.

Persad, Wertheimer, Emanuel 2009: How does the DALY system differ from QALYs, and what issues does it have?

DALYs incorporate instrumental value and age-weighting, prioritizing economically productive individuals. It is criticized for treating life-years of older and disabled people as less valuable and for being distributively unjust.

Persad, Wertheimer, Emanuel 2009: What is the "Complete Lives System," and which principles does it incorporate?

The Complete Lives System incorporates five principles: youngest-first, prognosis, saving the most lives, lottery (for ties), and instrumental value (only in public health emergencies).

Persad, Wertheimer, Emanuel 2009: Why does the Complete Lives System prioritize younger individuals?

It prioritizes younger individuals because they have had the fewest life-years and the greatest potential to live a "complete life." Adolescents and young adults are prioritized over infants due to investments already made in their education and development.

Persad, Wertheimer, Emanuel 2009: How does the Complete Lives System address concerns of corruption and fairness?

It is resistant to corruption because age and prognosis are easily verifiable. It also balances multiple principles, ensuring fair consideration of morally relevant factors.

Persad, Wertheimer, Emanuel 2009: How do the authors respond to the claim that age-based allocation is discriminatory?

They argue that age-based allocation is not discriminatory because everyone progresses through the same life stages. Treating older individuals differently acknowledges that they have already lived more life-years.

Persad, Wertheimer, Emanuel 2009: What makes the Complete Lives System superior to existing allocation systems?

It incorporates the largest number of morally relevant principles (e.g., youngest-first, prognosis, saving lives), avoids the flaws of first-come, first-served or sickest-first, and ensures a fair distribution of life-saving interventions.

Persad, Wertheimer, Emanuel 2009: What role does legitimacy play in just allocation systems?

Legitimacy requires that allocation systems be publicly understandable, accessible, open to discussion, and resistant to corruption. Fair procedures alone cannot ensure justice

morally relevant values must also be incorporated.

Daniels and Sabin 1997: What is the central problem addressed by the paper?

The paper addresses the legitimacy problem in healthcare limit-setting. It asks why patients or clinicians should accept as legitimate the decisions of private institutions (like MCOs) that limit access to beneficial treatments, particularly when these decisions affect fundamental well-being.

Daniels and Sabin 1997: How is the fairness problem distinguished from the legitimacy problem?

The fairness problem asks whether patients or clinicians have sufficient reason to accept limit-setting decisions as fair. While legitimacy concerns authority over decisions, fairness examines the justifiability of the reasons behind them. A decision can be legitimate but unfair, and vice versa.

Daniels and Sabin 1997: Why does the “car purchase analogy” fail as an argument for legitimizing limit-setting decisions?

The car purchase analogy claims that market choices confer legitimacy on limit-setting decisions, as with purchasing cars. Daniels and Sabin argue it fails because:

Uncertainty in healthcare needs far exceeds that in car purchasing. Employer-driven choices mean consumers don’t directly choose their plans. Justice and social obligation: Society has an obligation to meet healthcare needs but no such obligation exists for cars.

Daniels and Sabin 1997: How do the authors justify society’s obligation to meet healthcare needs?

Society has a duty to ensure fair equality of opportunity. Health care preserves normal functioning, which protects a person’s ability to pursue life opportunities. Disease and disability impair this ability, so access to healthcare is a matter of distributive justice.

Daniels and Sabin 1997: What are the four conditions the authors propose to address the legitimacy problem in limit-setting?

The four conditions are:

Publicly Accessible Rationales:
1 Decisions and reasons must be transparent to stakeholders.
2. Reasonable Rationale: Decisions must aim to provide “value for money” under resource constraints, using reasons relevant to all affected parties.
3. Mechanism for Challenge: There must be a way to challenge and revise decisions based on further evidence or arguments.
4 Regulation: Voluntary or public oversight must ensure these conditions are met.

Daniels and Sabin 1997: How does the concept of “case law” relate to public rationales?

Public rationales for limit-setting decisions create a pattern of case law. This promotes consistency by ensuring similar cases are treated similarly. Deviations require clear, justified reasoning, which improves the quality and fairness of decision-making over time.

Daniels and Sabin 1997: How do the authors address objections to public decision-making processes?

Critics argue public decision-making is infeasible or morally problematic due to its visibility. Daniels and Sabin respond:

Feasibility: Non-public methods fail because distrust and litigation undermine decisions. Publicity, though untested, is more promising. Moral costs: Non-public methods erode public trust and fairness. Public decision-making preserves legitimacy and the social fabric, even if some outcomes are controversial.

Daniels and Sabin 1997: What are the moral controversies in noncomparative and comparative coverage decisions?

Noncomparative decisions, such as last-chance therapies, involve disagreements about prioritizing individual autonomy versus conserving resources. Comparative decisions, like Oregon’s prioritization system, face deeper moral dilemmas (e.g., “fair chances vs. best outcomes”) where reasonable people may disagree about the principles governing resource allocation.

Daniels and Sabin 1997: How do the authors propose solving moral disagreements in healthcare limit-setting?

The authors propose fair procedures rather than relying solely on abstract moral principles. Since moral consensus is unlikely, fair procedures (e.g., public rationales, challenges, and oversight) provide a practical way to resolve disputes while respecting diverse moral commitments.

Daniels and Sabin 1997: Provide a detailed schematization of the argument presented in the paper.

1. Introduction: The shift of authority in limit-setting from patients to private MCOs raises legitimacy and fairness problems in healthcare decisions.

2. Market and Justice Limitations:

Market-based solutions (e.g., consumer choice) fail because of uncertainty, lack of choice in employer-based plans, and society’s obligation to meet healthcare needs. Justice requires that healthcare protect fair equality of opportunity.
3. Moral Controversy: Noncomparative decisions (e.g., last-chance therapies) involve disagreements about autonomy vs. resource conservation. Comparative decisions (e.g., prioritization systems) raise unresolved moral problems like priorities (worst-off vs. best outcome).
4. Fair Procedures: The authors propose four conditions for legitimate and fair decision-making: Public rationales ensure transparency. Reasonable reasons align with principles all can accept. Challenge mechanisms allow revisions based on evidence. Oversight ensures accountability.
5. Case-Law and Deliberative Democracy: Over time, public rationales establish coherent “case law,” promoting consistency, fairness, and trust in MCOs as legitimate authorities.
Conclusion: Fair procedures connect private healthcare decisions to broader public deliberation, addressing the legitimacy problem while enhancing justice in healthcare limit-setting.

Daniels and Sabin 1997: What role does “deliberative democracy” play in their solution?

Deliberative democracy emphasizes reasoned discussion to resolve disagreements. Daniels and Sabin extend this idea to private institutions, arguing that fair procedures (e.g., public rationales and challenges) empower broader democratic deliberation about healthcare resource allocation.

Daniels and Sabin 1997: What is the legitimacy problem faced by managed care organizations (MCOs) when setting limits on health care?

The legitimacy problem refers to why, and under what conditions, authority over morally controversial limit-setting decisions, which fundamentally affect patient well-being, should be placed in the hands of private organizations like MCOs. These decisions involve distributive justice and must be viewed as legitimate and fair. ]

Daniels and Sabin 1997: What is the fairness problem in limit-setting decisions by MCOs?

The fairness problem asks under what circumstances patients or clinicians can accept limit-setting decisions as fair. For example, decisions that deny a treatment because of economic interests (e.g., CEO salaries or investor returns) are unfair, whereas decisions prioritizing proven, effective treatments are more plausibly fair. ]

Daniels and Sabin 1997: How does the “car purchase analogy” attempt to justify MCO decisions?

The car purchase analogy claims that there is no legitimacy problem because consumers “consent” to health care plans by purchasing them, just as they buy cars with specific features. This analogy assumes that the market resolves fairness and legitimacy concerns. ]

Daniels and Sabin 1997: Why do Daniels and Sabin reject the car purchase analogy for MCO decisions?

The analogy fails because: (1) uncertainty about health care needs is much greater than car purchases

(2) most Americans receive insurance through employers and cannot “shop around”

(3) society has a moral obligation to meet health care needs, unlike car purchases. ]

Daniels and Sabin 1997: How do the authors relate the legitimacy and fairness problems to distributive justice?

Since limit-setting decisions impact well-being, they inherently involve distributive justice. Justice requires that these decisions be fair, publicly accountable, and justified with reasons that can be accepted by all reasonable parties involved. ]

Daniels and Sabin 1997: What are the four key conditions that MCOs must meet to solve the legitimacy and fairness problems?

1. Publicity: Coverage decisions and rationales must be publicly accessible
   Relevance Condition: Rationales must provide "value for money."

2. Appeals Condition: Dispute mechanisms must be in place.

3. Enforcement Condition: Oversight must ensure the process is followed

2. Relevance: Rationales must aim to provide a reasonable approach to meeting health needs under resource constraints

Daniels and Sabin 1997: What are the four key conditions that MCOs must meet to solve the legitimacy and fairness problems? relevance

3. Appeals: There must be a mechanism for challenging and revising decisions

Daniels and Sabin 1997: What are the four key conditions that MCOs must meet to solve the legitimacy and fairness problems? appeals

4. Regulation: There must be public or voluntary regulation to ensure the process meets conditions 1-3. ]

regulation Daniels and Sabin 1997: What are the four key conditions that MCOs must meet to solve the legitimacy and fairness problems?

Daniels and Sabin 1997: How does Condition 1 (Publicity) contribute to fairness in decision-making?

Publicly accessible rationales ensure transparency, allow for scrutiny, and help create consistency across cases. Over time, this “case law” builds coherence, improves fairness, and enhances public trust in decision-making processes. ]

Daniels and Sabin 1997: What is the importance of Condition 2 (Relevance) in MCO decision-making?

Condition 2 constrains the types of reasons that can justify limit-setting decisions. Reasons must focus on meeting health needs under reasonable resource constraints and must be recognized as appropriate and relevant by all reasonable parties involved. ]

Daniels and Sabin 1997: How do the authors distinguish between reasonable and unreasonable reasons in limit-setting decisions?

A reasonable reason is one that all can consider relevant to meeting health needs, such as cost-effectiveness or prioritization based on medical need. Unreasonable reasons include those based on religious faith or competitive business considerations that cannot be publicly justified. ]

Daniels and Sabin 1997: Why is Condition 3 (Appeals) necessary for addressing fairness concerns in MCOs?

Condition 3 ensures that affected parties have mechanisms to challenge decisions, enabling broader deliberation. It allows for feedback, reconsideration of decisions, and strengthens trust by making decision-making more responsive to reasonable concerns. ]

Daniels and Sabin 1997: How can Condition 4 (Regulation) be implemented in practice?

Condition 4 can be met through voluntary self-regulation (e.g., National Committee on Quality Assurance guidelines) or public regulation by legislatures. It ensures MCO accountability and connects their practices to broader public deliberation about fairness in health care. ]

Daniels and Sabin 1997: What role does democratic deliberation play in their proposed solution?

The authors argue that the constraints on reasoning (Condition 2) are analogous to democratic deliberation, where reasons must be publicly justifiable to all reasonable parties. Even without direct public participation, fair procedures enhance legitimacy by aligning MCO decisions with deliberative democratic principles. ]

Daniels and Sabin 1997: Why do MCOs resist using cost-effectiveness as an explicit reason for limit-setting decisions?

MCOs fear being labeled as “rationers” and facing public backlash or litigation. While cost-effectiveness is a reasonable justification, it remains controversial, especially when decisions appear to place a monetary value on life or deny expensive treatments with marginal benefits. ]

Daniels and Sabin 1997: Provide a substantive schematization of the paper, including its argument buildup, stance, counter-arguments, and replies.

Buildup: The authors address the growing authority of private MCOs in limit-setting decisions, which raises legitimacy and fairness concerns. They identify three inadequate solutions:
(1) market-based consent, (doesn’t work because of public good element of healthcare)
(2) reliance on philosophical principles, (doesn’t work because multiple reasonable conceptions of the good)
and
(3) purely procedural democratic approaches.

Stance: The authors propose four conditions to address these concerns: publicity,
relevance of reasons,
appeals mechanisms, and
regulation.

Counter-arguments: Critics fear that public reasoning increases litigation risks, or they argue that competitive business justifications suffice. Replies: The authors contend that reason-giving enhances trust, reduces arbitrary decisions, and strengthens fairness. Business-focused justifications lack broad public acceptability and exacerbate distrust. Ultimately, their solution connects private MCO deliberations to a larger democratic process, ensuring both fairness and legitimacy. ]

Daniels and Sabin 1997: How do public systems like the British NHS face similar legitimacy and fairness problems?

Public systems also face challenges in justifying limit-setting decisions, as abstract principles articulated by commissions often fail to address specific cases. The absence of explicit, reason-based processes undermines trust and accountability, similar to the issues in private systems. ]

Glover 2019: What is the central argument of Jacqueline Glover’s paper?

Glover argues that physicians’ advocacy obligations extend beyond individual patients (“individualistic view”) to include intelligent, research-based allocation schemes promoting good outcomes and cost-effective care for all patients (“systemic view”). Physicians should participate in systemic allocation decisions, policy formation, and public discussions to advance healthcare justice.

Glover 2019: What are the two opposing views of physicians' advocacy obligations?

Battisti and Camporesi 2023: What is the aim of the paper?

The paper aims to propose five formal fairness requirements for triage in Emergency Departments (EDs)—publicity, accessibility, relevance, standardisability, and accountability—and map out the conceptual and empirical research questions that must be addressed for fair and legitimate ED triage.

Battisti and Camporesi 2023: Why do the authors focus on triage in EDs?

The authors focus on ED triage because it highlights explicit ethical questions about resource allocation, has been underexplored in ordinary times (outside of disaster ethics), and shows increasing pressure post-pandemic with rising admissions and wait times.

Battisti and Camporesi 2023: What are the two main fairness issues in ED triage?

The two main fairness issues are substantive fairness (what criteria should be used?) and formal fairness (how and by whom should these criteria be chosen?).

Battisti and Camporesi 2023: What is the ‘sickest first’ criterion, and how is it justified?

The ‘sickest first’ criterion prioritizes patients in the most urgent need. It is justified by utilitarianism (maximizing aggregate well-being), fair equality of opportunity (Rawls’ principles), and prioritarianism (benefiting those worse off).

Battisti and Camporesi 2023: What is the publicity requirement for ED triage?

Publicity requires transparency about triage criteria and the rationale for decisions, ensuring the public understands how allocation choices are made and the value judgments underpinning them.

Battisti and Camporesi 2023: How does accessibility relate to formal fairness?

Accessibility ensures that triage information, while public, is also easy to understand and access for laypersons, for example through posters, brochures, or digital formats.

Battisti and Camporesi 2023: What does the relevance condition require?

Relevance ensures that triage criteria are supported by scientific evidence and moral reasoning that can be accepted by fair-minded individuals. It acknowledges there may be multiple justifiable approaches.

Battisti and Camporesi 2023: What is standardisability, and why is it important?

Standardisability means having a consistent triage method across hospitals to ensure similar cases are treated similarly. It prevents arbitrary decision-making and promotes fairness.

Battisti and Camporesi 2023: What is the accountability requirement for ED triage?

Accountability involves defining who is responsible for triage decisions, ensuring transparency in processes, and holding decision-makers answerable to patients and the healthcare system.

Battisti and Camporesi 2023: What are the conceptual and empirical research questions outlined in the paper?

The authors propose six research questions focusing on transparency, accessibility, moral justification, standardisation, context-specific differences, and the appropriate accountability model for ED triage.

Battisti and Camporesi 2023: What overarching argument do the authors make?

The authors argue that formal fairness in ED triage—ensuring transparency, accessibility, relevance, standardisability, and accountability—is crucial for legitimacy and fairness. While the ‘sickest first’ principle is widely accepted, meeting formal fairness criteria prevents ethical concerns around arbitrary decision-making. They emphasize the need for both conceptual and empirical research to evaluate how well these conditions are satisfied in national healthcare systems. This ensures public trust and legitimacy in ordinary and crisis contexts.

Battisti 2022: What is the central focus of the paper?

The paper explores whether procreative intentions and attitudes play a moral role in defining procreative responsibilities concerning current and future assisted reproductive technologies like PGD, reproductive genome editing (rGE), and ectogenesis, in a way compatible with person-affecting morality