Distributive Justice

Whart is the definition of justice?

respect broader rights, norms, and groups

In what situations is justice used in healthcare rationing in Bioethics?

• healthcare spending

• distributing finite resources (organs, interventions)

What was the God Committee?

• 1961

• committee of the Seattle Artificial Kidney Center tasked with rationing renal dialysis

• composed of several commmunity members

• social worth criteria included merits of individuals (like past achievements)

• disbanded once the technology became more available in part due to government intervention

• in 1971, US congress approved the End-Stage renal disease (ESRD) supplement to Medicare

How would Kant vs. Mill answer the quentsion, “Are all human lives equal?”

Kant: all lives count equally

Mill: longer, happier, more consequential lives count more

What are the principles of healthcare rationing?

• help the most deserving

• helth those with greeatest social utility

• help the most at risk

• help those most likely to benefit

• help those needing interventions supported by the best evidence

What is evidence based rationing?

• good evidence should guide healthcare rationing

• what is good evidence and how should it be weighed with other principles for rationing?

• (editorials, expert opinion)→ mechanistic studies→ (case reports, case studies)→ (cross-sectional studies, surveys)→ (case-control studies)→ (cohort studies)→ randomised controlled trials→ (systematic reviews and meta-analyses of RCTs) (chain of low quality evidence to higher quality of evidence)

What is welfare maximization?

• identifying the difference between quality of life versus quantity of life

• prolong life or palliate suffering?

• QALY: quality adjusted life year

What is Rose’s ‘high risk’ vs. ‘population’ strategies?

• 1985

• treating more people at low risk will often save more lives than trating fewer people at high risk

• High risk strategy: treate those at high-risk (higher percentage of ppl saved but lower number)

• populations strategy: treat the population (or those at low risk too) (lower perecntage of ppl saved but higher number)

What matters: the average or the distribution in realtion to population vs. hidh-risk strategies?

Population strategy: the average

High-risk: the distribution

What strategy is favored by utilitarian Justice?

• utility principle: net happiness is morally relevant

• favor population strategy

What is Rawl’s Theory of Justice?

• Kantian contractarianism

• considered from the original positions: viel of ignorance

  • Principle of liberty: same freedoms for all

  • principles of equal opportunity: same opportunities for all

  • difference principle: no unequal distribution of goods, except to improve the lot of the worst off (maximize welfare of the minimally well)

What are the components of Rawlsian justice?

• equal opportunity and difference principles

• favor high-risk strategy

What is the Rule of rescue? Why might the rule be right?

• we are most justified in rescuing an identifiable individual at high risk of serious harm, even at the expense fo greater net harm to others

• might be right because we can identify the individual in need of rescue and because the individual in need of resscue is at hihgh risk of serious harm?

What is the Pitt framework for rationing Critical Care resources?

• Ethical goals: saving lives, and promoting equitable access to scare resources

• efficeint-focused considerations:

  • likelihood of survviving to hospital discharge, asses with an objective risk predictor

  • near-term prognosis, assessed as the rpesence of end-stage illness such that the patient is expected to die within a year even if they survuved the acute critical illness

• Equity-focused considerations:

  • disallowing consideration of long-term life expectancy, percieve quality of life or social worth, rejuecting categoricla exlcusion fo any patients groups

  • heightened priority to frontline essential workers

  • correction factor to lessen the extent to which severe structural inequities disadvantege already-disadvantaged patients in triage

  • heightened priority to the young, who are the worst off in the sense that is they die, they will have had the least opportunity to live through life’s stages

What parts of the Pitt framework for rationing Critical Care resources are utilitarian, rawlsian, or kantian?

1,2,4 are utilitarian

3-6 are kantian/rawlsiean or contractarian

4,5, are also relevant for corrective justice

What are the foundational ethical principles?

• maximum benefit

  • the obligation to protect and promote the publics health and its socioeconmoic well-being in the short and long term

• equal concern

  • the obligation to consider and treat every person as having equal dignity, worth, adn value

• mitigation of health inequities

  • the obligation to explicitly address the higher burden of COVID-19 experienced by the populations affected most heavily, given thiernexposure and compounding health inequities

Foundational procederal principles:

• fairness

  • decision should incorporate input from affected groups, especially those disproportionately affected by the pandemic once informed by public input, decision should be data-driven adn made by impartial decision makers, such as public health officials

• transparency

  • the obligation to communicate with the public openly, accurately and stright-forwardly about vaccine allocation criteria and framework, as they are being developed and deployed

• evidence-based

  • vaccination phases, specifying who recieves the vaccination when, should be based on the best available scientific evidence, regarding risk of disease, transmission, adn societal impact

Which of the foundational ethical and procedural principles match theoretical principles like utilitarianism, rawlsian, kantiant, etc.

• maximum benefit: utility principle

• equal concern: kantian respect for persons

• mitigation of health inequities: rawlsian difference principle and possibly also Rawlsian principle of equal opportunity

• fairness, transparency: democratic principles

• evidence-based: principles of evidence-based medicine