Justice Transcript Notes
Justice
Justice is a concept familiar from a young age, often expressed as 'fairness'.
Fairness implies equal treatment unless differences justify unequal treatment.
Examples range from sharing treats to basic human rights.
Different spheres of justice include:
Criminal justice: fairness in defining, addressing, and punishing crimes.
Civil justice: arbitration in disputes (finance, property, contracts).
Social justice: balance between individual rights and overall societal welfare.
Distributive justice: fair allocation of societal burdens and benefits.
Focus of chapter: social and distributive justice in bioethics.
Dilemmas of public health ethics, balancing societal good and individual freedom.
Key issues in distributive justice: access to healthcare, global health inequities, global survival.
Public Health Ethics
Rooted in 19th-century England during cholera outbreaks.
John Snow's discovery: cholera spread through contaminated water, not 'bad air'.
Stopped the spread by removing the Broad Street pump handle.
Public health ethics involves:
Scientific study of disease patterns (epidemiology).
Decisive social action.
Ethical aspects of policies preventing disease and promoting health.
Potential restrictions on individual freedom for public good.
Examples in health policies:
Preventive medicine: measures to prevent/control disease.
Health promotion: encouraging healthier lifestyles through persuasion, education, legislation.
Preventive Medicine
Measures to prevent or control disease spread:
Screening.
Vaccination and immunization.
Compulsory disease notification and movement controls for infected people.
Screening
Administering tests to detect existing or potential diseases.
Done prenatally (Down syndrome), postnatally (PKU), or in young people/adults (STIs, cancer susceptibility).
Ethical concerns:
Test accuracy.
Whether tests are optional or mandatory.
PKU screening is often compulsory due to effective dietary treatment.
Inaccurate tests (false positives/negatives) raise ethical issues about mandatory screening.
Optional screening is preferred, with full information on prediction strength and potential actions.
Vaccination and Immunization
Vaccines contain dead/weakened germs, triggering antibody production.
Immunization: body develops immunity via vaccination or contracting/recovering from the disease.
Vaccination reduces infectious diseases, especially in wealthier nations.
Widespread vaccination leads to 'herd immunity', lowering infection risk for all.
Ethical issue: mandatory vs. voluntary vaccination policies (MMR vaccine example).
Conflict: individual choice vs. community benefit.
'Free riders' rely on herd immunity without vaccinating, which lacks social conscience and compromises herd immunity if widely adopted.
Most countries use indirect methods to encourage vaccination (e.g., school entry requirements).
Pandemic Controls
Pandemics necessitate restrictions on individual liberty.
Moderate controls: temperature screening, travel refusal.
Extreme controls: isolating infectious individuals via quarantine or special facilities.
Mandatory reporting by healthcare practitioners (breaching confidentiality).
Preventive medicine illustrates limits of individual autonomy as the sole bioethical norm.
Potential harm to others justifies compulsory measures.
Dilemma: determining the threshold of harm likelihood and justified restriction degree.
Proportionality between harm and benefit must be maintained to avoid unfair restrictions due to panic.
Health Promotion
Tension between freedom and control.
Extreme coercion example: China's 'one-child' policy.
Reduced population growth but caused gender imbalance, forced abortions/sterilizations, infanticide.
Coercive measures in more liberal countries: seat belt and helmet laws.
Effective in reducing traffic accident injuries and healthcare costs.
Advertising techniques to warn of health risks (e.g., Australian 'grim reaper' ads, graphic images on cigarette packets).
Seek to change behavior using persuasive methods similar to those used to sell products.
Raises questions about informed, rational decision-making.
Health education relies on factual evidence and rational arguments (e.g., diet information, food labeling).
Advertising techniques apply 'nudge theory'.
'Nudges' are positive reinforcements/indirect suggestions influencing decisions without removing options/altering economic incentives.
Example: eye-level placement of healthy foods.
Social justice requires persuading/compelling people for the common good.
Prioritizing liberty requires a civil society committed to the welfare of all (communitarian approach).
Achieving this may require using advertising or law to maximize public good.
Fair Access and the Paradox of Health Care
Focus shifts to distributive justice: ensuring a fair share of good for all.
Discrimination in healthcare access (gender, ethnicity, etc.) is unjust unless justified.
Fairness can mean treating people unequally based on relevant differences.
Aristotle: treat equals equally, unequals unequally.
Equitable treatment: proportionate to relevant differences.
Examples of relevant differences: age, inherited disabilities, catastrophic events.
Distributive justice: addressing needs and improving capacities.
Defining health is challenging.
WHO definition: complete physical, mental, and social well-being.
Criticized as idealistic but emphasizes social/physical conditions.
Fair treatment means providing equal access and fostering a supportive environment.
Paradox of health care: success leads to rising demand and costs.
Factors:
Ability to extend life expectancy.
Increased expectations.
Chronic diseases requiring long-term care.
Aging population with cognitive impairments.
'Diseases of affluence' (diabetes, heart disease) linked to obesity.
Effective healthcare can lead to discontent and unhealthy behaviors (alcohol/drug abuse, smoking).
Determining Fair Shares
Demand for healthcare always exceeds supply.
Resource distribution at three levels:
Macro-allocation: national financial resources devoted to health.
Meso-allocation: distribution among services/patient groups.
Micro-allocation: who gets treatment when resources are limited ('healthcare rationing').
What Price Health?
Vast diversity in GDP percentage spent on healthcare globally.
USA spends the most (18%) but has poorer health outcomes than countries with lower spending.
Equitable health outcomes not achieved through higher spending alone.
Factors:
Fairness and efficiency of distribution.
Lack of universal healthcare leads to delayed care and poorer outcomes.
Reimbursement systems incentivize unnecessary tests and over-treatment.
Over-provision of MRI scanners and unnecessary surgeries.
Health status depends on social factors: poverty, housing, diet, employment, education.
Health problems and shorter life expectancy linked to social deprivation.
Achieving good health requires addressing welfare, housing, education, and income distribution.
The Inverse Care Law
Effectiveness depends on distribution between groups and services.
Parable of the village on the cliff edge: invest in a fence at the top rather than ambulance at the bottom.
Acute medical care absorbs a large proportion of the budget.
Prevention is harder to achieve than crisis intervention.
Altering behaviors (e.g., drinking habits) is slow and patchy.
'Shroud waving' makes it politically impossible to curb spending in the acute sector.
Leads to unfair resource distribution, prioritizing rescue medicine over prevention.
Commercial interests behind health-hazardous products impede prevention efforts.
Struggle between disease-prevention and commercial interests (e.g., restrictions on cigarette packaging).
Difficulties in comparing needs of different patient groups (e.g., dementia care vs. cancer treatment).
Tudor Hart's 'inverse care law': availability of good medical care varies inversely with the need of the population served.
'Post code rationing': unfairness of unequal needs being met due to location.
Healthcare practitioners prefer socially desirable areas.
Deprived individuals may lack trust in professional helpers.
Justice must consider both need and capacity to benefit.
Death by Numbers - Rationing Health Care
Micro-level problem: choosing who receives treatment when resources are limited.
Garage analogy: good, quick, or cheap - choose any two, not all three.
Examples of rationing dilemmas:
Kidney transplants.
Hip/cataract operations.
Dementia medication.
Long-term care placement.
Intensive care unit admissions.
Publicly funded provision often employs the 'cheap and good, but not quick' option (waiting lists).
Raises ethical problems:
Queue jumping.
Criteria for wait length.
Risk of 'death by numbers'.
Queue Jumping
Wealthier people can purchase quicker access, which is unjust.
Wealth should not grant a greater right to life and health.
Health is not a commodity.
Ability to benefit is a morally relevant difference, while ability to pay is not.
Who Comes First?
Scenario with three potential kidney recipients: young man, mother, older man.
QALYs (Quality Adjusted Life Years) calculation favors the young man.
But is QALY-based rationing fair?
Considers entitlement to treatment in terms of the ability to benefit, discriminating against the older man.
Who Shall Live?
'Death by numbers': QALY calculation determines treatment.
Should older, non-compliant patients be denied a second chance?
Is it right to prioritize the young, single man over the mother?
Ability to benefit may not be the only relevant criterion.
An Interlude - Two Exercises
Need for a sophisticated account of justice.
Scenario One: The Birthday Cake
Five children sharing a cake.
Possible solutions:
Equal shares.
Procedural solutions (parent cuts, 'one cuts/others choose').
Role-related solutions (host distributes, birthday child distributes).
Individual choice.
Sharing/gratitude type solutions.
Illustrates principles of justice:
Equality: if no special needs/claims, equal shares/individual choices are fair.
Luxury, not necessity, reduces disadvantage.
Procedural/role-related solutions based on equality/impartiality.
Gratitude and sharing reflect communal values.
Scenario Two: The Lifeboat
Six people, limited rations, nearest land is 10 days away.
Utilitarian assumes maximizing survival: prioritize physically fit young men to row the boat.
Old lady and baby should not be using up supplies.
Young woman will need to abandon her baby.
Alternative approach of voluntary principle.
A different solution is to reject assumption that Survival is all that matters.
Value of each should be ranked equally.
Principles for Just Healthcare
Principles that might be used to decide how to allocate fairly:
To each an equal share.
To each according to individual choice.
To each according to potential for future life years.
To each according to what they deserve.
To each according to their social usefulness.
To each according to their needs.
Problems with some principles:
Equal shares not fair in situations of necessity.
Individual choices may not be fair to everyone.
Life-years ahead is unacceptable ageist discrimination if imposed.
Utility and needs/rights are the main problems.
Utilitarian theory: social benefit is final arbiter.
Individual will need to be subordinated to the welfare of the majority.
If followed correctly this has serious consequences.
Deontologically based theory: sees every human being as equally deserving of consideration and respect, and so everyone should have equal access to services that meet their health needs.
The most influential has been that of the political philosopher John Rawls.
Rawls (1973) defines the fundamental principles of justice as follows:
First principle
Each person is to have an equal right to the most extensive total system of equal basic liberties compatible with a similar system of liberty for all.
Second principle
Social and economic inequalities are to be arranged so that they are both:(1) to the greatest benefit of the least advantaged… and (2) attached to offices and positions open to all under conditions of fair equality of opportunity.
(p. 302)
Rawls does not believe that justice requires that everyone have an equal share of social or economic resources.
Health status come into this theory via Norman Daniels.
They have a right to health care interventions that will allow them to pursue the 'normal opportunity range' for their society.
These accounts make the definition of health relative to a person's specific society, or to personal awareness of what make them happy.
Global Inequity in Health
Grim picture of health inequalities globally.
Child born in Swaziland likely to die nearly 30 times more than a child born in Sweden.
Most deaths are from communicable diseases and occur in the low-income countries.
Social injustice is killing people on a grand scale.
WHO report points out that factors:
Lack of access to Health Care.
Report urges action in the countries of poor health outcomes.
Improve daily living conditions.
Tackle the inequitable distribution of power,money and resources.
Measure and understand the problem and assess the impact of possible actions to deal with it.
Move from a 'right to health care' to a 'right to health'.
The Capability to Be Healthy (CH) Theory
Alternative to those theories is one with a universal right to health based on an understanding of the equal worth and dignity of every human being.
What is every human being morally entitled to in terms of their health status?
This involves considerations for:
Biological endowments and needs.
Individual behaviours.
Physical environment.
Social conditions.
Health injustice occurs when the social and physical environment fail to provide people in their capacity to be healthy.
Nussbaum suggests a list of attainable human capabilities that we should see as normative, they are:
Being able to live a normal length of lifespan.
Having good health.
Maintain bodily integrity.
Being able to use senses, imagination and think.
Having emotions and emotional attachments.
Possess practical reason to form a conception of the good.
Have social affiliations that are meaningful and respectful.
Express concern for other species.
Be able to play.
Have control over one's material and political environment.
(Nussbaum, 2006, pp. 76-77)
Global Survival
Even greater threat faces our generation species itself.
Bioethics overlaps with environmental ethics.
Human life will be unsustainable if we continue to use resources as we do at present.
Two major and interrelated aspects to this threat to human survival: global warming and population expansion.
The failure to control greenhouse gas emissions in the major industrialized countries has a direct effect on the health and, eventually, the survival of those in the poorest parts of the world.
The depletion of the world's resources overall by current population trends and patterns of consumption.
That the most significant of all bioethical issues that we have to confront at the present time is not concerned with the dilemmas of health care or with the confusing range of choices that new medical technologies raise from birth to death.
The Royal Society's report makes it clear that this can happen only if governments throughout the world take decisive action now.
It is of the utmost urgency to reduce consumption and emissions that are already causing damage, for example greenhouse gases, deforestation, and land use change amongst others.
Furthermore, unless the goal is a world in which extreme inequality persists, it is necessary to make space for those in poverty, especially the 1.3 billion people living in absolute poverty, to achieve an adequate standard of living.
Longer-term, the stabilization of the population is essential to avoid further exceeding planetary limits and increasing poverty. This will mean more effective (but not compulsory) use of contraception in countries with high fertility rates.
(Royal Society of London, 2012, pp. 99–101)
Justice
Justice is a concept familiar from a young age, often expressed as 'fairness'.
Fairness implies equal treatment unless differences justify unequal treatment.
Examples range from sharing treats to basic human rights.
Different spheres of justice include:
Criminal justice: fairness in defining, addressing, and punishing crimes.
Civil justice: arbitration in disputes (finance, property, contracts).
Social justice: balance between individual rights and overall societal welfare.
Distributive justice: fair allocation of societal burdens and benefits.
Focus of chapter: social and distributive justice in bioethics.
Dilemmas of public health ethics, balancing societal good and individual freedom.
Key issues in distributive justice: access to healthcare, global health inequities, global survival.
Public Health Ethics
Rooted in 19th-century England during cholera outbreaks.
John Snow's discovery: cholera spread through contaminated water, not 'bad air'.
Stopped the spread by removing the Broad Street pump handle.
Public health ethics involves:
Scientific study of disease patterns (epidemiology).
Decisive social action.
Ethical aspects of policies preventing disease and promoting health.
Potential restrictions on individual freedom for public good.
Examples in health policies:
Preventive medicine: measures to prevent/control disease.
Health promotion: encouraging healthier lifestyles through persuasion, education, legislation.
Preventive Medicine
Measures to prevent or control disease spread:
Screening.
Vaccination and immunization.
Compulsory disease notification and movement controls for infected people.
Screening
Administering tests to detect existing or potential diseases.
Done prenatally (Down syndrome), postnatally (PKU), or in young people/adults (STIs, cancer susceptibility).
Ethical concerns:
Test accuracy.
Whether tests are optional or mandatory.
PKU screening is often compulsory due to effective dietary treatment.
Inaccurate tests (false positives/negatives) raise ethical issues about mandatory screening.
Optional screening is preferred, with full information on prediction strength and potential actions.
Vaccination and Immunization
Vaccines contain dead/weakened germs, triggering antibody production.
Immunization: body develops immunity via vaccination or contracting/recovering from the disease.
Vaccination reduces infectious diseases, especially in wealthier nations.
Widespread vaccination leads to 'herd immunity', lowering infection risk for all.
Ethical issue: mandatory vs. voluntary vaccination policies (MMR vaccine example).
Conflict: individual choice vs. community benefit.
'Free riders' rely on herd immunity without vaccinating, which lacks social conscience and compromises herd immunity if widely adopted.
Most countries use indirect methods to encourage vaccination (e.g., school entry requirements).
Pandemic Controls
Pandemics necessitate restrictions on individual liberty.
Moderate controls: temperature screening, travel refusal.
Extreme controls: isolating infectious individuals via quarantine or special facilities.
Mandatory reporting by healthcare practitioners (breaching confidentiality).
Preventive medicine illustrates limits of individual autonomy as the sole bioethical norm.
Potential harm to others justifies compulsory measures.
Dilemma: determining the threshold of harm likelihood and justified restriction degree.
Proportionality between harm and benefit must be maintained to avoid unfair restrictions due to panic.
Health Promotion
Tension between freedom and control.
Extreme coercion example: China's 'one-child' policy.
Reduced population growth but caused gender imbalance, forced abortions/sterilizations, infanticide.
Coercive measures in more liberal countries: seat belt and helmet laws.
Effective in reducing traffic accident injuries and healthcare costs.
Advertising techniques to warn of health risks (e.g., Australian 'grim reaper' ads, graphic images on cigarette packets).
Seek to change behavior using persuasive methods similar to those used to sell products.
Raises questions about informed, rational decision-making.
Health education relies on factual evidence and rational arguments (e.g., diet information, food labeling).
Advertising techniques apply 'nudge theory'.
'Nudges' are positive reinforcements/indirect suggestions influencing decisions without removing options/altering economic incentives.
Example: eye-level placement of healthy foods.
Social justice requires persuading/compelling people for the common good.
Prioritizing liberty requires a civil society committed to the welfare of all (communitarian approach).
Achieving this may require using advertising or law to maximize public good.
Fair Access and the Paradox of Health Care
Focus shifts to distributive justice: ensuring a fair share of good for all.
Discrimination in healthcare access (gender, ethnicity, etc.) is unjust unless justified.
Fairness can mean treating people unequally based on relevant differences.
Aristotle: treat equals equally, unequals unequally.
Equitable treatment: proportionate to relevant differences.
Examples of relevant differences: age, inherited disabilities, catastrophic events.
Distributive justice: addressing needs and improving capacities.
Defining health is challenging.
WHO definition: complete physical, mental, and social well-being.
Criticized as idealistic but emphasizes social/physical conditions.
Fair treatment means providing equal access and fostering a supportive environment.
Paradox of health care: success leads to rising demand and costs.
Factors:
Ability to extend life expectancy.
Increased expectations.
Chronic diseases requiring long-term care.
Aging population with cognitive impairments.
'Diseases of affluence' (diabetes, heart disease) linked to obesity.
Effective healthcare can lead to discontent and unhealthy behaviors (alcohol/drug abuse, smoking).
Determining Fair Shares
Demand for healthcare always exceeds supply.
Resource distribution at three levels:
Macro-allocation: national financial resources devoted to health.
Meso-allocation: distribution among services/patient groups.
Micro-allocation: who gets treatment when resources are limited ('healthcare rationing').
What Price Health?
Vast diversity in GDP percentage spent on healthcare globally.
USA spends the most (18%) but has poorer health outcomes than countries with lower spending.
Equitable health outcomes not achieved through higher spending alone.
Factors:
Fairness and efficiency of distribution.
Lack of universal healthcare leads to delayed care and poorer outcomes.
Reimbursement systems incentivize unnecessary tests and over-treatment.
Over-provision of MRI scanners and unnecessary surgeries.
Health status depends on social factors: poverty, housing, diet, employment, education.
Health problems and shorter life expectancy linked to social deprivation.
Achieving good health requires addressing welfare, housing, education, and income distribution.
The Inverse Care Law
Effectiveness depends on distribution between groups and services.
Parable of the village on the cliff edge: invest in a fence at the top rather than ambulance at the bottom.
Acute medical care absorbs a large proportion of the budget.
Prevention is harder to achieve than crisis intervention.
Altering behaviors (e.g., drinking habits) is slow and patchy.
'Shroud waving' makes it politically impossible to curb spending in the acute sector.
Leads to unfair resource distribution, prioritizing rescue medicine over prevention.
Commercial interests behind health-hazardous products impede prevention efforts.
Struggle between disease-prevention and commercial interests (e.g., restrictions on cigarette packaging).
Difficulties in comparing needs of different patient groups (e.g., dementia care vs. cancer treatment).
Tudor Hart's 'inverse care law': availability of good medical care varies inversely with the need of the population served.
'Post code rationing': unfairness of unequal needs being met due to location.
Healthcare practitioners prefer socially desirable areas.
Deprived individuals may lack trust in professional helpers.
Justice must consider both need and capacity to benefit.
Death by Numbers - Rationing Health Care
Micro-level problem: choosing who receives treatment when resources are limited.
Garage analogy: good, quick, or cheap - choose any two, not all three.
Examples of rationing dilemmas:
Kidney transplants.
Hip/cataract operations.
Dementia medication.
Long-term care placement.
Intensive care unit admissions.
Publicly funded provision often employs the 'cheap and good, but not quick' option (waiting lists).
Raises ethical problems:
Queue jumping.
Criteria for wait length.
Risk of 'death by numbers'.
Queue Jumping
Wealthier people can purchase quicker access, which is unjust.
Wealth should not grant a greater right to life and health.
Health is not a commodity.
Ability to benefit is a morally relevant difference, while ability to pay is not.
Who Comes First?
Scenario with three potential kidney recipients: young man, mother, older man.
QALYs (Quality Adjusted Life Years) calculation favors the young man.
But is QALY-based rationing fair?
Considers entitlement to treatment in terms of the ability to benefit, discriminating against the older man.
Who Shall Live?
'Death by numbers': QALY calculation determines treatment.
Should older, non-compliant patients be denied a second chance?
Is it right to prioritize the young, single man over the mother?
Ability to benefit may not be the only relevant criterion.
An Interlude - Two Exercises
Need for a sophisticated account of justice.
Scenario One: The Birthday Cake
Five children sharing a cake.
Possible solutions:
Equal shares.
Procedural solutions (parent cuts, 'one cuts/others choose').
Role-related solutions (host distributes, birthday child distributes).
Individual choice.
Sharing/gratitude type solutions.
Illustrates principles of justice:
Equality: if no special needs/claims, equal shares/individual choices are fair.
Luxury, not necessity, reduces disadvantage.
Procedural/role-related solutions based on equality/impartiality.
Gratitude and sharing reflect communal values.
Scenario Two: The Lifeboat
Six people, limited rations, nearest land is 10 days away.
Utilitarian assumes maximizing survival: prioritize physically fit young men to row the boat.
Old lady and baby should not be using up supplies.
Young woman will need to abandon her baby.
Alternative approach of voluntary principle.
A different solution is to reject assumption that Survival is all that matters.
Value of each should be ranked equally.
Principles for Just Healthcare
Principles that might be used to decide how to allocate fairly:
To each an equal share.
To each according to individual choice.
To each according to potential for future life years.
To each according to what they deserve.
To each according to their social usefulness.
To each according to their needs.
Problems with some principles:
Equal shares not fair in situations of necessity.
Individual choices may not be fair to everyone.
Life-years ahead is unacceptable ageist discrimination if imposed.
Utility and needs/rights are the main problems.
Utilitarian theory: social benefit is final arbiter.
Individual will need to be subordinated to the welfare of the majority.
If followed correctly this has serious consequences.
Deontologically based theory: sees every human being as equally deserving of consideration and respect, and so everyone should have equal access to services that meet their health needs.
The most influential has been that of the political philosopher John Rawls.
Rawls (1973) defines the fundamental principles of justice as follows:
First principle - Each person is to have an equal right to the most extensive total system of equal basic liberties compatible with a similar system of liberty for all.
Second principle
Social and economic inequalities are to be arranged so that they are both:
(1) to the greatest benefit of the least advantaged… and (2) attached to offices and positions open to all under conditions of fair equality of opportunity.
(p. 302)
Rawls does not believe that justice requires that everyone have an equal share of social or economic resources.
Health status come into this theory via Norman Daniels.
They have a right to health care interventions that will allow them to pursue the 'normal opportunity range' for their society.
These accounts make the definition of health relative to a person's specific society, or to personal awareness of what make them happy.
Global Inequity in Health
Grim picture of health inequalities globally.
Child born in Swaziland likely to die nearly 30 times more than a child born in Sweden.
Most deaths are from communicable diseases and occur in the low-income countries.
Social injustice is killing people on a grand scale.
WHO report points out that factors:
Lack of access to Health Care.
Report urges action in the countries of poor health outcomes.
Improve daily living conditions.
Tackle the inequitable distribution of power,money and resources.
Measure and understand the problem and assess the impact of possible actions to deal with it.
Move from a 'right to health care' to a 'right to health'.
The Capability to Be Healthy (CH) Theory
Alternative to those theories is one with a universal right to health based on an understanding of the equal worth and dignity of every human being.
What is every human being morally entitled to in terms of their health status?
This involves considerations for:
Biological endowments and needs.
Individual behaviours.
Physical environment.
Social conditions.
Health injustice occurs when the social and physical environment fail to provide people in their capacity to be healthy.
Nussbaum suggests a list of attainable human capabilities that we should see as normative, they are:
Being able to live a normal length of lifespan.
Having good health.
Maintain bodily integrity.
Being able to use senses, imagination and think.
Having emotions and emotional attachments.
Possess practical reason to form a conception of the good.
Have social affiliations that are meaningful and respectful.
Express concern for other species.
Be able to play.
Have control over one's material and political environment.
(Nussbaum, 2006, pp. 76-77)
Global Survival
Even greater threat faces our generation species itself.
Bioethics overlaps with environmental ethics.
Human life will be unsustainable if we continue to use resources as we do at present.
Two major and interrelated aspects to this threat to human survival: global warming and population expansion.
The failure to control greenhouse gas emissions in the major industrialized countries has a direct effect on the health and, eventually, the survival of those in the poorest parts of the world.
The depletion of the world's resources overall by current population trends and patterns of consumption.
That the most significant of all bioethical issues that we have to confront at the present time is not concerned with the dilemmas of health care or with the confusing range of choices that new medical technologies raise from birth to death.
The Royal Society's report makes it clear that this can happen only if governments throughout the world take decisive action now.
It is of the utmost urgency to reduce consumption and emissions that are already causing damage, for example greenhouse gases, deforestation, and land use change amongst others.
Furthermore, unless the goal is a world in which extreme inequality persists, it is necessary to make space for those in poverty, especially the 1.3 billion people living in absolute poverty, to achieve an adequate standard of living.
Longer-term, the stabilization of the population is essential to avoid further exceeding planetary limits and increasing poverty. This will mean more effective (but not compulsory) use of contraception in countries with high fertility rates.
(Royal Society of London, 2012, pp. 99–101)