Ethical Principle of Justice

1
Ethical Principleof Justice

• principle of justice
• involves giving to all persons their "rights" or
  "desserts"
• the distribution of various resources in society
  often is governed by different philosophies
• to each according to their need,
• to each according to their merit,
• to each according to their worth/contribution to
  society
• to each an equal share
• to each according to their effort

2
Distributive justice

• Society uses various rules and principles (moral,
  legal, and ethical) to decide how to distribute
  in a just manner its benefits and burdens
• process is called distributive justice
• distributive justice becomes an important issue
  when a resource is limited and when there is
  competition for it

3
Justice

• Justice
• appropriate ethical framework from which to
  approach rationing decisions
• equals should be treated equally and unequals
  treated unequally - Aristotle's formal Principle
  of Justice
• implies the fair distribution of goods in society
• justice in health care is usually defined as a
  form of fairness
• logical opposite of justice is discrimination

4
Material principles of distributive justice

• Material principles specify relevant criteria of
  equality
• to each person an equal share
• to each person according to individual need
• to each person according to individual effort
• to each person according to societal contribution
• to each person according to merit
• to each person according to free market exchanges
  
• Beauchamp and Childress 2001-

5
Theories of Distributive Justice

• Egalitarian (deontological)
• everyone should be treated the same
• Utilitarian
• what produces the most benefit for society as a
  whole
• Libertarian
• emphasize rights to social and economic liberty
  (invoking fair procedures rather than substantive
  outcomes)
• Communitarian
• stresses principles and practices of justice that
  evolve through tradition in a community
• Rawlss theory of justice
• fair opportunity/fairness

6
Rawlss theory of "justice as fairness"

• John Rawls
• claimed that people are to be treated equally
  unless there are relevant differences among them
  or unless an unequal distribution would be to
  everyone's advantage
• Rawls idea that a society is just or fair if and
  only if it is governed by principles that
  reasonable people would agree to if they knew
  nothing about their own place in society at the
  time of drawing up the agreement (original
  position)
• any principles chosen in the original position
  (from behind the veil of ignorance) would be
  justified, and so any state that ran according to
  those principles would be justified

7
Rawls Two Principles

• two principles to govern the basic structure of
  society
• FIRST PRINCIPLE each person has an equal right
  to a fully adequate scheme of equal basic
  liberties which is compatible with a similar
  scheme of liberties for all
• SECOND PRINCIPLE Social and economic principles
  are to satisfy two conditions
• first, they must be attached to offices and
  positions open to all under conditions of fair
  equality of opportunity (the opportunity
  principle) and
• second, they must be to the greatest benefit of
  the least advantaged members of society (the
  difference principle).

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Healthcare resources

• the claim to health care
• health care as a right ?
• health care based on justice according to need
  (fairness)
• what is meant by healthy?
• e.g. infertility treatment
• inequalities of health care
• age learning disabilitysocial class women
  access to certain treatments rare disorders

9
Healthcare resources issues

• Risky lifestyle/detrimental behaviour by the
  individuals
• sky-divers/high risk sports
• smokers
• alcohol-related problems
• drug addicts
• coronary artery disease
• obesity
• drug addiction
• sexually transmitted diseases (STD), HIV
• Genetic disorders
• genetic testing

10
Allocation of health care resources

• priorities for the allocation of resources for
  and in healthcare.
• macro-allocation
• determine how much should be expended and what
  goods will be made available to a society
  decisions at governmental level
• meso-allocation
• purchase plans - trusts
• micro-allocation
• rationing or triage
• decisions determine who will receive the
  available resources

11
Scarce medical resources

• Ethical question is "Who should be treated when
  not all can be treated?"

12
Scarce medical resources

• Selecting recipients of scarce resources
• moral principle of medical utility
• use resources carefully to maximise the number of
  lives saved i.e. given first to those whose
  chance of survival with them is very high but
  whose chance of survival without them is very low
• chance/lottery
• impersonal justified by equality and fair
  opportunity
• first come, first served
• random choice
• weighing the lives in question
• moral principle of social utility
• social value of potential recipients
• triage

13
Economics of Health Care

• Continually increasing health care costs
• inflation based on overall increase in
• population increase
• ageing population
• increase demand for healthcare
• new technologies, new procedures
• personnel and other resources

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Some questions

• How much of societys wealth should be spent on
  health care ?
• How should the health care funds be allocated
• prevention vs. treatment
• What categories of disease should have priority,
• HIV or cancer?
• infertility treatment
• cosmetic surgery
• Within each disease category, which technology or
  procedure should be funded?
• transplants
• How far can/should doctors be advocates for their
  patients and ignore the public and societal
  implications of their decisions?