Reverse migration,brain drain and global justice

This paper contributes to the discussion of the ethics of brain drain against the background of the book Debating Brain Drain co-authored by Gillian Brock and Michael Blake. Whereas Gillian Brock argued in this book that a plausible response of global justice would, under certain conditions, permit that developing countries impose taxes or demand compulsory service from their professionals who emigrate, Michael Blake rejects such claims in his defence of the right to emigrate. Extending this debate to the context of reverse immigration, I attempt in this paper to establish if the arguments provided by both scholars are capable of accounting for the cogency or otherwise of preference in reverse immigration. My proposal is that the arguments provided by both Brock and Blake require further contextualisation to make them capable of deciding the question of preference in reverse immigration.     

Fair equality of opportunity and decent minimums: a reply to Buchanan

Responding to criticism by Allen Buchanan in a Winter 1984 Philosophy and Public Affairs article on "The right to a decent minimum of health care," Daniels defends his thesis that if justice requires protecting equality of opportunity, then health care institutions should be governed by the principle of fair equality of opportunity because impairments of normal functioning, seen as impediments to opportunity, are obviated by good health care. He defines his concept of normal opportunity range, which is relative to certain social considerations, and shows that health care services affect the distribution of opportunity, but not the normal opportunity range, among individuals. He agrees with the criticism that his argument does not guarantee minimum health care or solve problems of resource allocation.     

Can Norman Daniels Help You Get a Wheelchair? A Commentary on Durocher et al.

Durocher and colleagues (2019) argue that Norman Daniels’s notion of just health could provide a useful framework for decreasing inequities in access to assistive technology. I argue that it would provide limited help for two reasons. First, Daniels’s reliance on normal species functioning as the goal of health care and his assumptions regarding the impact of normal species functioning on reasonable life projects create substantial difficulties for application to assistive technology. Second, although Daniels’s requirements for distributive justice provide a critical starting point for any discussion of health equity, these requirements appear already met within current assistive technology funding schemes.     

Is Health (Really) Special? Health Policy between Rawlsian and Luck Egalitarian Justice

In recent work, Norman Daniels extends the application of Rawls's principle of ‘fair equality of opportunity’ from health care to health proper. Crucial to that account is the view that health care, and now also health, is special. Daniels also claims that a rival theory of distributive justice, namely luck egalitarianism (or ‘equal opportunity for welfare’), cannot provide an adequate account of justice in health and health care. He argues that the application of that theory to health policy would result in an account that is, in a sense, too narrow, for it denies treatment to imprudent patients (e.g. lung cancer patients who smoked). In a different sense, Daniels argues, luck egalitarian health policy would be too wide: it arguably tells us to treat individuals for such brute‐luck conditions as shyness, stupidity, ugliness, and having the ‘wrong’ skin colour. I seek to advance three claims in response to Daniels's revised theory, and in defence of a luck egalitarian view of health policy. First, I question Daniels's assertion regarding the specialness of health. While he is right to abandon his insistence on the specialness of health care, it is doubtful that health proper can be depicted as special. Second, I try and meet Daniels's objections to luck egalitarianism. Luck egalitarian health policy escapes being too narrow for it does not in fact require denying basic care to imprudent patients. As for it being allegedly too wide, I try to show that it is not, after all, counterintuitive to rid individuals of unfortunate and disadvantageous biological traits (say, a disadvantageous skin colour). And third, I question whether Daniels's own Rawlsian account is in fact wide enough. I argue that fair equality of opportunity fails to justify some standard medical procedures that many health systems do already practice.     

Interpreting Surrogate Consent using Counterfactuals

Philosophers such as Dan Brock believe that surrogates who make health care decisions on behalf of previously competent patients, in the absence of an advance directive, should make these decisions based upon a substituted judgment principle. Brock favours substituted judgment over a best interests standard. However, Edward Wierenga claims that the substituted judgment principle ought to be abandoned in favour of a best interests standard, because of an inherent problem with the substituted judgment principle. Wierenga's version of the substituted judgment principle and his counterexample to the principle's successful interpretation of valid surrogate consent is presented. A new version of what is meant by the substituted judgment principle is advanced. The new version is not beset with the problems Wierenga initially ascribed to the substituted judgment principle.     

Debating brain drain: Three objections that complicate the picture

In my contribution to this brain drain debate sparked by Brock and Blake’s book, Debating Brain Drain, I respond only to Brock’s position, and raise three objections which I suggest complicate the picture that she sketches. First, I take issue with the way in which she frames the moral question, namely by limiting her focus to what home countries may legitimately do to address the problems associated with the brain drain. I argue that the way in which she frames the question has important ideological consequences, because she does not adequately account for the larger context, in particular, by leaving out the moral obligations of the host countries who are the main beneficiaries of the brain drain. My second objection is rooted in the distinction between technical knowledge and practical knowledge found in the work of Habermas – an important distinction which gets obscured in Brock’s analysis in precisely the kind of ideological ways that Habermas was concerned about. She namely attempts to solve what are mainly practical (political) problems through purely instrumental, technical means. Several distortions accompany this fundamental confusion. My third point of critique has to do with the problem that an ethics of care (an ethics of responsibility and obligation) encounters within a liberal paradigm strongly shaped by an ethics of rights. Drawing on the work of Kroeger-Mappes, I argue that Brock arbitrarily singles out a group of people and holds them to an ethics of care which is strictly supererogatory within her own liberal paradigm.     

Just health care (II): Is equality too much?

In a previous essay I criticized Engelhardt's libertarian conception of justice, which grounds the view that society's obligation to assure access to adequate health care for all is a matter of beneficence [1]. Beneficence fails to capture the moral stringency associated with many claims for access to health care. In the present paper I argue that these claims are really matters of justice proper, where justice is conceived along moderate egalitarian lines, such as those suggested by Rawls and Daniels, rather than strong egalitarian lines. Further, given the empirical complexity associated with the distribution of contemporary health care, I argue that what we really need to address the relevant policy issues adequately is a theory of health care justice, as opposed to an all-purpose conception of justice. Daniels has made an important start toward that goal, though there are some large policy areas which I discuss that his account of health care justice does not really speak to. Finally, practical matters of health care justice really need to be addressed in a ‘non-ideal’ mode, a framework in which philosophers have done little.     

论丹尼尔斯医疗保健公正理论

诺曼·丹尼尔斯将罗尔斯的正义理论应用到医疗资源分配公正领域,他的理论认为医疗保健的道德重要性就在于它保护正常的功能从而保护机会,平等机会不仅提供医疗保健权利的基础,它也帮助我们确定这个权利的承诺限度。此外我们应该依靠公平的程序达到医疗保健公正的分配。     

Restricting health worker migration in the name of solidarity

This paper explores and adds to Gillian Brock and Michael Blake’s debate on health worker migration. Brock argues for a limited right of states to restrict the migration of health workers beyond their borders. She offers a range of reasons to support this argument based broadly on her account of global justice. In the context of health worker migration, she supports her argument more specifically by linking health workers’ obligations to duties of reciprocity and not imposing costs on their compatriots. In this paper, I seek to support her argument by offering solidarity, as developed in the literature on public health ethics, as a ground for the obligations of health workers to their compatriots and a limited right of states to restrict their movements. On a narrow view of reciprocity, health workers are obligated to repay their communities for the benefits that they have received during their childhoods and training. Solidarity augments this view by arguing that all persons also have positive obligations to take public actions to address injustices. This complementary ground for restrictions on the movements of health workers helps to address Blake’s critiques of communitarianism and reciprocity as justifying state restrictions.     

Is Age Special? Justice,Complete Lives and the Prudential Lifespan Account

This article explores the problem of justice between age‐groups. Specifically, it presents a challenge to a leading theory in this field, Norman Daniels' Prudential Lifespan Account. The challenge relates to a key assumption that underlies this theory, namely the assumption that all individuals live complete lives of equal length. Having identified the roles that this assumption plays, the article argues that the justifications Daniels offers for it are unsatisfactory and that this threatens the foundation of his position, undermining his claim that ‘the fact that we all age’ makes age a special problem of distributive justice. This shows that the problem of justice between age‐groups is not special in the way Daniels proposes; rather it involves the same irreducibly interpersonal distributive decisions as other problems of justice. The consequences of this argument are several‐fold. Most importantly, it shows that the Rawlsian account of justice to which Daniels hopes to attach his theory to requires significantly greater benefits to be conferred on those in earlier age‐groups relative to those in later age‐group, not a distribution similar to simultaneous equality as Daniels proposes.     

Christian Supersessionism,Zionism, and the Contemporary Scene

Postliberal theology has been a topic of considerable theological debate over the past few decades. In his 2011 book Another Reformation, Peter Ochs deploys a postliberal theological model for the purpose of developing a sophisticated understanding of the future of interreligious relations. Ochs argues that postliberal theology is a reparative theology focusing on alleviating human suffering. He argues that the Christian idea of supersessionism may be the most challenging for Christians to confront as they explore avenues for making interreligious dialogue more effective. Ochs critiques the Mennonite theologian John Howard Yoder's understanding of Zionism as Jewish Constantianism for being an instance of an ostensibly postliberal theology losing its way. In this essay, I offer a critique of Ochs's reading of Yoder, claiming that Yoder's view actually mirrors an important intra‐Jewish debate about the relationship between political power and piety, and retrieves an ingenious contribution of both early Judaism and early Christianity that is effaced in today's growing Constantinian approach to Christian imperialism and Jewish nationalism.     

Age rationing,the virtues,and wanting more life

The goal of this paper is to show that Callahan's reasons for withholding life extending care cannot be made out exclusively in terms of contemporary notions of distributive justice and fair allocation. I argue that by relying on a notion of justice which links the merit of the individual with the fairness of a social pattern of shares, Callahan imputes vice to the elderly as he denies them eligibility for life-prolonging care. Aristotle's doctrine of the mean is a useful tool for character evaluation. One can speak meaningfully of a proper disposition of a person of a certain type (an elderly person) with respect to the good of continued life. I claim that the mean of one's disposition with respect to the good of continued life would be relative to one's age group, and would be determined by that principle by which an elderly person of practical wisdom would determine it. This leads to very different conclusions than those drawn by Callahan.     

Why treat the wounded? Warrior care, military salvage, and national health

Because the goal of military medicine is salvaging the wounded who can return to duty, military medical ethics cannot easily defend devoting scarce resources to those so badly injured that they cannot return to duty. Instead, arguments turn to morale and political obligation to justify care for the seriously wounded. Neither argument is satisfactory. Care for the wounded is not necessary to maintain an army's morale. Nor is there any moral or logical connection between the right to health care (a universal human right) and the duty to defend one's nation (a local political duty). Once badly wounded, soldiers enjoy the same right to medical care as any similarly ill or injured individual. National health care systems grasp this point and offer few additional health care benefits to veterans. In the United States, however, lack of universal health coverage skews the debate to focus on special entitlements for veterans without considering the health care rights that other citizens enjoy.     

Governing Humanity

In the United Kingdom, clinical governance has become a master narrative for health care over the last decade. While many see this political imperative as embodying both enlightening and humanistic goals, I argue that it has also become an apparatus for resuscitating a hypermodernist worldview which further conceals the political drivers of health care delivery. While resistance to clinical governance seems futile, insistence on the inclusion of historical analysis in understanding modern health care delivery may be profitable. Drawing from selected dramatic texts by Henrik Ibsen, an historical moment of clinical governance may be analysed showing the complex interplay of the personal, social, empirical and ethical dimensions of health care delivery.     

Emigration and community

In this paper I consider Gillian Brock’s and Michael Blake’s discussion of emigration in Debating Brain Drain in relation to the particular case of South Africa, and explore whether skilled white people have a duty to remain in the country. Focusing on the role of community in this debate, I argue that communities and allegiances in South Africa are still too divided and antagonistic for them to play the duty-grounding role that Brock requires.     

Beyond a western bioethics?

Like theology and ethics generally, bioethics has increasingly developed a global consciousness. Controversies over AIDS research and access to affordable AIDS treatment have generated new awareness about the importance of international collaboration as well as the difficulty of achieving moral consensus across economic, political, and cultural divides. Advances in scientific and medical knowledge through initiatives such as the Human Genome Project invite new questions about the nature of health care as a common good. This budding global consciousness serves as a starting point for examining contemporary challenges to the secular, principle-based Western bioethics that has dominated national and international debate for three decades.     

Access to Assistive Technology,Systems Thinking,and Market Shaping: A Response to Durocher et al.

Fairness of access to assistive technology is important for its allocation on an equitable basis and for broader social justice and rights issues. Although the use of Daniels’s notion of “justice as fair opportunity” is helpful to the context of assistive technology, other aspects of Daniels’s broader conceptualisation of “just health” are not appropriate in this context. It is argued that fairness of access to assistive technology is crucial for the equitable attainment of the sustainable development goals; however, such access will be achieved only by the sector developing a much stronger systems thinking and market shaping perspective.     

Protecting reasonable conscientious refusals in health care

Theoretical Medicine and Bioethics - Recently, debate over whether health care providers should have a protected right to conscientiously refuse to offer legal health care services—such as...     

Morality and the market in blood

ABSTRACT The late Richard Titmuss made a persuasive case against allowing the sale of human blood in his book, The Gift Relationship. His arguments have been developed further by Peter Singer in recent articles. While the issues of quantity and quality of blood under market and non-market systems have received much attention, the moral and political aspects of the Titmuss-Singer case have gone relatively unexamined. First, I question their claim that a donation-only system promotes greater freedom, which rests on a confusion of liberty and opportunity. Next, I consider reasons for doubting their view that altruism is fostered significantly more under the non-market approach. Finally, I survey recent developments in the quantity-quality debate and possible implications of the blood controversy for national health care.     

NONIDENTITY, WRONGFUL CONCEPTION AND HARMLESS WRONGS

Joel Feinberg and Dan Brock have independently developed a solution to the Problem of Nonidentity as it occurs in cases where a mother's negligent act of conception causes her child to be born with a severe disability. I display three problems in the Feinberg‐Brock proposal and develop an alternative view that explains both cases of wrongful conception and additional instances of the Problem of Nonidentity presented by Derek Parfit and others.