Just health: meeting health needs fairly is an ambitious book, in which Norman Daniels attempts to bring together in a single framework all his work on health and justice from the past 25 years. One major aim is to reconcile his earlier work on the special moral importance of healthcare with his later work on the socialdeterminants of health. In his earlier work, Daniels argued that healthcare is of special moral importance because it (...) protects opportunity. In this later work, Daniels argues that the socialdeterminants of health (which in fact tend to have a larger effect on health outcomes than healthcare does) should also be considered special. This paper argues that it is a mistake to base a theory of justice for health on the claim that health (or the socialdeterminants of health) are "special", for three reasons. First, once we realise that health is to a large part socially determined by features such as distribution of income, which are also of independent importance for justice, we cannot talk about a theory of justice for health in isolation from an overall theory of justice. Second, when we are trying to work out the place of health in a general theory of justice, being told that health (or the socialdeterminants of health) is special is unhelpful. The relevant starting point should rather be whether health matters in a fundamental way for justice, or whether it matters merely for the effects it has on those goods which are of fundamental importance for justice. Third, treating the socialdeterminants of health as special would in fact be counterproductive in terms of the broad approach to justice Daniels favours. (shrink)
The article discusses two areas at the intersection of socialdeterminants of health research and social justice theory. The first section examines the affinity between social epidemiology and the capabilities approach. The second section examines how social epidemiology's expansion of the scope of the causal chain and determinants raises questions about epistemology and ontology in epidemiology as well as the field's link to the moral concern for human health.
The paper describes a project in which the thesis of the socialdeterminants of health is used in order to help identify groups that will be among the least advantaged members of society, when disadvantage is understood in terms of lack of genuine opportunity for secure functioning. The analysis is derived from the author's work with Avner de-Shalit in Disadvantage (Oxford University Press, 2007).
In May 2009 the World Health Assembly passed a resolution on reducing health inequities through action on the socialdeterminants of health, based on the work of the global Commission on SocialDeterminants of Health, 2005–2008. The Commission's genesis and findings raise some important questions for global health governance. We draw out some of the essential elements, themes, and mechanisms that shaped the Commission. We start by examining the evolving nature of (...) global health and the Commission's foundational inspiration – the universal pattern of health inequity and the imperative, driven by a sense of social justice, to make better and more equal health a global goal. We look at how the Commission was established, how it was structured internally, and how it developed external relationships – with the World Health Organization, with global networks of academics and practitioners, with country governments eager to spearhead action on health equity, and with civil society. We outline the Commission's recommendations as they relate to the architecture of global health governance. Finally, we look at how the Commission is catalyzing a movement to bring socialdeterminants of health to the forefront of international and national policy discourse. (shrink)
The present article identifies how socialdeterminants of health raise two categories of philosophical problems that also fall within the smaller domain of ethics; one set pertains to the philosophy of epidemiology, and the second set pertains to the philosophy of health and social justice. After reviewing these two categories of ethical concerns, the limited conclusion made is that identifying and responding to socialdeterminants of health requires inter-disciplinary reasoning across epidemiology and (...) philosophy. For the reasoning used in epidemiology to be sound, for its scope and (moral) purpose as a science to be clarified as well as for social justice theory to be relevant and coherent, epidemiology and philosophy need to forge a meaningful exchange of ideas that happens in both directions. (shrink)
Globalization, a process characterized by the growing interdependence of the world's people, impacts health systems and the socialdeterminants of health in ways that are detrimental to health equity. In a world in which there are few countervailing normative and policy approaches to the dominant neoliberal regime underpinning globalization, the human rights paradigm constitutes a widely shared foundation for challenging globalization's effects. The substantive rights enumerated in human rights instruments include the right to the highest (...) attainable level of physical and mental health and others that are relevant to the determinants of health. The rights stipulated in these documents impose extensive legal obligations on states that have ratified these documents and confer health entitlements on their residents. Human rights norms have also inspired civil society efforts to improve access to essential medicines and medical services, particularly for HIV/AIDS. Nevertheless, many factors reduce the potential counterweight human rights might exert, including and specifically the nature of the human rights approach, weak political commitments to promoting and protecting health rights on the part of some states and their lack of institutional and economic resources to do so. Global economic markets and the relative power of global economic institutions are also shrinking national policy space. This article reviews the potential contributions and limitations of human rights to achieving greater equity in shaping the socialdeterminants of health. (shrink)
In spite of vast global improvements in living standards, health, and well-being, the persistence of absolute poverty and its attendant maladies remains an unsettling fact of life for billions around the world and constitutes the primary cause for the failure of developing states to improve the health of their peoples. While economic development in developing countries is necessary to provide for underlying determinants of health – most prominently, poverty reduction and the building of comprehensive primary (...) class='Hi'>health systems – inequalities in power within the international economic order and the spread of neoliberal development policy limit the ability of developing states to develop economically and realize public goods for health. With neoliberal development policies impacting entire societies, the collective right to development, as compared with an individual rights-based approach to development, offers a framework by which to restructure this system to realize socialdeterminants of health. The right to development, working through a vector of rights, can address socialdeterminants of health, obligating states and the international community to support public health systems while reducing inequities in health through poverty-reducing economic growth. At an international level, where the ability of states to develop economically and to realize public goods through public health systems is constrained by international financial institutions, the implementation of the right to development enables a restructuring of international institutions and foreign-aid programs, allowing states to enter development debates with a right to cooperation from other states, not simply a cry for charity. (shrink)
In spite of vast global improvements in living standards, health, and well-being, the persistence of absolute poverty and its attendant maladies remains an unsettling fact of life for billions around the world and constitutes the primary cause for the failure of developing states to improve the health of their peoples. While economic development in developing countries is necessary to provide for underlying determinants of health – most prominently, poverty reduction and the building of comprehensive primary (...) class='Hi'>health systems – inequalities in power within the international economic order and the spread of neoliberal development policy limit the ability of developing states to develop economically and realize public goods for health. With neoliberal development policies impacting entire societies, the collective right to development, as compared with an individual rights-based approach to development, offers a framework by which to restructure this system to realize socialdeterminants of health. The right to development, working through a vector of rights, can address socialdeterminants of health, obligating states and the international community to support public health systems while reducing inequities in health through poverty-reducing economic growth. At an international level, where the ability of states to develop economically and to realize public goods through public health systems is constrained by international financial institutions, the implementation of the right to development enables a restructuring of international institutions and foreign-aid programs, allowing states to enter development debates with a right to cooperation from other states, not simply a cry for charity. (shrink)
Health research has been identified as a vehicle for advancing global justice in health. However, in bioethics, issues of global justice are mainly discussed within an ongoing debate on the conditions under which international clinical research is permissible. As a result, current ethical guidance predominantly links one type of international research (biomedical) to advancing one aspect of health equity (access to new treatments). International guidelines largely fail to connect international research to promoting broader aspects of health (...) equity – namely, healthier social environments and stronger health systems. Bioethical frameworks such as the human development approach do consider how international clinical research is connected to the socialdeterminants of health but, again, do so to address the question of when international clinical research is permissible. It is suggested that the narrow focus of this debate is shaped by high-income countries' economic strategies. The article further argues that the debate's focus obscures a stronger imperative to consider how other types of international research might advance justice in global health. Bioethics should consider the need for non-clinical health research and its contribution to advancing global justice. (shrink)
In this paper, we present an argument strengthening the view of Norman Daniels, Bruce Kennedy and Ichiro Kawachi that justice is good for one's health. We argue that the pathways through which social factors produce inequalities in sleep more strongly imply a unidirectional and non-voluntary causality than with most other public health issues. Specifically, we argue against the 'voluntarism objection' – an objection that suggests that adverse public health outcomes can be traced back to the free (...) and voluntary choices of individual actors. Our argument proceeds along two lines: an empirical line and a conceptual line. We first show that much of the empirical research on sleep supports the view that those with fewer opportunities are those who have poorer sleep habits. We then argue that sleep-related decisions are not of the same nature as most other lifestyle choices, and therefore are not as easily susceptible to the voluntarism objection. (shrink)
The publication of the Report of the International Bioethics Committee of Unesco on Social responsibility and health provides an opportunity to reshape the conceptual framework of the right to health care and its practical implications. The traditional distinctions between negative and positive, civil-political and economic-social, legal and moral rights are to be questioned and probably overcome if the goal is to pursue ‘the highest attainable standard of health’ as a fundamental human right, that should as (...) such be guaranteed to every human being. What we are called upon to, is the commitment not to exclude now and forever anyone from having access to the ‘excellence’ of scientific and medical progress. Therefore, the addressees of this ‘responsibility’ cannot be just the governments and the states within the limits of their ‘jurisdiction’. The challenge is to tackle at the same time the social and global determinants of health. (shrink)
Corresponding Author, Health Policy & Ethics Fellow, Chronic Disease Prevention & Control Research Center, Department of Medicine, Baylor College of Medicine, 1709 Dryden, Suite 1025, Houston, TX 77030, USA. Tel.: 713.798.5482; Fax: 713 798 3990; Email: danielg{at}bcm.edu ' + u + '@' + d + ' '//--> . Abstract This article defends a broad model of public health, one that specifically addresses the social epidemiologic research suggesting that social conditions are primary determinants of health. (...) The article proceeds by critiquing one of the strongest arguments in favor of a narrow model, advanced by Mark Rothstein. The critique sets up the argument that a model of public health that does not address what actually causes health and disease is unlikely to improve public health. Assessing the substantial evidence regarding the socialdeterminants of health, the article engages the policy paradox that precludes utopian prescriptions but demands more than mere expedience. CiteULike Connotea Del.icio.us What's this? (shrink)
This paper seeks to define and delimit the scope of the social responsibilities of health professionals in reference to the concept of a social contract. While drawing on both historical data and current empirical information, this paper will primarily proceed analytically and examine the theoretical feasibility of deriving social responsibilities from the phenomenon of professionalism via the concept of a social contract.
The aim of this paper is to analyze whether a number of firm and industry characteristics, as well as media exposure, are potential determinants of corporate social responsibility (CSR) disclosure practices by Spanish listed firms. Empirical studies have shown that CSR disclosure activism varies across companies, industries, and time (Gray et al., Accounting, Auditing & Accountability Journal 8(2), 47–77, 1995; Journal of Business Finance & Accounting 28(3/4), 327–356, 2001; Hackston and Milne, Accounting, Auditing & Accountability Journal 9(1), 77–108, (...) 1996; Cormier and Magnan, Journal of International Financial Management and Accounting 1(2), 171–195, 2003; Cormier et al., European Accounting Review 14(1), 3–39, 2005), which is usually justified by reference to several theoretical constructs, such as the legitimacy, stakeholder, and agency theories. Our findings evidence that firms with higher CSR ratings present a statistically significant larger size and a higher media exposure, and belong to more environmentally sensitive industries, as compared to firms with lower CSR ratings. However, neither profitability nor leverage seem to explain differences in CSR disclosure practices between Spanish listed firms. The most influential variable for explaining firms’ variation in CSR ratings is media exposure, followed by size and industry. Therefore, it seems that the legitimacy theory, as captured by those variables related to public or social visibility, is the most relevant theory for explaining CSR disclosure practices of Spanish listed firms. (shrink)
Analyses of biological concepts of disease and social conceptions of health indicate that they are structurally interdependent. This in turn suggests the need for a bridge theory of illness. The main features of such a theory are an emphasis on the logical properties of value terms, close attention to the features of the experience of illness, and an analysis of this experience as action failure, drawing directly on the internal structure of action. The practical applications of this theory (...) are outlined for a number of problems in each of the three main practical areas, clinical work, teaching and research. In each case the resources of the theory suggest new models and generate new results. The full practical significance of the theory, however, is shown to consist in the way in which it ties together biological and social theories into an integrated picture of the conceptual structure of medicine as a whole. It is argued, finally, that practical efficiency of this kind is a test of theory not only in the philosophy of medicine but also in general philosophy. (shrink)
Previous research in the social responsibility/social performance area has failed to systematically address the institutional determinants of social responsibility and its various manifestations in terms of social performance. This paper examines the relationship between the configuration of institutional structures at various levels and the necessary and sufficient conditions for the concept of social responsibility to manifest in the practice of stakeholder management. In particular we hypothesize that smaller, closely held firms in profitable niches are (...) in the optimum position to practice stakeholder management, assuming the management of these firms is predisposed to do so. (shrink)
The Article focuses on the concept of social solidarity, as it is used in the Report of the International Bioethics Committee On Social Responsibility and Health. It is argued that solidarity plays a major role in supporting the whole framework of social responsibility, as presented by the IBC. Moreover, solidarity is not limited to members of particular groups, but potentially extended to all human beings on the basis of their inherent dignity; this sense of human solidarity (...) is a necessary presupposition for a genuinely universalistic morality of justice and human rights. (shrink)
For decades, health professionals have asserted the importance of public participation in interventions for health. Medicine has pursued patient participation in clinical decision-making. In the public health realm, target groups have been asked to assist in the design and implementation of initiatives for health. In practice, however, patients and populations expect health professionals to give advice and - in some cases - to make decisions on their behalf. This implies limits to the ideal of participation. (...) In this innovative work, the author contrasts public and professional understandings of health and the best ways to achieve health. The result is a model of lay participation in the structuring of medical and public health activity. The book is unique due to its policy-applicable, quantitative studies and its theoretical analysis of works by René Dubos and Aaron Antonovsky. It will be of value to professionals in health promotion, health education, medical anthropology, and social epidemiology. (shrink)
This paper presents an empirical analysis of the determinants of quantity of health insurance in the context of employer-based health insurance using the micro-level data from the 1987 National Medical Expenditure Survey (NMES). It extends the previous research by including additional factors in the analysis, which significantly affect health insurance offers by employers. This paper emphasizes two determinants of employers’ insurance offer decisions that are particularly relevant: union membership and selfinsured versus not self-insured health (...) plans. The conducted empirical analysis reported in this paper reveals the following predictors of higher health insurance coverage: union membership, not self-insured health plan(s), union membership in Midwest or South, as well as self-insured union membership. Further, other factors such as: age, male, income, for profit and other employer organizational forms, and firm’s size determine a higher level of health insurance. (shrink)
This book clarifies the distinctions between three key concepts - Anti-Racist Practice (ARP), Anti-Discriminatory Practice(ADP) and Anti-Oppressive Practice (AOP). Critically and constructively analysing these three approaches to practice it reappraises their potential in the light of emerging equality issues in the health service. With contributions from leading teachers and practitioners in the field, Equalising Opportunities provides students and practitioners in health and social care with a clear overview of an area where there is much confusion and imperfect (...) understanding. (shrink)
(2013). Motivational determinants of reasoning about social relations: The role of need for cognitive closure. Thinking & Reasoning. ???aop.label???. doi: 10.1080/13546783.2012.752407.
Because medicine can preserve and restore health and function, it has been widely acknowledged as a basic good that a just society should provide its members. Yet there is wide disagreement over the scope of what is to be provided, to whom, how, when and why. In this uniquely comprehensive book some of the best-known philosophers, doctors, lawyers, political scientists, and economists writing on the subject discuss the concerns and deepen our understanding of the theoretical and practical issues that (...) run through the contemporary debate. The first section lays a broad theoretical basis for understanding the subject of justice, particularly as it relates to the distribution of health care. The second section critically examines how medical care is distributed in different countries around the world and the particular advantages and injustices associated with those systems. The third section draws attention to the special needs of different social groups and the specific issues of justice that are raised by the impact of various policies on health care distribution. The concluding section delves into the dilemmas that confront those designing health care systems - the politics, the priorities, and the place of desires as opposed to needs in a socially just scheme. (shrink)
Bengt Brülde in his article ``The Goals of Medicine. Towards a Unified Theory'' has proposed a normative theory of the goals of medicine within which the concept of quality of life plays a crucial role. In Brülde's analysis, however, the very concept of medicine is deliberately left quite vague and it is therefore difficult to see how the goals of medicine are related to the goals of closely allied enterprises such as health promotion and social welfare. In this (...) reply I therefore propose an analysis of these related conceptual areas. I do this mainly in two respects. (1) Following the nomenclature in a previously published article (Nordenfelt, 1998) I propose a systematic conceptual framework for all varieties of health enhancement and distinguish different notions of medicine within this framework. A consequence of this analysis is, for instance, that the means and also the immediate goals of medicine in its broadest sense are more diversified than the means and immediate goals of medicine in its narrowest sense. (2) From this position I expand the topic further by comparing medicine and health enhancement with social welfare and try to trace the basic features between â as well as the common properties of â these different enterprises. (shrink)
Older minority Americans experience worse health outcomes than their white counterparts, exhibiting the need for social justice in all areas of their health care. Justice, fairness, and equity are crucial to minimizing conditions that adversely affect the health of individuals and communities. In this paper, Alzheimer's disease (AD) is used as an example of a health care disparity among elderly Americans that requires social justice interventions. Cultural factors play a crucial role in AD screening, (...) diagnosis, and access to care, and are often a barrier to support and equality for minority communities. The “conundrum of health disparities” refers to the interplay between disparity, social justice, and cultural interpretation, and encourages researchers to understand both (1) disparity caused by economic and structural barriers to access, treatment, and diagnosis, and (2) disparity due to cultural interpretation of disease, in order to effectively address health care issues and concerns among elderly Americans. (shrink)
Edited by four leading members of the new generation of medical and healthcare ethicists working in the UK, respected worldwide for their work in medical ethics, Principles of Health Care Ethics, Second Edition_is a standard resource for students, professionals, and academics wishing to understand current and future issues in healthcare ethics. With a distinguished international panel of contributors working at the leading edge of academia, this volume presents a comprehensive guide to the field, with state of the art introductions (...) to the wide range of topics in modern healthcare ethics, from consent to human rights, from utilitarianism to feminism, from the doctor-patient relationship to xenotransplantation. This volume is the Second Edition of the highly successful work edited by Professor Raanan Gillon, Emeritus Professor of Medical Ethics at Imperial College London and former editor of the Journal of Medical Ethics, the leading journal in this field. Developments from the First Edition include:_ The focus on ‘Four Principles Method’ is relaxed to cover more different methods in health care ethics. More material on new medical technologies is included, the coverage of issues on the doctor/patient relationship is expanded, and material on ethics and public health is brought together into a new section. (shrink)
Background Social and structural inequities shape health and illness; they are an everyday presence within the doctor-patient encounter yet, there is limited ethical guidance on what individual physicians should do. This paper draws on a study that explored how doctors and their professional associations ought to respond to the issue of socialhealth inequities. Results Some see doctors as bound by a notion of care that is blind to a patient's social position, while others respond (...) to this issue through invoking notions of justice and human rights where access to care is a prime focus. Both care and justice orientations however conceal important tensions linked to the presence of bioethical principles underpinning these. Other normative ethical theories like deontology, virtue ethics and utilitarianism do not provide adequate guidance on the problem of socialhealth inequities either. Conclusion This paper explores if Bauman's notion of "forms of togetherness" provides the basis of a relational ethical theory that can help to develop a response to socialhealth inequities of relevance to individual physicians. This theory goes beyond silence on the influence of social position of health and avoids amoral regulatory approaches to monitoring equity of care provision. (shrink)
This paper provides an interpretation, based on the social systems theory of German sociologist Niklas Luhmann, of the recent paradigmatic shift of mental health care from an asylum-based model to a community-oriented network of services. The observed shift is described as the development of psychiatry as a function system of modern society and whose operative goal has moved from the medical and social management of a lower and marginalized group to the specialized medical and psychological care of (...) the whole population. From this theoretical viewpoint, the wider deployment of the modern social order as a functionally differentiated system may be considered to be a consistent driving force for this process; it has made asylum psychiatry overly incompatible with prevailing social values (particularly with the normative and regulative principle of inclusion of all individuals in the different functional spheres of society and with the common patterns of participation in modern function systems) and has, in turn, required the availability of psychiatric care for a growing number of individuals. After presenting this account, some major challenges for the future of mental health care provision, such as the overburdening of services or the overt exclusion of a significant group of potential users, are identified and briefly discussed. (shrink)
One of the most controversial issues in many health care systems is health care rationing. In essence, rationing refers to the denial of - or delay in - access to scarce goods and services in health care, despite the existence of medical need. Scarcity of financial and medical resources confronts society with painful questions. Who should decide which medicine or new treatment will be covered by social security and on which criteria such decisions must be based? (...) Can age, for example, be justified as a selection criterion? Should decision-making be left to health care policymakers, hospital administrators, or rather, to treating physicians ('bedside rationing')? And finally: is there a role for individual patients? These are difficult questions that suggest the need for transparent and democratic decision-making. In reality, however, the rationing debate occurs in a sub rosa world, based on imperfect information, distorted interpretations of effectiveness, and hidden cost concerns. This book explores these and other questions from various perspectives (medicine, philosophy, ethics, economics, and law). Each of the book's contributors analyzes the debate from a different angle, in search of fair and just rationing decisions. (shrink)
Funding agencies in Canada are attempting to break down the organizational boundaries between disciplines to promote interdisciplinary research and foster the integration of the social sciences into the health research field. This paper explores the extent to which biomedical and clinician scientists’ perceptions of social science research operate as a cultural boundary to the inclusion of social scientists into this field. Results indicated that cultural boundaries may impede social scientists’ entry into the health research (...) field through three modalities: (1) biomedical and clinician scientists’ unfavourable and ambivalent posture towards social science research; (2) their opposition to a resource increase for the social sciences; and (3) clinician scientists procedural assessment criteria for social science. The paper also discusses the merits and limitations of Tom Gieryn’s concept of boundary-work for studying social dynamics within the field of science. (shrink)
To survive and be successful in today's setting of globalisation and complexity, companies are obliged to think in wider strategic terms, developing active and enterprising strategies that include social, political and ecological elements, besides the economic ones. The analysis of the relationship between companies and society is especially interesting when these companies operate in international markets. Countries demand that large corporations contribute to local, regional and national development in such a way that their resources are exchanged for a significant (...) increase in their citizens' quality of life. Faced with that fact, the aim of this work is to establish what actions the subsidiaries will take in order to offer a response to the needs of their stakeholders in the host countries. Secondly, we attempt to identify the factors explaining the different levels of social response of the subsidiaries established in a particular country by different parent companies. The empirical study was carried out on a sample of Spanish subsidiaries in the two manufacturing industries with most foreign investment (the chemical and automobile industries) and the results obtained both confirmed the validity of the tool used to measure social response and permitted us to determine which factors influence the institutionalisation of social responsiveness. (shrink)
This article empirically investigates how Chinese executives and managers perceive and interpret corporate social responsibility (CSR), to what extent firms’ productive characteristics influence managers’ attitudes towards their CSR rating, and whether their values in favour of CSR are positively correlated to firms’ economic performance. Although a large proportion of respondents express a favourable view of CSR and a willingness to participate in socially responsible activities, we find that the true nature of their assertion is linked to entrepreneurs’ instincts of (...) gaining economic benefits. It is the poorly performing firms, or rather, firms with vulnerable indicators – smaller in size, State-owned, producing traditional goods and located in poorer regions that are more likely to have managers who opt for a higher CSR rating. Managers’ personal characteristics per se are not significant in determining their CSR choice. Moreover, controlling for other observed variables, we find that managers’ CSR orientation is positively correlated with their firms’ performance. The better-off a firm is, the more likely its manager is to get involve in CSR activities. Firms with better economic performance before their restructuring would sustain higher post-restructuring performance. (shrink)
In bioethics, discussions of justice have tended to focus on questions of fairness in access to health care: is there a right to medical treatment, and how should priorities be set when medical resources are scarce. But health care is only one of many factors that determine the extent to which people live healthy lives, and fairness is not the only consideration in determining whether a health policy is just. In this pathbreaking book, senior bioethicists Powers and (...) Faden confront foundational issues about health and justice. How much inequality in health can a just society tolerate. The audience for the book is scholars and students of bioethics and moral and political philosophy, as well as anyone interested in public health and health policy. (shrink)
A rich literature in public health has demonstrated that health is strongly influenced by a host of environmental factors that can vary according to social, economic, geographic, cultural or physical contexts. Bioethicists should, we argue, recognize this and – where appropriate – work to integrate environmental concerns into their field of study and their ethical deliberations. In this article, we present an argument grounded in scientific research at the molecular level that will be familiar to – and (...) so hopefully more persuasive for – the biomedically-inclined in the bioethics community. Specifically, we argue that the relatively new field of molecular epigenetics provides novel information that should serve as additional justification for expanding the scope of bioethics to include environmental and public health concerns. We begin by presenting two distinct visions of bioethics: the individualistic and rights-oriented and the communitarian and responsibility-oriented. We follow with a description of biochemical characteristics distinguishing epigenetics from genetics, in order to emphasize the very close relationship that exists between the environment and gene expression. This then leads to a discussion of the importance of the environment in determining individual and population health, which, we argue, should shift bioethics towards a Potterian view that promotes a communitarian-based sense of responsibility for the environment, in order to fully account for justice considerations and improve public health. (shrink)
Recent research in epidemiology has identified a number of factors beyond access to medical care that contribute to health disparities. Among the so-called socioeconomic determinants of health are income, education, and the distribution of social capital. One factor that has been overlooked in this discussion is the effect that stigmatization can have on health. In this paper, I identify two ways that social stigma can create health disparities: directly by impacting health-care seeking (...) behaviour and indirectly through the internalization of negative interpersonal judgments. I then argue that social arrangements that foster self-respect can reduce the impact of stigmatization on health disparities. I conclude by showing how John Rawls' conception of justice can be used to address the intersection of stigma, health, and self-respect, in contrast to critics of his position, who have seen him as excessively focused on the allocation of material goods. (shrink)
Although the effectiveness of some tobacco programs and policies has been clearly demonstrated in reducing the overall population smoking prevalence, the health benefits are not equally distributed across all socio-economic classes; a situation that clearly runs against the equalitarian ethos of most modern states. In this article, we evaluate the benefits of using Sen’s Capability Approach as a theory of social justice to guide public health program and policy development in a way that would prevent the further (...) increase of inequalities in health outcomes. Starting from four consensual goals of tobacco control practice (i.e. that individuals live a smoke-free life, that smokers quit smoking, that non-smokers are protected from exposure to second-hand smoke and that smoking cessation support is accessible) we found that besides the standard interventions (e.g. education on the harms of smoking, policies to reduce exposure to SHS) an iniquity-proof tobacco control program needs also to address the lack of options of underprivileged people in affordable smoke-free settings and in leisure activities. We conclude that an ethical tobacco prevention program needs to address the broader socialdeterminants of health such as the socio-economic policies that put a strain on people’s capacity to shun or quit smoking. (shrink)
With the publication of the final report of the WHO Commission on the SocialDeterminants of Health, it becomes clear that there is considerable convergence between a policy agenda rooted on social epidemiology and one rooted in a concern for human rights. As commentators like Jonathan Mann have argued, concern for human rights and the achievement of social justice can inform and improve public health. In this article, we ask a different question: what does (...) a health perspective adds to the enduring fight for a more just world? We consider three possibilities: (1) that public health, in an inversion of Mann's argument, actually provides useful tools for specifying social injustice; (2) that, contrary to the usual critical stance and assumption of weakness, the institutions of public health bring powerful capacities to the practical promotion of social justice; and (3) that health as a banner mobilizes people who would not be mobilized to act in the name of social justice. (shrink)
Social exclusion and legal marginalization are important determinants of health outcomes for people who use illicit drugs, sex workers, and persons who face criminal penalties because of homosexuality or transgenderism. Incarceration may add to the health risks associated with police repression and discrimination for these persons. Access to legal services may be essential to positive health outcomes in these populations. Through concrete examples, this paper explores types of legal problems and legal services linked to (...) class='Hi'>health outcomes for drug users, sex workers, and sexual minorities and makes recommendations for donors, legal service providers, and civil society organizations. (shrink)
This article investigates the influence of innovation on the relationship between corporate strategy and social issues. Specifically, we employ firm-level data for a large sample of U.K. companies drawn from a diverse range of industrial sectors to investigate, given innovation, the determinants of both the probability that the innovation brings reduced environmental impacts and/or improved health and safety, and the strength of this effect. In this connection, we find evidence of a dichotomy between product and process innovations, (...) and roles for firm size, industrial sector, a foreign market presence, access to various information sources (e.g. universities and government research organisations) and the extent to which activities are constrained by regulation. Furthermore, we find a tendency for the influences of many of these factors to vary between older and newer firms. (shrink)
Research ethics is the most developed aspect of bioethics in Africa. Most African countries have set up Institutional Review Boards (IRBs) to provide guidelines for research and to comply with international norms. However, bioethics has not been responsive to local needs and values in the rest of the continent. A new direction is needed in African bioethics. This new direction promotes the development of a locally-grounded bioethics, shaped by a dynamic understanding of local cultures and informed by structural and institutional (...) problems that impact the public's health, as well as cognisant of the salient contribution of social sciences and social epidemiology which can bring a lasting impact on African local communities. In today's post-Structural Adjustment Africa, where healthcare has been liberalized and its cost increased, a bioethics agenda that focuses essentially on disease management and clinical work remains blind in the face of a structural marginalization of the masses of poor. Instead, the multidimensional public health crisis, with which most African countries are confronted, calls for a bioethics agenda that focuses primarily, but not exclusively, on health promotion and advocacy. Such an approach to bioethics reckons with the macro-determinants of health and well-being and places clinical and research ethics in the broader context of population's health. The same approach underscores the need to become political, not only by addressing health policymaking processes and procedures, but also by becoming an advocacy forum that includes other constituencies equipped with the potentialities to impact the population's health. (shrink)
BackgroundIncrease in global health research undertaken in resource poor settings in the last decade though a positive development has raised ethical concerns relating to potential for exploitation. Some of the suggested strategies to address these concerns include calls for providing universal standards of care, reasonable availability of proven interventions and more recently, promoting the overall social value of research especially in clinical research. Promoting the social value of research has been closely associated with providing fair benefits to (...) various stakeholders involved in research. The debate over what constitutes fair benefits; whether those that addresses micro level issues of justice or those focusing on the key determinants of health at the macro level has continued. This debate has however not benefited from empirical work on what stakeholders consider fair benefits. This study explores practical experiences of stakeholders involved in global health research in Kenya, over what benefits are fair within a developing world context.Methods and resultsWe conducted in-depth interviews with key informants drawn from within the broader health research system in Kenya including researchers from the mainstream health research institutions, networks and universities, teaching hospitals, policy makers, institutional review boards, civil society organisations and community representative groups.The range of benefits articulated by stakeholders addresses both micro and macro level concerns for justice by for instance, seeking to engage with interests of those facilitating research, and the broader systemic issues that make resource poor settings vulnerable to exploitation. We interpret these views to suggest a need for global health research to engage with current crises that face people in these settings as well as the broader systemic issues that produce them.ConclusionGlobal health research should provide benefits that address both the micro and macro level issues of justice in order to forestall exploitation. Embracing the two is however challenging in terms of how the various competing interests/needs should be balanced ethically, especially in the absence of structures to guide the process. This challenge should point to the need for greater dialogue to facilitate value clarification among stakeholders. (shrink)
This paper investigates the relative importance of social responsibility criteria in determining organizational effectiveness as seen by managers of two service industries. The Organizational Effectiveness Menu (Kraft and Jauch, 1988) was used as a questionnaire with a sample of 53 firms. The conclusion is that while managers view ethical conduct as among the most important determinants of organizational effectiveness, numerous other social responsibility criteria are assigned relatively low priority. A question remains as to what managers will actually (...) do when faced with limited resources. (shrink)
This paper investigates the relative importance of social responsibility criteria in determining organizational effectiveness. The organizational effectiveness menu was used as a questionnaire with a sample of 151 senior undergraduates. Each respondent was asked to rate the importance of the criteria from three constituent perspectives within a service organization: (1) as a manager, (2) as an investor, (3) as an employee. Later, a subsample of students (n=61) responded to the same questionnaire acting as a manager in an assigned case (...) study. The results indicated that students acting as managers, investors, or employees rate social responsibility criteria among the least important of the determinants of organizational effectiveness. Moreover, while specific situations may call for changes in the relative importance of these criteria, social responsibility criteria were not viewed, generally, as the most important determinants of organizational effectiveness. (shrink)
This paper, Study II, is the second in a series of papers investigating the relative importance of social responsibility criteria in determining organizational effectiveness, using student samples. A revised version of the Organizational Effectiveness Menu was used as a questionnaire with a sample of 182 senior undergraduate and the MBA students from three universities. Each respondent was asked to rate the importance of the criteria from a manager''s perspective. The results support the earlier findings that students responding as managers (...) rate social responsibility criteria, individually and collectively, among the least important of the potential determinants of organizational effectiveness. (shrink)
With increasing calls for global health research there is growing concern regarding the ethical challenges encountered by researchers from high-income countries (HICs) working in low or middle-income countries (LMICs). There is a dearth of literature on how to address these challenges in practice. In this article, we conduct a critical analysis of three case studies of research conducted in LMICs. We apply emerging ethical guidelines and principles specific to global health research and offer practical strategies that researchers ought (...) to consider. We present case studies in which Canadian health professional students conducted a health promotion project in a community in Honduras; a research capacity-building program in South Africa, in which Canadian students also worked alongside LMIC partners; and a community-university partnered research capacity-building program in which Ecuadorean graduate students, some working alongside Canadian students, conducted community-based health research projects in Ecuadorean communities. We examine each case, identifying ethical issues that emerged and how new ethical paradigms being promoted could be concretely applied. We conclude that research ethics boards should focus not only on protecting individual integrity and human dignity in health studies but also on beneficence and non-maleficence at the community level, explicitly considering social justice issues and local capacity-building imperatives. We conclude that researchers from HICs interested in global health research must work with LMIC partners to implement collaborative processes for assuring ethical research that respects local knowledge, cultural factors, the social determination of health, community participation and partnership, and making social accountability a paramount concern. (shrink)
This article presents a new interpretation of the concept of social relations of production in Marx. Against G.A. Cohen, it argues that social relations of production are relations of interaction between persons, not relations of de facto control between persons and means of production. It argues further that these relations are relations of 'de facto recognition', that is, relations constituted by actions in which individuals treat each other as if they recognised each other in certain ways, whether or (...) not the relevant recognitional attitudes are present. (shrink)
The widespread impression that recent philosophy of science has pioneered exploration of the “social dimensions of scientific knowledge‘ is shown to be in error, partly due to a lack of appreciation of historical precedent, and partly due to a misunderstanding of how the social sciences and philosophy have been intertwined over the last century. This paper argues that the referents of “democracy‘ are an important key in the American context, and that orthodoxies in the philosophy of science tend (...) to be molded by the actual regimes of science organization within which they are embedded. These theses are illustrated by consideration of three representative philosophers of science: John Dewey, Hans Reichenbach, and Philip Kitcher. [Copyright &y& Elsevier]. (shrink)
This paper attempts some predictions about the social consequences of nanotechnology and the ethical issues they raise. I set out four features of nanotechnology that are likely to be important in determining its impact and argue that nanotechnology will have significant social impacts in—at least—the areas of health and medicine, the balance of power between citizens and governments, and the balance of power between citizens and corporations. More importantly, responding to the challenge of nanotechnology will require confronting (...) “philosophical” questions about the sort of society we wish to create and the role that technology might play in creating it. This in turn will require developing institutions and processes that allow the public to wield real power in relation to technological trajectories. My ultimate contention is that the immediate task established by the likely social impacts of nanotechnology is not so much to develop an ethics of nanotechnology as to facilitate an ethical conversation about nanotechnology. (shrink)
In recent years we have seen the emergence of “personalised medicine.” This development can be seen as the logical product of reductionism in medical science in which disease is increasingly understood in molecular terms. Personalised medicine has flourished as a consequence of the application of neoliberal principles to health care, whereby a commercial and social need for personalised medicine has been created. More specifically, personalised medicine benefits from the ongoing commercialisation of the body and of genetic knowledge, the (...) idea that health is defined by genetics, and the emphasis the state places on individual citizens as being “responsible for” their own health. In this paper I critique the emergence of personalised medicine by examining the ways in which it has already impacted upon health and health care delivery. (shrink)
The recent confirmation of the constitutionality of the Obama administration’s Patient Protection and Affordable Care Act (PPACA) by the US Supreme Court has brought to the fore long-standing debates over individual liberty and religious freedom. Advocates of personal liberty are often critical, particularly in the USA, of public health measures which they deem to be overly restrictive of personal choice. In addition to the alleged restrictions of individual freedom of choice when it comes to the question of whether or (...) not to purchase health insurance, opponents to the PPACA also argue that certain requirements of the Act violate the right to freedom of conscience by mandating support for services deemed immoral by religious groups. These issues continue the long running debate surrounding the demands of religious groups for special consideration in the realm of health care provision. In this paper I examine the requirements of the PPACA, and the impacts that religious, and other ideological, exemptions can have on public health, and argue that the exemptions provided for by the PPACA do not in fact impose unreasonable restrictions on religious freedom, but rather concede too much and in so doing endanger public health and some important individual liberties. (shrink)
Background Next Generation Sequencing (NGS) is expected to help find the elusive, causative genetic defects associated with Bipolar Disorder (BD). This article identifies the importance of NGS and further analyses the social and ethical implications of this approach when used in research projects studying BD, as well as other psychiatric ailments, with a view to ensuring the protection of research participants. Methods We performed a systematic review of studies through PubMed, followed by a manual search through the titles and (...) abstracts of original articles, including the reviews, commentaries and letters published in the last five years and dealing with the ethical and social issues raised by NGS technologies and genomics studies of mental disorders, especially BD. A total of 217 studies contributed to identify the themes discussed herein. Results The amount of information generated by NGS renders individuals suffering from BD particularly vulnerable, and increases the need for educational support throughout the consent process, and, subsequently, of genetic counselling, when communicating individual research results and incidental findings to them. Our results highlight the importance and difficulty of respecting participants’ autonomy while avoiding any therapeutic misconception. We also analysed the need for specific regulations on the use and communication of incidental findings, as well as the increasing influence of NGS in health care. Conclusions Shared efforts on the part of researchers and their institutions, Research Ethics Boards as well as participants’ representatives are needed to delineate a tailored consent process so as to better protect research participants. However, health care professionals involved in BD care and treatment need to first determine the scientific validity and clinical utility of NGS-generated findings, and thereafter their prevention and treatment significance. (shrink)
In this paper I analyze interpersonal and institutional recognition and discuss the relation of different types of recognition to various principles of social justice (egalitarianism, meritarianism, legitimate favouritism, principles of need and free exchange). Further, I try to characterize contours of good autonomous life, and ask what kind of preconditions it has. I will distinguish between five kinds of preconditions: psychological, material, cultural, intersubjective and institutional. After examining what the role of recognition is among such preconditions, and how they (...) figure in the work of Axel Honneth, Nancy Fraser and Charles Taylor, I suggest a somewhat complex and hopefully rich picture of interpersonal and institutional recognition as a precondition of autonomous good life. (shrink)
The human ability to represent, conceptualize, and reason about mind and behavior is one of the greatest achievements of human evolution and is made possible by a “folk theory of mind” — a sophisticated conceptual framework that relates different mental states to each other and connects them to behavior. This chapter examines the nature and elements of this framework and its central functions for social cognition. As a conceptual framework, the folk theory of mind operates prior to any particular (...) conscious or unconscious cognition and provides the “framing” or interpretation of that cognition. Central to this framing is the concept of intentionality, which distinguishes intentional action (caused by the agent’s intention and decision) from unintentional behavior (caused by internal or external events without the intervention of the agent’s decision). A second important distinction separates publicly observable from publicly unobservable (i.e., mental) events. Together, the two distinctions define the kinds of events in social interaction that people attend to, wonder about, and try to explain. A special focus of this chapter is the powerful tool of behavior explanation, which relies on the folk theory of mind but is also intimately tied to social demands and to the perceiver’s social goals. A full understanding of social cognition must consider the folk theory of mind as the conceptual underpinning of all (conscious and unconscious) perception and thinking about the social world. (shrink)
This paper discusses the concept of Dána or charity as the foundation of Indian Social life. Dána has been in vogue in India since the Vedic times, but it was codified by the smritis which prescribe do’s and don’ts of the life of the individual. Limiting its scope to Yagnavalkya smriti the paper analyses the significance of Dána as a regulative principle of accumulation of wealth.
mechanism" is frequently encountered in the social science literature, but there is considerable confusion about the exact meaning of the term. The article begins by addressing the main conceptual issues. Use of this term is the hallmark of an approach that is critical of the explanatory deficits of correlational analysis and of the covering-law model, advocating instead the causal reconstruction of the processes that account for given macro-phenomena. The term "social mechanisms" should be used to refer to recurrent (...) processes generating a specific kind of outcome. Explanation of social macro-phenomena by mechanisms typically involves causal regression to lower-level elements, as stipulated by methodological individualism. While there exist a good many mechanism models to explain emergent effects of collective behavior, we lack a similarly systematic treatment of generative mechanisms in which institutions and specific kinds of structural configurations play the decisive role. Key Words: causal regression • correlational analysis • emergent effects • micro-macro processes • social mechanisms • structural determinants. (shrink)
The context of international health research involving human subjects, and this should appear obvious, is the human community. As such, basic questions of how human beings should be treated by other human beings, particularly in situations of unequal power – e.g., in the form of control, choice, or opportunity – lay at the foundations of related ethical discourse when ethics are discussed at all. I trace a narrative that follows upon a recent revision process of international guidelines for biomedical (...) research involving human subjects. I focus in particular upon the issue of a standard of care. In the second section, I draw upon philosophers John Rawls, Claudia Card, and Allen Buchanan to discuss concerns regarding the 'least advantaged members of society' in the context of global inequality. The paper includes reflections upon pedagogy in courses focused upon international health research involving human subjects. (shrink)
A clear understanding of the concept of health plays a key role in defining what health care should comprise and in developing adequate strategies for overcoming the current "health care crisis". This volume is the result of an international and interdisciplinary cooperation between medicine and philosophy on the current debate on the concept of health.Besides offering a critical analysis of the WHO definition and a review of both ancient and contemporary conceptions of health, the cooperative (...) effort of physicians and philosophers presented in this book works through the challenges which any definition of health faces, if it is to be both truly personalist, and at the same time operational.The overall purpose of this book is to capture the essentials of human health and to propose the outlines for a personalist understanding of this concept, i.e., a conception that does justice to the personal nature of human beings by introducing dimensions that are essential to personal life and well-being, such as the realms of rationality, affectivity and freedom, the realms of meaning, values, morality, and spirituality, the realms of social and interpersonal relations. To grasp the uniqueness of the human person is not yet to grasp the specific nature of personal health. But it is certainly a first step, and it becomes evident that every theory of human health presupposes a theory of the person. Accordingly, the debate presented in this book is no less a debate about the nature of the human person than it is a debate about the nature of health.The investigations offered in this volume intend to provide an impetus for new conceptions of personhood and human health. The phenomenological approach has the advantage of advocating a systematic conception of the total person which combines surface experiences (subjective experiences of well-being) with deeper dimensions of the person (value and being). An adequate conception of the human person has enormous implications not only for our understanding of what constitutes the health and well-being of the person, but also for our conception of what health care should comprise. Hence, answering the philosophical questions, such as those raised in this volume about health, is crucial for the solution of political problems such as how to legislate health care policy. (shrink)
This paper aims to increase the reader’s understanding of how the notion of the ‘bobby on the beat’ has been elevated to iconic, if not mythical, status within British policing. In doing so, the article utilises the semiotic idea of myth, as conceptualized by Roland Barthes, to explore how through representations of the ‘bobby on the beat’ police officers have been projected in a more avuncular re-assuring role to a public fearful of crime, which fails to do service to the (...) signifying practices that accompany and embody the visible police patrol. Indeed, police patrol work secures social space for the State and although it does re-assure anxious members of society that their social world is safe and secure, for others, it further illustrates how their social space is fragile and troubled. On another level, the ‘bobby’ narrative has also been harnessed as part of a broader mythologizing of ‘Englishness’ and quintessential British characteristics. (shrink)
The foundations of the health sciences need to be re-conceptualized. The mechanistic biomedical model seemingly so successful in the past is now criticized for its failure to explain what health is and how it can be maintained. The world's major health problems no longer seem to be under control. Towards a New Science of Health presents a radical alternative to current biomedical thinking. This unique and controversial book is the first to offer serious practical ideas for (...) the renewal of the health sciences. It provides both a radical spirit of inquiry which draws on a broad knowledge base and a variety of approaches, and a science which will build on innovative research. Presenting an overview of all major paradigms in the health sciences, their historical development, sociocultural background and value, the book provides a framework for innovative thinking in health. Drawing on a range of disciplinary perspectives and focusing on a variety of approaches systems theory, human experience, and biography, the healing process and social relations the authors aim to bridge the gap between personal experience and scientific knowledge. (shrink)
Road traffic injury and deaths (RTID) are an important public health problem in Kenya, primarily affecting uneducated and disenfranchised people from lower socioeconomic groups. Studies conducted by Kenyan experts from police reports and surveys have shown that pedestrian and driver behaviors are the most important proximal causes of crashes, signifying that the occurrence of crashes results directly from human action. However, behaviors and risk factors do not fully explain the magnitude of RTID neither does it account for socioeconomic gradient (...) in RTID. Instead, a social justice approach to RTID highlights the need for emphasizing distal causal factors. They allow us to understand how social inequities determine risk for RTID. Hence, designing policies that focus on behaviors will simply mask the underlying systemic causes of this growing phenomenon. To eradicate the RTID and address the gradient, a broader policy framework that includes the social dimension of injury, a strong political will to address the underlying causes of RTID and an effective partnership with stakeholders needs to be developed. (shrink)
Social change is a structural transformation of political, social and economic systems and institutions to create a more equitable and just society and it is a universal phenomenon and it occurs in every society. Technically said that social change refers to an alteration in the social order of a social group or society; a change in the nature, social institutions, social behaviours or social relations of a society. As we know Change is (...) inevitable and it takes place in all fields. The term “social change” is often used to describe variations in, or, modifications of any respect of social process, social patterns, social interaction or social organization. Great thinkers emerged from various societies induce social change in different times. (shrink)
Research has shown that the brain is constantly making predictions about future events. Theories of prediction in perception, action and learning suggest that the brain serves to reduce the discrepancies between expectation and actual experience, i.e., by reducing the prediction error. Forward models of action and perception propose the generation of a predictive internal representation of the expected sensory outcome, which is matched to the actual sensory feedback. Shared neural representations have been found when experiencing one's own and observing other's (...) actions, rewards, errors, and emotions such as fear and pain. These general principles of the “predictive brain” are well established and have already begun to be applied to social aspects of cognition. The application and relevance of these predictive principles to social cognition are discussed in this article. Evidence is presented to argue that simple non-social cognitive processes can be extended to explain complex cognitive processes required for social interaction, with common neural activity seen for both social and non-social cognitions. A number of studies are included which demonstrate that bottom-up sensory input and top-down expectancies can be modulated by social information. The concept of competing social forward models and a partially distinct category of social prediction errors are introduced. The evolutionary implications of a “social predictive brain” are also mentioned, along with the implications on psychopathology. The review presents a number of testable hypotheses and novel comparisons that aim to stimulate further discussion and integration between currently disparate fields of research, with regard to computational models, behavioral and neurophysiological data. This promotes a relatively new platform for inquiry in social neuroscience with implications in social learning, theory of mind, empathy, the evolution of the social brain, and potential strategies for treating social cognitive deficits. (shrink)
What is health policy for? In Health and the Good Society, Alan Cribb addresses this question in a way that cuts across disciplinary boundaries. His core argument is that biomedical ethics should draw upon public health values and ethics; specifically, he argues that everybody has some share of responsibility for health, including a responsibility for promoting greater health equality. In the process, Cribb argues for a major rethink of the whole project of health education.
This paper considers proposals for developing ‘co-productive’ medical partnerships, within the UK National Health Service (NHS), concentrating in particular on the potential problem involved in combining professional and lay conceptions of health. Much of the literature that advocates the introduction of co-productive healthcare partnerships assumes that medical professionals and patients share, or can easily come to share, a common set of beliefs about what is valuable with regard to health interventions and outcomes. However, a substantial literature documents (...) the contestability of the concept of health, particular across professional and lay divides. We suggest that this potential disagreement ought to be taken seriously, and suggest that the prospect of a co-productive NHS in which patients and professionals act in partnership is threatened by the existence of unresolved epistemic differences. We suggest that part of the solution may lie in re-framing this potential disagreement in the terms provided by Engel’s bio-psycho-social account of health, and demonstrate how support for this account can be grounded upon a critical realist foundation. What we call a ‘stratified conception of health’ reveals the potential complementarity between health beliefs which may have at first seemed to be essentially contradictory. We consider some of the practical implications this idea has for conceiving and creating co-productive medical partnerships. (shrink)
Powers and Faden argue that social justice ‘is concerned with securing and maintaining the social conditions necessary for a sufficient level of well-being in all of its essential dimensions for everyone’ (2006: 50). Moreover, social justice is concerned with the ‘achievement of well-being, not the freedom or capability to achieve well-being’ (p. 40). Although Powers and Faden note that an agent alone cannot achieve well-being without the necessary social conditions of life (e.g. equal civil liberties and (...) basic material resources, such as food and shelter), it seems that achievement requires that an agent actually pursue the six dimensions of well-being. In this article, I question the extent to which an individual has an obligation to achieve well-being, even if he or she would choose to do otherwise. For example, can an agent choose to forgo being healthy even if all the social conditions are met in her life, thereby choosing to not achieve well-being? It remains unclear how the dimension of self-determination coheres with the remaining five dimensions of well-being and the extent of society’s obligations toward an individual’s achievement of well-being, even in those instances when society’s actions may go against an individual’s right to self-determination. (shrink)
In my 1990 work – Marxism, Morality, and Social Justice – I argued for four modifications of Rawls’s principles of social justice and rendered a modified version of his theory in four principles, the first of which is the Basic Rights Principle demanding the protection of people’s security and subsistence rights. In both his Political Liberalism (1993) and Justice as Fairness (2001) Rawls explicitly refers to my version of his theory, clearly accepting three of my four proposed modifications (...) but rejecting the fourth -- the demand for social and economic (in addition to political) democracy – on grounds that it automatically justifies socialism as opposed to capitalism. I argue, contrary to Rawls, that it is not true that this demand automatically picks (democratic) socialism as the preferable socioeconomic/political system and that a Social and Economic Democracy Principle demanding workplace and neighborhood democracy is officially neutral between these two systems … although plausible empirical assumptions may, indeed, favor the former. I then reprise my second version of Rawls’s theory of social justice which is composed of the following principles arranged in a very strong order of priority (if not quite a lexical order): (1) Basic Rights Principle, (2) Equal Basic Liberties Principle, (3) Fair Equality of Opportunity Principle, (4) Modified Difference Principle, and (5) Social and Economic Democracy Principle. (shrink)
Akrasia is not always --or only-- a solitary failure to act on a person's judgment of what is, all things considered, best. Nor is it always a species of moral or ethical failure prompted by a form of irrationality. It is often prompted by social support and sustained by structuring political institutions.
