This paper develops a conceptual framework, which can accommodate a wide range of value judgements used in ethical evaluations of extended social states and which can be used to differentiate different categories of value judgements by referring to the type of information on which they may be based. The notions of consequentialism, non-consequentialism, exclusive focus on personal well-being, exclusive focus on utility, etc. are conceptualized in operational ways in the framework. The framework and the discussion of different types of ethical (...) criteria that may be used in evaluating extended social states contribute to conceptual clarity about the ethical bases of public policies. (shrink)

Growing data on the socioeconomic determinants of health pose a challenge to analysis and application of fairness in health. In Just health: meeting health needs fairly, Norman Daniels argues for a change in the population end of our thinking about just health. What about clinical care? Given our knowledge of the importance of wealth, education or social status to health, is fairness in medicine served better by continuing to avoid considering our patients’ social status in setting clinical priorities, or by (...) attempting to equalise existing health inequalities by giving priority to the socioeconomically disadvantaged at the point of care? In this article, I argue that doctors should not attempt the latter. Granted, giving priority to low status would go some way towards compensating unjust health inequalities and the impression of being left aside in other social spaces. It would represent reverse discrimination, but could still be justified inasmuch as disadvantaged groups could be identifiable, and as long as the intent was compensation rather than retribution. However, under current circumstances such priority would risk being attributed arbitrarily, would represent a form of medical proselytising, risk leaving the worst-off with less by alienating the powerful, and require teaching doctors to act in strongly counter-cultural ways—possibly at great cost. Crucially, however, we protect both equal health and equal regard by treating all alike: priority to low status would promote the first somewhat, but at the expense of sacrificing the second. (shrink)

Affirmative action has been a particularly contentious policy issue that has polarised contributions to the debate. Over recent times in most western countries, support for affirmative action has, however, been largely snuffed out or beaten into retreat and replaced by the concept of ‹diversity management’. Thus, any contemporary study that examines the development of affirmative action would suggest that its opponents have won the battle. Nonetheless, this article argues that because the battle has been won on dubious ethical grounds it (...) is important that we do not allow affirmative action to sink unnoticed. This article explores and challenges the ethical and philosophical underpinnings of opponents’ views and finds their cases against affirmative action are not ethically sound. The article concludes there are strong ethical grounds for those organisations which seek to do well, to reassert affirmative action programmes in the global efforts to eradicate systemic discrimination and disadvantage. (shrink)

This dissertation is a critical examination and rejection of the two principal types of moral justification, the compensatory and noncompensatory, of affirmative action involving preferential treatment for blacks, Hispanics,American Indians, and women in hiring, promotions, andadmissions. Neither of these approaches to the justification of AA, I have argued, is able to defend AA successfully. AA not morally justified. Thus, succeeding compensatory arguments for AA, individualand group oriented, are unable to evade, undermine,or disarm the objections that AA violates the principles of (...) compensatory justice governing who is owed compensation, what compensation is owed, and who owes compensation, and that AA violates the principles of justice and fundamental individual moral rights governing the distribution of such social goods or benefits as desirable and valuable positions. The principles of justice and moral rights violated by AA govern the distribution of social benefits, including desirable positions, and burdens and systematize, unify, and explain correct moral judgments about the injustice of actions, policies, and practices in a variety of contexts of distribution. Moreover, backward-looking or compensatory arguments for AA have the implication that unjust and morally unacceptable compensatory policies that are morally similar to AA would be justified in contexts other than hiring, promotions, and admissions. Furthermore, the noncompensatory justifications of AA, including meritocratic and utilitarian forward-looking arguments, are unable to evade or to undermine the objection that AA violates principles of justice and fundamental individual moral rights and the objection that these attempted justifications of AA have the implication that unjust and morally unacceptable noncompensatory, forward-looking policies that are morally similar to AA would also be justified in contexts other than the standard ones. (shrink)