Abstract
Applying equity to health care is difficult and it is especially challenging when applied to cases that involve urgent military medicine care under resource scarcity. Part of the difficulty centers on the concept of equity itself. It is not clear what the best concept of equity applicable to medical care would be, or that there should be only one, or the same ones, across all levels of military health care. Despite the fact that equity is a key concern in health care, particularly in the age of the COVID-19 pandemic, it may be that there is no single theory of justice that would be most justified for military physicians to use. This paper examines whether a hybrid position of equity might be both theoretically robust and applicable in practice. After briefly introducing the discussion, we outline four major philosophical definitions of equity – (1) Egalitarianism, (2) Prioritarianism, (3) Desertism, and (4) Sufficientism. We then report empirical findings suggesting that a practice-based hybrid concept of equity is used by physicians within the practice of micro-allocation. Our findings will shed lights on ethical justifications and reasoning which should guide medical rules for military and humanitarian health care providers.
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Notes
- 1.
In light of the global pandemic and the resulting plethora of bioethical literature surrounding the equitable distribution of ICU beds, hospital ventilators, and COVID-19 vaccines, this chapter will focus on what the authors suspect may be more prominent future ethical concerns. However, the contemporary literature surrounding fairness is still included in the chapter’s argumentative framework.
- 2.
More precisely, this is what Parfit calls the Telic egalitarianism. See (Parfit 1997, 204).
- 3.
This definition by Broome is quite similar to Rawls’s principle of difference. Fleurbaey also calls it the Pareto principle. For Brown, the major distinction between Absolute Prioritarianism and Rawl’s difference principle is that the latter is defined in space of “primary goods” rather than that of wellbeing. See Brown footnote 11 in (Brown 2005).
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- 5.
- 6.
Although it is not purely a hybrid, Huseby’s sufficientism has some analogies with Casal’s suggestion of sufficiency-constrained prioritarianism. Huseby view defends that below the threshold, a form of prioritarian reasoning might be adopted to specify how distribution should be conducted. See (Huseby 2010).
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Gilbert, F., Stevens, I., Hurst, S. (2023). Fairness in Military Care: Might a Hybrid Concept of Equity Be the Answer?. In: Eagan, S.M., Messelken, D. (eds) Resource Scarcity in Austere Environments. Military and Humanitarian Health Ethics. Springer, Cham. https://doi.org/10.1007/978-3-031-29059-6_10
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