Equity in Early Modern Legal Scholarship takes the reader through the vast amount of legal writings on equity that were published in continental Europe in early modern times. The book offers the first comprehensive overview of the development of the legal concept of equity through the sixteenth and seventeenth century. During this time, equity scholarship broke with its medieval past and entered a lively debate on the nature and function of the concept. Lorenzo Maniscalco links these (...) developments to the early modern identification of equity with Aristotelian epieikeia, a conceptual shift that brought down the barrier that divided theological and legal writings on equity and led to its development as a tool for the interpretation and amendment of legal rules. (shrink)

Both intertemporal and intratemporal equity are central to the examination of policy towards climate change. However, many discussions of intertemporal issues have been marred by serious analytical errors, particularly in applying standard approaches to discounting; the errors arise, in part, from paying insufficient attention to the magnitude of potential damages, and in part from overlooking problems with market information. Some of the philosophical concepts and principles of Paper 1 are applied to the analytics and ethics of pure-time discounting and (...) infinite-horizon models, providing helpful insights into orderings of welfare streams and obligations towards future generations. Such principles give little support for the idea of discrimination by date of birth. Intratemporal issues are central to problematic and slow-moving international discussions and are the second focus of this paper. A way forward is to cast the policy issues and analyses in a way that keeps equity issues central and embeds them in the challenge of fostering the dynamic transition to the low-carbon economy in both developed and developing countries. This avoids the trap of seeing issues primarily in terms of burden-sharing and zero-sum games – that leads to inaction and the most inequitable outcome of all. (shrink)

Offering a new answer to an age-old problem: the meaning of a just or equitable distribution of resources, Julian Le Grand examines the principal interpretations of equity used by economists and political philosophers. He argues that none captures the essence of the term as well as an alternative conception relating equity to the existence or otherwise of individual choice. Le Grand shows that this conception is not only philosophically well-grounded but is also directly relevant to key areas of (...) distributional policy. His theoretical argument is complemented by detailed discussion of the application of the central idea to specific areas of policy, including the distribution of health and health care, central government grants to local governments and the measurement of income for tax purposes. Equity and Choice is written by an economist, but is intended for political philosophers and social policy analysts as well as economists. Hence the key chapters are written in a non-technical fashion, with specialized material relegated to appendices. This book is a unique combination of philosophical, economic and policy analysis and represents a major contribution in all three areas. (shrink)

This paper focuses on the potential of “equitech”—AI technology that improves equity. Recently, interventions have been developed to reduce the harm of implicit bias, the automatic form of stereotype or prejudice that contributes to injustice. However, these interventions—some of which are assisted by AI-related technology—have significant limitations, including unintended negative consequences and general inefficacy. To overcome these limitations, we propose a two-dimensional framework to assess current AI-assisted interventions and explore promising new ones. We begin by using the case of (...) human resource recruitment as a focal point to show that existing approaches have exploited only a subset of the available solution space. We then demonstrate how our framework facilitates the discovery of new approaches. The first dimension of this framework helps us systematically consider the analytic information, intervention implementation, and modes of human-machine interaction made available by advancements in AI-related technology. The second dimension enables the identification and incorporation of insights from recent research on implicit bias intervention. We argue that a design strategy that combines complementary interventions can further enhance the effectiveness of interventions by targeting the various interacting cognitive systems that underlie implicit bias. We end with a discussion of how our cognitive interventions framework can have positive downstream effects for structural problems. (shrink)

We report the results of a vignette study with an online sample of the German adult population in which we analyze the interplay between need, equity, and accountability in third-party distribution decisions. We asked participants to divide firewood between two hypothetical persons who either differ in their need for heat or in their productivity in terms of their ability to chop wood. The study systematically varies the persons’ accountability for their neediness as well as for their productivity. We find (...) that participants distribute significantly fewer logs of wood to persons who are held accountable for their disadvantage. Independently of being held accountable or not, the needier person is partially compensated with a share of logs that exceeds her contribution, while the person who contributes less is given a share of logs smaller than her need share. Moreover, there is a domain effect in terms of participants being more sensitive to lower contributions than to greater need. (shrink)

Access to education for undocumented migrant children in South Africa remains a significant challenge. While the difficulties related to their inability to access education within the country have been highlighted elsewhere, there remains a lack of clarity on an approach to how this basic human right can be achieved. In this conceptual paper, we draw on the distinction between equality and equity, and describe the various ways in which education has been conceptualised in the South African Constitution – which (...) in part contributes to the existing confusion on education for various groups, including undocumented migrant children. In this paper, we critically reflects on the need to develop an integrated approach for creating a platform that allows all undocumented migrant children access to education in South Africa. We argue that an integrated approach – which entails ways through which access to education can be delivered through the lens of equity – will enhance the right to education for undocumented migrant children in South Africa. We conclude that the South African government must urgently consider this integrated approach to enable access to education for undocumented migrant children, so that they can achieve their full educational potential. (shrink)

The fusion of law and equity in common law systems was a crucial moment in the development of the modern law. In this volume leading scholars assess the significance of the fusion of law and equity from comparative, doctrinal, historical and theoretical perspectives.

The dominance of agency theory can reduce our collective scope to analyse private equity in all its diversity and depth. We contribute to theorisation of private equity by developing a contrasting perspective that draws on a rich tradition of virtue ethics. In doing so, we juxtapose 'private equity' with 'public good' to develop points of rhetorical and analytical contrast. We develop a typology differentiating various forms of private equity, and focus on the 'take private' form. These (...) takeovers are where private equity funds are used to buy all a firm's publicly listed shares. Take private deals reduce reporting requirements and lessen the amount of public scrutiny a firm comes under. They allow greater control of a firm's assets and resources but also have effects in terms of the wider social fabric. The 'public good' and virtue ethics offer an alternative basis for theorisation of these deals. This provides a needed contrast to accounts of private equity based on agency theory. (shrink)

ABSTRACT:In this response, I reiterate my argument that price gouging undercuts the goal of equity in access to essential goods whereas Zwolinski emphasizes the importance of the efficient provision of essential goods above all other goals. I agree that the efficient provision of essential goods is important as I argue for the goal of equitable access to sufficient of the goods essential to living a minimally flourishing human life. However, efficiency is a means to this goal rather than the (...) end itself. Finally, I offer additional arguments against the non-worseness claim. (shrink)

Health equity is increasingly identified as a principal goal to be achieved through public health policies and activities. However, what is to be measured in the assessment of health equity and how inequities in health ought to be redressed are among the pressing questions that must be answered if health equity is to serve as a meaningful and consistent ethical guide for measurement and intervention in public health. In this article I argue that the concept of health (...) equity, in the form it is predominantly found in public health, suffers from normative indeterminacy and is therefore unlikely to provide actionable normative guidance to public health policy-makers, practitioners and researchers. I argue that the concept of health equity, as it is commonly defined in public health, ultimately rests upon assumptions of a more fundamental, yet tacit, conception of justice to do its normative work. In this vein, I expand upon a critique of Margaret Whitehead’s oft-cited definition of health equity made by James Wilson to raise additional reasons not explored by Wilson, or others, as to why Whitehead’s definition remains inadequate in providing normative guidance to policy-makers, practitioners and researchers in public health. (shrink)

This book sets out to defend the claim that Equity ought to remain a separate body of law; the temptation to iron-out the differences between neighbouring doctrines on the two sides of the Equity/Common Law divide should, in most cases, be resisted. The theoretical part of the book is argues that the characteristics of Equity, namely, appeal to conscience, flexibility, retroactivity and the use of morally-freighted jargon, are essential for the implementation of a legal ideal that has (...) been neglected by the Common Law: 'Accountability Correspondence'. According to this fundamental legal ideal, liability imposed by legal rules should correspond to the pattern of moral duty in the circumstances to which the rules apply. Equity promotes this ideal in the fields of property and obligations by disallowing parties to exploit the rule-like nature of Common Law norms in a way that breaches their moral duty to the other party. By reference to various equitable doctrines, it is argued that the faults identified by critics of Equity, especially from the perspective of the Rule of Law, are highly exaggerated, and that the criticism often reflects a political belief in the supremacy of individualism and free market over empathy and social justice. The theoretical part is followed by three chapters, each dedicated to an in-depth analysis of the equitable doctrines of fiduciary duties, proprietary estoppel, and clean hands. For each doctrine, it is shown how their equitable characteristics are indispensable for achieving their social, ethical and economic purpose. (shrink)

We wholeheartedly agree with Schmidt and colleagues’ efforts to promote equity in intensive care unit triage. We also take issue with their characterisation of the New Jersey allocation framework for ICU beds and ventilators, which is modelled after the multi-principle allocation framework we developed early in the pandemic. They characterise it as a two-criterion allocation framework and claim—without evidence—that it will ‘compound disadvantage for black patients’. However, the NJ triage framework—like the model allocation policy we developed—actually contains four allocation (...) criteria: the two criteria that the authors mentioned and two criteria that they failed to mention which we included to promote equity: giving priority to frontline essential workers and giving priority to younger patients. These omissions are problematic both for reasons of factual accuracy and because the two criteria they failed to acknowledge would likely mitigate rather than exacerbate racial disparities during triage. (shrink)

Equity in health and health care is animportant issue. It has been proposed that thepursuit of equity in health care is beinghampered by the dominance of individualism inhealth care practices. This paper explores theway in which communitarian ideals and practicesmight lend themselves to the pursuit of equity.Communitarians acknowledge, respect and fosterthe bonds that unite and identify communities.The paper argues that, to achieve equity inhealth care, these bonds need to be recognisedand harnessed rather than ignored. The notionof (...) individual autonomy in the context of thecommunity is examined. Alternative concepts ofautonomy – social autonomy and communityautonomy – are seen to be more respectful andnurturing of both the individual and thecommunity. Moreover, these concepts appeardesirable for the pursuit of health care equitygoals. The paper concludes with some thoughtsabout how equity in Australia's health caresystem can reasonably progress within acommunitarian vision. Disadvantaged communitiesare discussed throughout, in particular,Australian Aboriginal communities. (shrink)

Organs for transplantation are a scarce resource. Markedly, the transplant community’s primary challenge is the stark disparity between the number of patients awaiting deceased donor organ transplants and the rate at which organs become available. However, the allocation of a limited number of organs poses another constant challenge: maintaining an equilibrium between renal transplant utility and equity, that is, striking a balance between the utilitarian argument of medical efficiency and the principle of equity. In this comprehensive overview, the (...) authors delve into the challenge of maintaining an acceptable balance between equity and efficiency and elaborate on some of the factors that might inform a decisionmaker’s evaluation of the extent to which a given allocation scheme is efficient or equitable. (shrink)

Aristotelian equity has often been relegated to scholarly discussions of retributive justice. Recently, however, political theorists have recast equity as the virtue of a sympathetic democratic citizen. I build on this literature by offering a more precise explanation of equity’s internal structure and political significance. In particular, I reveal equity’s deliberative dimension. For Aristotle, equitable citizens, statesmen, and legislators correct or go beyond the law, as appropriate, not only when they render retrospective judgments about matters of (...) punishment or distribution, but also when they deliberate about future-oriented questions of legislation or political action. In addition, I show, more concretely, the role of equity in democratic citizenship. Drawing upon the Aristotelian Constitution of the Athenians, I argue that the Athenian demos exemplified equity when it brought about the reconciliation and the amnesty of 403 BC. Attention to this episode clarifies the conceptual linkages between equity, deliberation, sympathy, and democracy. (shrink)

In this response, I reiterate my argument that price gouging undercuts the goal of equity in access to essential goods whereas Zwolinski emphasizes the importance of the efficient provision of essential goods above all other goals. I agree that the efficient provision of essential goods is important as I argue for the goal of equitable access to sufficient of the goods essential to living a minimally flourishing human life. However, efficiency is a means to this goal rather than the (...) end itself. Finally, I offer additional arguments against the non-worseness claim. (shrink)

This paper introduces this mini-series on vertical equity in health care. It reflects on the fact that by and large equity policies in health care have failed and that there is a need for positive discriminationto promote equity better in future. This positive discrimination is examined under the heading of`vertical equity'. The paper considers Varian's notion of 'envy' as a basis for equity in health care but concludes that this is not a helpful route to (...) go down. Better it would seem to pursue the idea from Sen of 'freedoms' and 'communitarian claims' (as raised previously by this author). While it is argued that procedural justice is to be preferred in the longer run as a basis for equity there are gains in adopting a short run goal of promoting distributive justice. Some preliminary evidence is presented on the weighting of health gains to reflect such vertical equity concerns. (shrink)

For a sample comprising 36,105 U.S. firm-year observations from 1985 to 2008, we find that firms located in more religious counties enjoy cheaper equity financing costs. This result is robust to a battery of sensitivity tests, including alternative assumptions and model specifications, additional controls for noise in analyst forecasts, and various approaches to addressing endogeneity. In another set of tests, we find that the equity pricing role that religion plays comes predominantly from Mainline Protestants. We also document that (...) the effect of religiosity on firms’ cost of equity capital is larger for firms (periods) lacking alternative monitoring (regulation) mechanisms as measured by lower institutional ownership (the pre-SOX era), implying that religion plays a corporate governance role. Finally, we find that the importance of religion to equity pricing is concentrated in firms that suffer lower visibility, which tend to be more sensitive to local social and economic factors. By examining the links between religiosity and valuation at the firm level, we provide strong, robust evidence supporting the perspective that religion facilitates economic development. (shrink)

Based on the concept of shareholder primacy, many scholars have argued that it is more important for businesses to earn profits for their shareholders than to provide benefits to society at large. Corporate social responsibility is often regarded as an investment that comes at the expense of shareholders. In contrast, research analyzing the connections between the equity ownership structure of a company and its level of CSR engagement suggests that CSR offers benefits to shareholders that go beyond direct financial (...) returns from investments. This study provides a comprehensive review and systematic assessment of theoretical considerations and approaches regarding different forms of equity ownership and their relationships to CSR, and it discusses the relevant benefits and motivations of shareholders. The perceived value of these CSR benefits varies among different types of shareholders, as they assign unequal values to short-term financial or to rather long-term CSR benefits. Based on a literature sample of 146 publications, this review demonstrates central problems inherent in previous analyses. Given the ambiguous and partially contradictory findings of prior research, this study identifies potential moderating influences that help clarify empirical evidence. A contingency approach is suggested in future research, as this can help resolve the problem of contradictory empirical findings and theoretical arguments. (shrink)

The tension between equity and excellence is fundamental in science policy. This tension might appear to be resolved through the use of merit-based evaluation as a criterion for research funding. This is not the case. Merit-based decision making alone is insufficient because of inequality aversion, a fundamental tendency of people to avoid extremely unequal distributions. The distribution of performance in science is extremely unequal, and no decision maker with the power to establish a distribution of public money would dare (...) to match the level of inequality in research performance. We argue that decision makers who increase concentration of resources because they accept that research resources should be distributed according to merit probably implement less inequality than would be justified by differences in research performance. Here we show that the consequences are likely to be suppression of incentives for the very best scientists. The consequences for the performance of a national research system may be substantial. Decision makers are unaware of the issue, as they operate with distributional assumptions of normality that guide our everyday intuitions. (shrink)

This paper explores how managers’ and supervisors’ equity incentives impact the likelihood of committing corporate fraud in Chinese-listed firms. Previous research has shown that corporate fraud in China is a widespread phenomenon and has severe consequences for affected firms and executives. However, our understanding of the reasons that fraud is committed in a Chinese setting has been very limited thus far. This is an increasingly important topic, because corporate governance is rapidly changing in China, and it is unclear whether (...) adopting the executive compensation practices of the West is appropriate for Chinese firms. We show that managers’ equity incentives increase their propensity to commit corporate fraud. We also find that this effect is more pronounced for state-owned firms. However, we find a negative but not significant relationship between the equity incentives of the supervisory board and the incidence of fraud. (shrink)

The concept of the "unlevel playing field" is critiqued for its tendency to take the prevailing masculinist managerial paradigm for granted. Rather than assume that both men and women should assimilate to corporate masculinity, feminist alternatives are suggested. The pervasiveness of the masculine ethic and the "myth of meritocracy" in organizations are reviewed, with the space shuttle Challenger disaster serving as a focal point to demonstrate the dysfunctionality of masculine management and the rationale for feminist-based organizational transformation to promote not (...) only gender equity, but more effective and ethical organizational behavior. (shrink)

Modern health care rhetoric promotes choice and individual patient rights as dominant values. Yet we also accept that in any regime constrained by finite resources, difficult choices between patients are inevitable. How can we balance rights to liberty, on the one hand, with equity in the allocation of scarce resources on the other? For example, the duty of health authorities to allocate resources is a duty owed to the community as a whole, rather than to specific individuals. Macro-duties of (...) this nature are founded on the notion of equity and fairness amongst individuals rather than personal liberty. They presume that if hard choices have to be made, they will be resolved according to fair and consistent principles which treat equal cases equally, and unequal cases unequally.In this paper, we argue for greater clarity and candour in the health care rights debate. With this in mind, we discuss (1) private and public rights, (2) negative and positive rights, (3) procedural and substantive rights, (4) sustainable health care rights and (5) the New Zealand booking system for prioritising access to elective services. This system aims to consider: individual need and ability to benefit alongside the resources made available to elective health services in an attempt to give the principles of equity practical effect. We describe a continuum on which the merits of those, sometimes competing, values—liberty and equity—can be evaluated and assessed. (shrink)

Health incentive schemes aim to produce healthier behaviors in target populations. They may do so both by making incentivized options more salient and by making them less costly. Changes in costs only result in healthier behavior if the individual rationally assesses the cost change and acts accordingly. Not all people do this well. Those that fail to respond rationally to incentives will typically include those who are least able to make prudent choices more generally. This group will typically include the (...) least advantaged more generally, since disadvantage inhibits one's effective ability to choose well and since poor choices tend to cause or aggravate disadvantage. Therefore, within the target population, health benefits to the better off may come at the cost of aggravated inequity. This is one instance of a problem I name the Able Chooser Problem, previously emphasized by Richard Arneson in relation to coercive paternalism. I describe and discuss this problem by distinguishing between policy options and their effects on the choice situation of individuals. Both positive and negative incentives, as well as mandates that are less than perfectly effective, require some sort of rational deliberation and action and so face the Able Chooser Problem. In contrast, effective restriction of what options are physically available, as well as choice context design that makes some options more salient or appealing, do not demand rational agency. These considerations provide an equity-based argument for preferring smart design of our choice and living environment to incentives and mandates. (shrink)

In ethics and political philosophy, the concepts of equity, equality, need satisfaction, and justice are significant for the fulfilment of underlying requirements of human rights, and the attainment of peace in societies. Studies show these as potential frames for defining processes, distributing resources, sharing responsibilities, allocating rewards, demonstrating respect and dispensing with unequal treatments. Justice, as the ideal that impels us to impartially adjudicate between competent claims, is linked to equality. But as the moral force that propels actions for (...) needs’ satisfaction, it is linked to equity. Hence, equality and equity are two elements of the theory of justice: both are grounded on the principles of distributive justice. This ‘common grounding’ apparently obfuscates their distinctive features, and over time, has elicited their equiparation. This essay highlights the archetypal frames of the notions of equity and equality as indispensable principles of social justice. It identifies the skewed distribution of resources in Nigeria as arising from a legal framework that removes the power of personal/group autonomy from the people. The essay notes the misleading tendency in the insulated use of equality for justice, and accepts the primacy of distributive justice amongst rival pathways to national cohesive living. (shrink)

Obesity is often considered a public health crisis in rich countries that might be alleviated by preventive regulations such as a sugar tax or limiting the density of fast food outlets. This paper evaluates these regulations from the point of view of equity. Obesity is in many countries correlated with socioeconomic status and some believe that preventive regulations would reduce inequity. The puzzle is this: how could policies that reduce the options of the badly off be more equitable? Suppose (...) we distinguish: (1) the badly off have poor options from (2) the badly off are poor at choosing between their options (ie, have a choosing problem). If obesity is due to a poverty of options, it would be perverse to reduce them further. Some people in public health say that preventive regulations do not reduce options but, I shall argue, they are largely wrong. So the equity case for regulations depends on the worst off having a choosing problem. It also depends on their having a choosing problem that makes their choices against their interests. Perhaps they do. I ask, briefly, what the evidence has to say about whether the badly off choose against their interests. The evidence is thin but implies that introducing preventive regulations for the sake of equity would be at least premature. (shrink)

We report the results of a vignette experiment with a quota sample of the German population in which we analyze the interplay between need, equity, and accountability in third-party distributive decisions. We asked subjects to divide firewood between two hypothetical persons who either differ in their need for heat or in their productivity in terms of their ability to chop wood. The experiment systematically varies the persons’ accountability for their neediness as well as for their productivity. We find that (...) subjects distribute significantly fewer logs of wood to persons who are held accountable for their disadvantage. Independently of being held accountable or not, the needier person is always compensated with a share of logs that exceeds her contribution, while the person who contributes less is punished in terms of receiving a share of logs smaller than her need share. Moreover, there is a domain effect in terms of subjects being more sensitive to lower contributions than to greater need. (shrink)

In this article, we develop a non-rights-based argument based on beneficence (i.e., the welfare of individuals and communities) and justice as the disposition to act justly to promote equity in health care resource allocation. To this end, we structured our analysis according to the following main sections. The first section examines the work of Amartya Sen and his equality of capabilities approach and outlines a framework of health care as a fundamental human need. In the subsequent section, we provide (...) a definition of health equity based on the moral imperative to guarantee that every individual ought to have the freedom to pursue health goals and well-being. In the later part of the article, we outline a non-right approach to health care based on three pillars: (1) human flourishing, (2) justice as a disposition not a process, and (3) solidarity. (shrink)

In ‘Obesity, equity and choice’, Timothy Wilkinson argues that preventive regulations to address obesity, such as taxes on sugary drinks, are at worst inequitable and at best fail to increase or improve equity. He concludes that we do not yet have good reasons to adopt them. I argue that equity considerations are not as problematic for preventive regulations as Wilkinson suggests.

Achieving gender equity in clinical trials requires that women be included in sufficient numbers to carry out analysis, that sub-sample analyses be performed, and that results be communicated in such a way as to expand medical knowledge, inform policy decisions, and educate patients. In this article, we examine the extent to which Canada promotes gender equity through its laws and guidelines, viewed within the context of its drug safety system and its research ethics board structure. We analyze the (...) structuring of information by the pharmaceutical industry and consider the impact of its promotional activities on the state of gender knowledge and health. In the final section, we propose ways to improve the structuring of health information to promote gender equity. (shrink)

Many anti-obesity policies face a variety of ethical objections. We consider one kind of anti-obesity policy — modifications to food assistance programs meant to improve participants' diet — and one kind of criticism of these policies, that they are inequitable. We take as our example the recent, unsuccessful effort by New York State to exclude sweetened beverages from the items eligible for purchase in New York City with Supplemental Nutrition Support Program assistance. We distinguish two equity-based ethical objections that (...) were made to the sweetened beverage exclusion, and analyze these objections in terms of the theoretical notions of distributive equality and social equality. First, the sweetened beverage exclusion is unfair or violates distributive equality because it restricts the consumer choice of SNAP participants relative to non-participants. Second, it is disrespectful or violates social equality to prohibit SNAP participants from purchasing sweetened beverages with food stamps. We conclude that neither equity-based ethical objection is decisive, and that the proposed exclusion of sugar-sweetened beverages is not a violation of either distributive or social equality. (shrink)

Fish stocks, as common pool resources, are more and more managed by giving fishermen exclusive access rights as Individual Transferable Quotas (ITQ). These have been widely discussed, with focus on social, economic and ecological issues. While equity aspects have been of great concern, there is very limited analysis about how to assess issues of equity and fair distribution when introducing ITQs. This paper applies an existing framework for assessing equity in resource use systems to tradable quota systems (...) in fisheries. The framework defines the perspectives of distributive fairness, the stakeholders who are bound by fair practice rules, and instruments of fairness, and identifies metrics to assess equity in practice. We assess if the framework provides practical guidance for evaluating whether a given ITQ system operates under an equitable framework programme. (shrink)

There is consistent and strong empirical evidence for social inequalities in health, as a vast and fast growing literature shows. In recent years, these findings have helped to move health equity high on international research and policy agendas. This paper examines how the empirical identification of social inequalities in health relates to a normative judgment about health inequities and puts forward an approach which embeds the pursuit of health equity within the general pursuit of social justice. It defends (...) an indirect approach to health equity, which views social inequalities in health as unjust in so far as they are the result of an unjust basic structure of society in Rawls’ sense. (shrink)

Since the onset of the COVID-19 pandemic, a controversial criterion for allocating scarce medical treatment has been defended and incorporated into policy: the criterion of equity. Equity-included allocation schemes prioritize, to some degree, patients from marginalized or historically disadvantaged racial/ethnic groups, or patients with low socioeconomic status, for scarce treatment. The use of such criteria has been most prominently defended in two ways: (1) as reflecting a risk factor for severe COVID-19, and thus as a way of tracking (...) medical need, and (2) as a form of remedial justice, viz. a way of redressing disparities in COVID outcomes that are caused by underlying unjust social conditions. Here, we delineate and critique those arguments. We argue that not only are such arguments unconvincing but also that there are compelling moral reasons to reject the sort of equity-included allocation schemes at issue. (shrink)

Can the institutional systems that prepare Black nurse researchers question the ways their systemic pathways have impacted health equity knowledge development in nursing? We invite our readers to keep this question in mind and engage with our conversation as Black nurse researchers, scholars, educators, and clinicians. The purpose of our conversation, and this article, is to explore the transactional impact of knowledge development pathways and Black faculty retention pathways on the state of health equity knowledge in nursing today. (...) Over a series of conversations, we discuss the research exploitation of communities of color, deficit research funding, knowledge capitalization, the marginalization of diversity as a continuous process, a lack of sociocultural authority, and our thoughts on solutions. We conclude by using the wisdom of a generation to answer our initial question. (shrink)

Achieving equity in international research is one of the pressing concerns of the twenty-first century. In this era of progressive globalization, there are many opportunities for the deliberate or accidental export of unethical research practices from high-income regions to low- and middle-income countries and emerging economies. The export of unethical practices, termed “ethics dumping,” may occur through all forms of research and can affect individuals, communities, countries, animals, and the environment. Ethics dumping may be the result of purposeful exploitation (...) but often arises from lack of awareness of good ethical and governance practice. This chapter describes the work of the TRUST project toward counteracting the practice of ethics dumping through the development of tools for the improvement of research governance structures. Multi-stakeholder consultation informs all of TRUST’s developments. Most importantly, this gives voice to marginalized vulnerable groups and indigenous people, who have been equal and active partners throughout the project. At the heart of the TRUST project is an ambitious aim to develop a Global Code of Conduct for Research in Resource-Poor Settings. Uniquely, the Code provides guidance across all research disciplines in clear, short statements, focusing on research collaborations that entail considerable imbalances of power, resources and knowledge and using a new framework based on the values of fairness, respect, care, and honesty. The code was recently adopted by the European Commission as a reference document for Horizon 2020 and Horizon Europe. (shrink)

Equity is a foundational concept for the new World Health Organization (WHO) Pandemic Treaty. WHO Member States are currently negotiating to turn this undefined concept into tangible outcomes by borrowing a policy mechanism from international environmental law: “access and benefit-sharing” (ABS).

This paper considers the ethical risks and opportunities presented by generalist medical artificial intelligence (GMAI), a kind of dynamic, multimodal AI proposed by Moor et al. (2023) for use in health care. The research objective is to apply widely accepted principles of biomedical ethics to analyze the possible consequences of GMAI, while emphasizing the distinctions between GMAI and current-generation, task-specific medical AI. The principles of autonomy and health equity in particular provide useful guidance for the ethical risks and opportunities (...) of novel AI systems in health care. The ethics of two applications of GMAI are examined: enabling decision aids that inform and educate patients about certain treatments and conditions, and expanding AI-driven diagnosis and treatment recommendation. Emphasis is placed on the potential of GMAI to improve shared decision-making between patients and providers, which supports patient autonomy. Another focus is on health equity, or the reduction of health and access disparities facing underserved populations. Although GMAI presents opportunities to improve patient autonomy, health literacy, and health equity, premature or inadequately regulated adoption of GMAI has the potential to compromise both health equity and patient autonomy. On the other hand, there are significant risks to health equity and autonomy that may arise from not adopting GMAI that has been thoroughly validated and tested. A careful balancing of these risks and benefits will be required to secure the best ethical outcome, if GMAI is ever employed at scale. (shrink)

The allocation of critical care resources and triaging patients garnered a great deal of attention during the COVID-19 pandemic, but there is a paucity of guidance regarding the ethical aspects of resource allocation and patient prioritization in ‘normal’ circumstances for Canadian healthcare systems. One context where allocation and prioritization decisions are required are surgical waitlists, which have been globally exacerbated due to the COVID-19 pandemic. In this paper, we detail the process used to develop an ethics framework to support prioritization (...) for elective surgery at The Hospital for Sick Children, Toronto, a tertiary pediatric hospital. Our goal was to provide guidance for the more value-laden aspects of prioritization, particularly when clinical urgency alone is insufficient to dictate priority. With this goal in mind, we worked to capture familial, relational, and equity considerations. As part of our institution’s concerted efforts to ethically and effectively address our surgical backlog, an ethics working group was formed comprising clinicians from surgery, anesthesiology, intensive care, a hospital bioethicist, a parent advisor, and an academic bioethics researcher. A reflective equilibrium process was used to develop an ethics framework. To this end, the same methodology was used to create a support for patient prioritization that identifies clinically and morally relevant factors for prioritization among medically similar surgical cases, with a substantive goal being to identify and redress health inequities in surgical prioritization, inasmuch as this is possible. While further steps are needed to validate several aspects of the framework, our research suggests that an ethics framework grounded in the practical realities of hospital operations provides consistency, transparency, and needed support for decisions that are often left to individual clinicians, as well as an opportunity to reflect upon the presence of health inequities in all domains of healthcare delivery. (shrink)

Menu labelling is a public health policy intervention that applies principles of nutrition labelling to the eating out environment. While menu labelling has received a good deal of attention with regard to its effectiveness in shaping food choices for obesity prevention, its premises have not yet been fully explored in terms of its broader applications to social equity and population health. In the following case, we focus on the example of menu labelling within the context of food policy at (...) the local level, a fruitful substantive area of consideration for public health ethics. (shrink)

Nurses play a crucial role in reducing health disparities and advancing health equity for individuals and communities. The future nursing workforce relies on their nursing education to prepare them to promote health equity. Nursing educators prepare students through a variety of andragogical learning strategies in the classroom and in clinical experiences and by intentionally updating and revising curricular content to address knowledge and competency gaps. This critical review aimed to determine the extent to which health equity concepts (...) are explicitly present in prelicensure undergraduate nursing curricula globally. Of 434 articles screened, 22 articles describing 20 studies met inclusion criteria. Frequency and quantity of health equity content, concepts and topics, teaching strategies, evaluation strategies, and the overall extent of integration varied widely. Notably, only two articles described overall well‐integrated explicit health equity content, and there was little attention to whether students transfer this learning into practice. A focus on individualism rather than population and community was noted, highlighting the presence of whiteness in nursing. Results from this review confirm that nursing education has room to improve with respect to health equity in the curricula. (shrink)

Local food systems can have economic and social benefits by providing income for producers and improving community connections. Ongoing global climate change and the acute COVID-19 pandemic crisis have shown the importance of building equity and resilience in local food systems. We interviewed ten stakeholders from organizations and institutions in a U.S. midwestern city exploring views on past, current, and future conditions to address the following two objectives: 1) Assess how local food system equity and resilience were impacted (...) by the COVID-19 pandemic, and 2) Examine how policy and behavior changes could support greater equity and resilience within urban local food systems. We used the Community Capitals Framework to organize interviewees’ responses for qualitative analyses of equity and resilience. Four types of community capital were emphasized by stakeholders: cultural and social, natural, and political capital. Participants stated that the local food system in this city is small; more weaknesses in food access, land access, and governance were described than were strengths in both pre- and post-pandemic conditions. Stakeholder responses also reflected lack of equity and resilience in the local food system, which was most pronounced for cultural and social, natural and political capitals. However, local producers’ resilience during the pandemic, which we categorized as human capital, was a notable strength. An improved future food system could incorporate changes in infrastructure (e.g., food processing), markets (e.g., values-based markets) and cultural values (e.g., valuing local food through connections between local producers and consumers). These insights could inform policy and enhance community initiatives and behavior changes to build more equitable and resilient local food systems in urban areas throughout the U.S. Midwest. (shrink)

Following the recommendations of the US National Academy of Sciences and the mandates of the 1987 Nuclear Waste Policy Amendments Act, the US Department of Energy has proposed Yucca Mountain, Nevada as the site of the world's first permanent repository for high-level nuclear waste. The main justification for permanent disposal (as opposed to above-ground storage) is that it guarantees safety by means of waste isolation. This essay argues, however, that considerations of equity (safer for whom?) undercut the safety rationale. (...) The article surveys some prima facie arguments for equity in the distribution of radwaste risks and then evaluates four objections that are based, respectively, on practicality, compensation for risks, scepticism about duties to future generations, and the uranium criterion. The conclusion is that, at least under existing regulations and policies, permanent waste disposal is highly questionable, in part, because it fails to distribute risk equitably or to compensate, in full, for this inequity. (shrink)

Surgery is an increasingly common and expensive mode of medical intervention. The ethical dimensions of the surgeon-patient relationship, including respect for personal autonomy and informed consent, are much discussed; but broader equity issues have not received the same attention. This paper extends the understanding of surgical ethics by considering the nature of evidence in surgery and its relationship to a just provision of healthcare for individuals and their populations.

Developing countries often rely on consumption taxes, because these are broad, easy to administer, and harder to evade. However, the taxation system becomes inherently regressive. To counter this problem of the regressive nature of consumption taxes, there is a temptation among policymakers to address equity concerns through a multiplicity of rates, making the consumption tax system complex. Here, complexity is considered the by-product, or companion, to pursuing goals of equity. Complex tax systems, however, pose a different problem relating (...) to equity. Assuming a minimum fixed cost of compliance imposed by a complex tax system, smaller firms and individuals face a much higher cost of compliance relative to larger firms and richer individuals. Oligarchic sectors dominated by a few large firms also find it easier to organize and lobby to get favorable rates compared to competitive sectors with small firms. Though complexity is considered a by-product of several equity-enhancing measures, the Indian experience with its Goods and Services Tax reform serves demonstrates the opposite, that there is a trade-off between equity and complexity. (shrink)

In the present world order unbridled forces of free market capitalism are frequently cited for much of the social injustice, inequity, and disparity of wealth between the rich and the poor. Although history''s verdict in favor of the free markets could hardly be harsher or clearer, it is clear that after the initial wave of triumph, the free market paradigm has developed some cracks in its façade. What marks the trail of such sustained and pronounced move toward free markets in (...) terms of ethics, morality, social welfare and social justice? How does one keep a social score in this seemingly relentless and irreversible move all over the world toward free market capitalism?In this paper we shall attempt to address these and related questions. Drawing on concepts from organization theory and social philosophy and using publicly available financial information, we shall illustrate how, amidst the myriad and mixed noises, some sense of order and signal can be discerned in addressing issues of equity and social justice. Toward this end, first, we provide a broad contrast between two models of financial markets: the command model and the free market model and proceed to examine publicly available financial information and analyze the trends and patterns with graphical representations using publicly available data from Handbook of International Economic Statistics. Next, we explore the implications of financial performance measures for social welfare and social justice and discuss the social perils of free markets using the Mexican and Asian Financial crises as the focal points. Finally, we present a set of recommendations for smoother structural transition. (shrink)

No progress has been made over the past decade in improving equity of access to higher education for young people from low socio-economic backgrounds. New evidence indicates that both family income and cultural factors explain this situation. The cultural factor is particularly strong for boys from blue collar backgrounds. Current Government equity policy ignores these findings.

The scientific evidence is reviewed for claims that a global transition to “green” fuels and technologies by global treaty obligations is needed. The likely equity implications of these efforts are discussed, and it is argued that this evidence remains shaky. Measures based on this contested knowledge cannot be defended on grounds of either environmental effectiveness or equity. Rather, they rely on commercial expectations and promises of secondary benefits usually requiring state intervention. Poorer groups and nations are unlikely to (...) benefit from proposals to redirect energy policies to “combat global warming.” The advocated decarbonization of global energy supplies is more likely to increase political instability than prevent climatic change. To support this argument, three areas of knowledge are consulted: controversies about the causation and likely impacts of global warming, advocated technical and fiscal solutions, and the interests of technical, commercial, and political elites. (shrink)