6 - Aggregation & responsibility of health

Question 1

describe the appendectomy vs tooth-capping case

Answer 1

o Tooth capping was ranked above appendectomy
o This makes sense: appendectomy is surgical and costs a lot of money while tooth capping is cheaper and done in one day
o Benefit of appendectomy is huge but so is cost
o Benefit of tooth capping is low and so is cost

· Aggregated benefit of tooth capping is much better than appendectomy

Question 2

what is the aggregation thesis?

Answer 2

o It is morally permissible to make ethical judgements on the basis of interpersonally aggregated benefits
§ Tooth capping = small benefit for large amount of ppl
§ appendectomy = large benefit for small amount of people

o Aggregation may imply that we should use any means to achieve a better outcome - the aggregated amount of benefits

Question 3

what is the prevention paradox?

Answer 3

a preventative measure may be helpful for a community but may actually be detrimental to an individual since it is a long term solution

Question 4

what are Taurek’s three claims?

Answer 4

The permissibility claim, the no-worse claim, the equal respect claim

Question 5

what are three solutions to the 5 vs 1 case?

Answer 5

o 1. Saving the lives of 5 individuals: utilitarian and some non-utilitarian
o 2. Flip a fair coin (Taurek)
o 3. A weighted lottery (fair chance)

Question 6

define contractualism

Answer 6

An action is wrong when and because it is ruled out by principles that nobody can reasonably reject, from individual stand points
=prima facie
(denies aggregation)

Question 7

what other principel can you accept if you accept the aggregation thesis?

Answer 7

survival lottery

Question 8

what is the principle of pairwise comparison?

Answer 8

ind the outcome that is the least unacceptable from individual standpoints. When there is a conflict of interests among different persons, no outcome can be completely acceptable to everyone. You must focus on a pair of people who are affected by the choice and compare one person’s possible loss with the other person’s possible loss in order to identify the outcome that minimizes the loss to each person

Question 9

What is the number problem, and what would the tie-breaking argument be?

Answer 9

an issue for critics rejecting aggregation thesis - intuitively, you’d rather save 5 people than one bc the benefits of saving those 5 outweighs the loss of one
aggregation thesis critics are happy to ignore nbr of people affected, have to be indiff and should thus just flip a coin, BUT this is highly counterintuitive

Question 10

create the connection between the aggregation problem and the number problem

Answer 10

The aggregation problem, they argue, involves a comparison between health improvements and the prevention of death. The number problem, in contrast, involves only comparisons of preventing death. You should accept the aggregation thesis in the number problem when only lives are at stake. You should also accept the thesis when only health improvements are at stake. It is permissible to count the number of people whose life you can save, and it is also permissible to add up health benefits. But it is not permissible to compare health improvements and the prevention of death. You should reject the aggregation thesis in the aggregation problem. Thus, there is no real inconsistency. Our argument rests on the fact that inconsistency in ethics must be avoided

Question 11

explain the weighted lottery for aggregation

Answer 11

randomised division procedure, each one of 6 has equally strong moral glaim to good, and ideally, the good should be divided equally between each person, ⅙ is a fair chance. You assign a 5⁄6 chance to the group of five people on the one hand, and a 1⁄6 chance to the one person, on the other. With this weighted lottery, it is highly likely that you end up preventing the deaths of the five people.

Question 12

why is the weighted lottery ideal?

Answer 12

(1) is sensitive to numbers, but recognises moral claims of each person affected
(2) doesnt rule out aggregation, gives weight to mora claims made
(3)it’s a lot less extreme than simply saving greater number
(4) it offers peace of mind bc lottery decided results, not you

Question 13

what is the prioritarian function?

Answer 13

a function used to measure the aggregated QALYs

Question 14

what is the connection between prioritarianism and egalitarianism?

Answer 14

egalitarian in some sense, bc avoids leveling down objection to egalitarianism
= rejects the egalitarian view that it is intrinsically good to eliminate the inequality of an outcome by lowering the relevant good of those better off to the level of those worse off.

Question 15

upon which two principles is egalitarianism based?

Answer 15

principle of quality - its in intself bad that some are worse off than others

principle of utility - its in itself better if people are better off

Question 16

what is the difference between maximin and leximin?

Answer 16

“maximin” focuses only on the well-being of the worst-off person. If one distribution makes the worst-off person better off than another, then the first distribution is better, regardless of how others are doing.

Leximin - starts by comparing the well-being of the worst-off individuals in different distributions. If they are the same, it looks at the second worst-off, and so on.

Question 17

what is one of the drawbacks of lexicon?

Answer 17

this results in “bottomless pit problem,” where all resources could end up going to help the worst-off, leaving everyone else in a bad situation. Because of these extreme consequences, many people disagree with giving absolute priority to the worst-off.

Question 18

what is taurek’s central thesis in “should numbers count”?

Answer 18

In situations where a choice must be made about whom to save, the number of people involved should not be the determining factor. He challenges the conventional utilitarian view that saving more lives is always better.

Question 19

what are the three approaches to responsibility in health?

Answer 19

1 - luck egalitarianism
2 - fair equality of opportunity
3 - The health-only framework

Question 20

what is the point of egalitarian justice?

Answer 20

to neutralise and minimse the effecs of brute luck

Question 21

what are the three different streams of argument around free will and responsibility for health?

Answer 21

determinism = health is determined by background conditions

compatibilism = free will to a certain extend

libertarianism = u are 100% respo for everything, no contingence ever and u must be respo for it

Question 22

what is Taurek’s view regarding impersonal evaluative judgement for the 5 vs 1 case?

Answer 22

author argues it is impossible to give an impersonal evaluative judgement as ground for his decision to give drugs to 5 people instead of one, arguing one or the other is necessarily giving a preference on outcome. Just because you have one preference does not mena you can expect other people to have the same one. Each object has a certain value in ur eyes and will affect the way you choose to act, here it is obvious you would choose to save 5 instead of one, but it is hard to think about human beings in the same way

Question 23

Describe Taurek’s claims of aggregated suffering in the 5 vs 1 case

Answer 23

• “five individuals each losing their life doesn’t add up to anyone’s experience a loss five times greater than the loss suffered by any of the five”
• preventing someone from suffering isnt greater than the suffering inflinged on the person who died
• you cannot add ‘small’ suffering to have it be equivalent to one big suffering, there is some kind of tradeoff

Question 24

what does it mean to be duty-bound?

Answer 24

to behave in accordance with a policy for the use of that resource agreeable to whose resource it is

Question 25

what is taurek’s coin toss solution?

Answer 25

Taurek famously suggests using a coin toss to decide whom to save in situations where resources can only save some but not all. He argues that this method respects each individual’s chance to live, irrespective of the number of people involved.

Question 26

What is Taurek’s view on individual rights?

Answer 26

Taurek places significant emphasis on the rights and value of individuals. He argues that each person has a moral claim not to be sacrificed merely for the sake of others, and this claim is not diminished by the presence of a larger group. A crucial aspect of Taurek’s argument is that the number of lives is morally irrelevant. He contends that the moral weight of saving a life does not increase simply because there are more lives that could be saved.

Question 27

What is revolutionary about Taurek’s paper?

Answer 27

Taurek’s argument has significant implications for moral decision-making in scenarios like triage, disaster response, and healthcare allocation. It challenges the notion that decision-makers should always prioritize scenarios where more lives can be saved.

Question 28

what is luck egalitarianism?

Answer 28

holds that inequality of well-being is unjust when and because it reflects the bad effects of brute luck. The effects of bad brute luck should be compensated as a matter of justice. It also claims that inequalities due to the effects of bad option luck are not unjust. They should not be compensated as a matter of justice.

Question 29

what is the difference between bad option luck and bad brute luck?

Answer 29

bad option luck (you got sick bc you chose to smoke) >< bad brute luck (you got sick despite ur lifestyle)

Question 30

when can health inequalities be considered unjust? (Bognar-Hirose)

Answer 30

inequalities in health are unjust when and because they reflect the bad effects of brute luck (or when they reflect something other than choice). it is unjust if some people are worse off than others in terms of health through no fault or choice of their own, and that as a matter of justice they should be compensated or helped to overcome the bad effects of brute luck, and should not be held responsible for csq

Question 31

What is the abandonment objection, and what is a possible reponse?

Answer 31

It seems that the luck egalitarianism view condones abandoning people who are responsible for their bad luck, which is unfair

pluralist response: other moral principles can mitigate this harshness and you can believe in multiple ones at the same time, ie charity/solidarity

Question 32

what is all-luck egalitarianism?

Answer 32

all-luck egalitarianism: some philosophers see no diff in bad luck, that healthy and unhealthy heavy smokers are both paying csq via tax, so there shouldnt be diff in priority

Question 33

what is the difference betweeen all-luck and standard egalitarianism?

Answer 33

difference between standard and all-luck egalitarianism is that standard luck egalitarianism tries to account for responsibility within the health care system, whereas all-luck egalitarianism tries to account for it outside of the health care system, via people’s extra contributions to the pool of health care resources.

Question 34

describe the fair equality of opportunity view

Answer 34

health(care) has strategic importance, bc its a prerequisite to pursue and realise your value, and thus, health ineqialities lead to disadvantages and broader societal inequalities => health inequalities are unfairm and healthcare system should protect people’s fair opportunities

Question 35

list the three aspects of the triple-jeopardy in healthcare outcomes

Answer 35

(1) these people live in poor socioeconomic circumstances,
(2) because of their low socioeconomic status, they are more likely to suffer from bad health conditions, and
(3) when they are given lower priority, they’re punished for their imprudent lifestyle, which they didnt choose entirely freely

Question 36

what did the whitehall studies prove?

Answer 36

important sets of studies demonstrating that individuals with higher income, greater wealth, higher education, or higher social status live longer and healthier lives
found strong correlation between mortality and employment grade level of civil servant
similar patterns can be found in other countries, also among racial groupsw

Question 37

what does the equal access view claim about the social gradient in health?

Answer 37

as long as equal access to health care is secured, there is no reason to care about it

Question 38

which two views demonstrate why social gradients in health give rise to ethical concerns?

Answer 38

air equality of opportunity view AND all-luck egalitarianism as reasons why government care about health inequalities beyond ensuring equal access
- FEO - health equality is desirable, protects opportunities and we should ensure even playing field and is required by justice
- All luck - health inequality is a result of differences in luck for which nobody should be held responsible

Question 39

what are examples of political leaders attempting to address SES disparities, and which implicit belief does it underline?

Answer 39

• some pol leaders have tried to address SES disparities via broad “upstream” social policies (Tony Blair in the UK, labour government)

implicit belief = reduction of inequalities in socioeconomic conditions will reduce health inequalities → takes on causal relationship, but it is rather X predicting Y

you can take health into account outside of the health care system through policies that make people take responsibility for their choices, but not the consequences of their choices.

Question 40

what were the two primary challenges highlighted by Hirose and Bognar in CH6, responsibility of health?

Answer 40

1 - individual responsibility for health - people are sharply divided when it comes to responsibility and whether it should play a role in healthcare allocation

2 - growing body of evidence on social determinants of health challenge health-only frameworks

Question 41

what are 4 significant findings in SDOH literature?

Answer 41

1. income/health gradient is influenced by policy choice
2. income/health is a gradiant operating across whole socioeconomic spectrum within society, and the slope is affected by degree of inequality
3. SES is as important/more imp than absolute lvl of income in determining health status
   “it is not about how big the pie is, but about how it is shared that matters for population health”
4. identifiable (psycho)social pathways through which ineq produces effect on health,

Question 42

when can health inequality be counted as a health inequity?

Answer 42

health inequality count as inequities when they are “avoidable, unnecessary and unfair”

Question 43

Why is social justice good for our health?

Answer 43

“social justice is good for out health. in a society that complies with its principles of justice, health inequalities will be minimised and population health status will be improved”