8: Resource Allocation - Lecture

Question 1

T or F: criminal justice is comparable to distributive justice

Answer 1

F: not the same thing

Question 2

T or F: resource allocation is a question about justice

Answer 2

T

Question 3

T or F: with proper resource allocation, we can have enough for everyone and conquer scarcity

Answer 3

F: scarcity is a realist, and we can never have enough for everyone

Question 4

distributive justice

Answer 4

Need to make the decision on who gets what under what circumstances in the fairest way possible for everyone to have an equitable opportunity

• Ensure not the same people winning every time (systemic injustice)

Question 5

Aristotle’s Principle of Distributive Justice
(+ and -)

Answer 5

“equals should be treated equally, and those who are unequal should be treated unequally”

(-): deciding one is unequal means they don’t need to be treated well = justifies injustice
(+): should treat everyone as they are all equals, not relevant distinguishing feature

Question 6

discrimination (popular use)

Answer 6

Being treated differently due to who you are, no other reason

Question 7

Discrimination (resource allocation)

Answer 7

basis to choose = making choices when you have limited supply of spots for something to qualify for vs having way more candidates

○ Evaluating and choosing between possibilities/candidates
- method of choosing based on relevant criteria
- set valid/defensible criteria for evaluating ppl

○ Equal consideration
- Job, university = what makes you relevant for a student or employee, NOT other things (race, gender .etc)
EX. HS program… discriminated against based on academic performance (relevant criteria)

○ Free from intentional bias

○ Recognizing encultured bias (unintentional)

Question 8

Alfred Bader

Answer 8

• CEO of pharmaceutical company
• applied to UofT and McGill but they both had quotas for Jewish students
• Did not accept too many bc belief that it could cause disruption to student life
• Didn’t get into either as they were too full of Jews = decision based on ethnicity and religion, NOT qualifications
  -excluded based on prejudicial info
  
  • is equal, made him an unequal
• went to Queens (didnt have quota) now XL benefactor

Question 9

morally relevant differences making people unequal in healthcare

Answer 9

1. medical need (acuity/triage)
   - whoever is in more medical distress
   ex. chest pain > priority over cough
2. likely benefit (% chance of recovery)
   - odds procedure will work/recovery
   - limited supply of treatment considers not giving it to you if other conditions may make it not work VS giving it to another person who will get better (or higher odds)
   ex. hip replacement on stage 4 cancer vs teenager

Question 10

elements of justice
(a) does a decision negatively effect some more than others?

Answer 10

(a) When you make a decision to/not to give someone treatment, is the effect on that person equal to other people?
- not giving hip replacement to 2 people doesn’t mean effect on their lives is equal
- take more factors into consideration

Ex. Single mom has people depending on her vs single person

Question 11

elements of justice
(b) Are the risks taken mostly by one group and the benefits enjoyed by another group?

Answer 11

do same people win/lose all the time?
- pluralism: look at diversity policies and laws
- systemic inequity if same people do/don’t benefit each time

Gradient:
○ richer + more education = less prone to illness, recover quicker, no lingering problems
○ Poor + less educated = more illness, worse outcomes, more comorbidities
- Gradient is linear; millionaire = good results, billionaire = better results

• paying equal share, getting equal share

Question 12

T or F: Outcomes replicate themselves - poor people replicate poverty vs rich people replicating wealth

Answer 12

T

Question 13

T or F: the gradient is not linear

Answer 13

F: is linear, millionaire = good results, billionaire = better results

Question 14

T or F: consistently disproportionate populations in prisons are a result of a unequally flawed social system

Answer 14

T

Question 15

Organ Donation cases
- proposal & concerns

Answer 15

• many people have intention of signing but never get around to it, want to alleviate organ shortage

Proposal: assume people will be organ donors unless they say no
- negative consent

1. will everyone know how to fill out form if they have a strong objection
   - does this influence their decision?
2. how to ensure ESL people fully understand
   - not equally accessible to all

Question 16

Preferential/conditional access to certain surgeries/treatments

Answer 16

• Treatment available for illness you have but there are conditions being put upon you to qualify (not discrimination)

ex. need to be smoke free for 6 months to get a bypass

ex. 6 month sobriety before liver transplant
- behavior pattern indicating new liver will be compromised = less chance
- need to see treatment will have maximum benefit, better outcome for non-alcoholic

ex. Britain - won’t perform hip/knee replacement procedures on women with BMI 30+
- complications + as BMI +
- long-term success diminished by higher BMI

ex. BMI 36+ shouldn’t be allowed to access fertility treatments
- problematic bc harm is greater if you’re UNDERWEIGHT, yet only precluded for women with higher
- 2 groups of people that should be ineligible, only do it for 1 group

Question 17

BMI questions of justice

1. What is the morally relevant distinction between patients with different BMIs?
2. Is this adversely effecting 1 group more than others?

Answer 17

1. **Medically unequal when BMI is over a certain point as it changes your status
   **Need data to demonstrate that - needs to be a fact

ANSWER: likely benefit (% change of recovery)
**Issue when there is another group with equally bad recovery/success but aren’t being recognized as such

2. Are we hitting on the same people being excluded over and over with IVF and replacements
   **Need to do research to look at demographics of these populations = do they share something in common

ANSWER: obesity-poverty link?
- Gradient and SDH suggest there is correlation between SES and health conditions
- Say it is more equitable by them excluding skinny girls too … are you denying people in a certain socioeconomic class? Proxy for poverty?
- Need to ensure you’re not inadvertently acting unjustly, not always with mal-intent just ignorance

Question 18

preferential access to prophylaxis

Answer 18

COVID in Italy = had good healthcare system, high life expectancy
○ Took out a whole generation of Italians
○ Elderly are disproportionately absorbing negative effects
○ Prioritizing youth

Question 19

substantive/material vs procedural/process questions of justice

Answer 19

1. substantive/material
   = answers Q “who should receive care first”
   - fundamental Q of triage
   - states what we value/why we choose 1 over other
   (preservation of life = one most in jeopardy)
2. procedural/process
   = answers Q “how we apply the answer of ‘who goes first’ “
   - application of our beliefs that answer #1
   - if Italy said they prioritize elderly… procedural aspect didn’t work

Question 20

5 substantive questions of justice
= main considerations when deciding who goes first

Answer 20

1. Need
   - how bad a situation you’re in determines what resources are directed to you
   - acuity should be decider … not always the case
   - controlling illness = more ppl live happy lives
   - measure of a society’s justice = ability to look after people
2. Equality
   - “horizontal equality”: equal resources for equal need
   - not subject to any gradient, all = attention
   - treat like cases alike
3. Utility
   - do what helps greatest #
   - most impact in terms of people and benefit
   - protect most vulnerable population (masks)
4. Liberty
   - bases allocation on deserving it
   - can disqualify yourself by your decisions (smoking b4 bypass)
5. Restitution
   - access and share should reflect past wrong-doings (historically denied/unjustly treated)
   - do something more to ensure participation of these groups that have been denied over & over
   ex. hesitation of aboriginals to take COVID vax… ensured availability to them (doing more)

Question 21

Issues in healthcare injustice

Answer 21

1. access & socio-epidemiological factors
   - gradient
   - greater efforts should be put into prevention on bottom end, more $$ allocated there
2. prevention is statistically hard to track, treatment is easy
   - want to see we did X, it did Y = $ well spent
   - no concrete decline with prevention, hard to prove
3. ulititarian mandate
   - same people winning over and over
   - maximize benefit and minimize harm, but for the SAME people