Blok 9 literatuur

Question 1

What are the four sources of moral disagreement according to G&T, and why it is important for their argument?

Answer 1

1. Scarcity
2. Limited generosity
3. Appreciating the competing claims of more than one fundamental value, struggling internally to resolve the conflict (even though there is abondance). Bron van conflict ligt in moraliteit zelf
4. Incomplete understanding

How do democracies of various forms respond to this disagreement and do they succeed?
Two types of democracy emerges, what is their overall aim? To avoid substantive moral disagreement by less controversial procedural means

Question 2

What is majoritarianism?

Answer 2

claims of each citizen should be weighed equally and the greatest number should prevail

Question 3

Why according to G&T is majoritarianism problematic?

Answer 3

It assumes that two conditions can be met that in reality are very complex and can hardly be met; those two conditions are?
1. Equal chances of constituting the majority
2. The majority must not infringe the vital interests of individuals

Question 4

Why is majority rule of interest group bargaining not suffice?

Answer 4

• Procedural indeterminacy  To decide whether majority decision is justified you need substantive value(s) (see liberty for example), for this you need deliberation
• Majority rule cannot be justified if it violates the vital interests of individuals
• Before voting there often is a process in which some people are informed about the issue, discuss the issue etc. This is also moral deliberation
• The majority rule only claims that the majority can decide, it cannot claim that the majority is morally right. Therefor the majority rule does not solve moral disagreements

Question 5

4 general reasons to make a case for moral deliberation

Answer 5

1. Moral deliberation contributes to the legitimacy of decisions and policies. (scarcity)
2. Deliberation responds to our limited generosity by creating forums in which we are encouraged to take a broader perspective on questions of public policy. (limited generosity)
3. Helps to clarify the nature of conflict and to come to a morally justified consensus (disagreement in nature of morality)
4. Process fosters learning from each other and develop views and policies that are more widely justifiable (incomplete understanding); trial and error; correction mechanism

Question 6

Problem with rationality project

Answer 6

• p.9 If you take out the politics of governance, what exactly is left? By suggesting that policy questions are only technical questions that can be solved rationally, these normative choices are not discussed; it misses attention to the normative choices that are part of political choices.
• p. 11 it ignores emotional feelings and moral intuitions

Question 7

Stone: what is rationality project?

Answer 7

Rationality project = op een rationale manier naar de politiek kijken

Question 8

3 pillars Stone describes as part of the ‘rationality project’

Answer 8

Model of reasoning = rationale besluitvorming, stappenplan. Rationeel proces waar emotie
geen onderdeel van is. Stappenplan:
1. Identify objectives
2. Identify alternative courses of action for achieving objectives
3. Predict the possible consequences of each alternative
4. Evaluate the possible consequences of each alternative
5. Select the alternative that maximized the attainment of objectives
Model of society = gaat over de markt. De maatschappij is een verzameling van rationele besluitvormers die keuze maken uit eigen interesse. Kiezen niet voor de gemeenschap maar voor zichzelf
Model of policy making, = production model. Procedure hoe beleid gemaakt kan worden.

Question 9

3. 3. What does Stone propose to focus on instead of the rationality model? Describe this for each of the three pillars identified under (2).

Answer 9

Model of reasoning = political reasoning, je probeert op een andere manier naar dingen te kijken. Als je het ander uitlegt, kan je er anders naar kijken. Metaforen werken goed.

Model of society = je gaat kijken wie er betrokken zijn

Model of policy making = welke mogelijkheden zijn er/welke ideeën zijn er en dan kijken wat je kan doen

Question 10

Principles of business ethics

Answer 10

1. Basic individual rights
2. Individual self-interest
3. The interests of the organization or institution
4. The public good / the community good.
   How should we rank these? 1 en 4 of equal value. Individual cases: conflict 1 and 4, je moet de casus goed analyseren.  3 (3 staat boven 2.)
   - 1 + 4  3  2.

Question 11

Guidelines for development of financial incentives for physicians (weber 2001)

Answer 11

1. Incentives should be not too high
2. Incentives should be based on meeting quality criteria, not just reduction of resource use
3. Financial incentives should be used sparingly as a method of influencing physician practice patterns.

Question 12

Explanation of commercial model

Answer 12

Commercial model –> a private good

the cost of medical benefits will be seen as an expense that should be kept as low as possible.

o Commercial model: no difference between healthcare business & any other business.
o Vb wie volgens die frame redeneert: Just compliance (naleving) (Nobel-winning economist Milton Friedman)
o He wrote a paper: the social responsibility of business is to increase its profits.
* Friedman: managers of coperations are employees of the stockholder  and therefor responsibilitys for profits. Charity stuff = stealing form the stockholders.
o Just following the law. And doing more is theft of shareholders.
o Central concerns for manager: potential gains of profits / reasonable turn of investements. So like a normal business.

Question 13

Service model

Answer 13

Service model –> a social or a public good

using as much of every dollar as possible for the healthcare services that the organization is designed to provide. (prevers terms like: medical care / cost ratio).

o Healtcare = social / public good. (everyone invest in it. + caring for sick people is a social obligation that extend beyond the commercial realm)
o Justice-based ethics
o Managers have stewardship responsibility for limited resources available for healthcare services. .
o You need to be able to design and implement Fair procedures for evaluating claims made by different stakeholders
o Setting priorities about the use of resourses.
* So: is it fair to give nurses higher salary compared to other hospitals in the region? In case there is a shortage in nurses.
* It is allowed to refuse clients who are lossmaking for the organization?
* What is a fair procedure to downsize the organization when you loss a contract with one of your commissioners.

Question 14

What is healthcare business ethics?

Answer 14

• Beyond compliance
  o Compliance offers at least a minimal standard of what should not be done
  o Weexpectmorefromhealthcareorganisationsthatjustfollowtherules,we
  expect them to do good * Beyond integrity
  o Manager is trusted to be honest and doing right by others before personal advantage or the organization advantage
  o It is more than personal integrity, it requires also the ability to understand issues from the perspective of those who have little opportunity to be heard such as lower skilled workers or uninsured patients→an manager should weight and balance the rights and needs of all important stakeholders
• Beyond clinical ethics
  o Ethical concerns can be related to patient care (important to understand), but
  also to other stakeholders
• Ethics is a manger’s business and cannot always be delegated

Question 15

What is the nature of business ethics?

Answer 15

• According to the commercial model – a private good
  o No difference between healthcare business and other business
  o Central concerns for a manger relate to potential gains of profits, reasonable
  return of investments etc. (like a normal business)
  o Just compliance, Nobel-winning economist Milton Friedman reasoning from
  this model→irritated by the idea of social responsibility (doing good for the community), social responsibility of business is to increase its profits, business ethics is just about following the law and doing more is theft of shareholders
  o Recognizingsocialresponsibility
• According to the service model – a social or public good
  o Makingcontributionstothehealthcaresystemofferingasmuchservicesas possible given the amount of resources
  o Healthcare management is a service profession and healthcare can be the best understood as a social and public
  o Managers have stewardship responsibility for limited resources available for healthcare services
  o As future healthcare managers you need to be able to design and implement fair procedures for evaluating claims made by different stakeholders and for setting priorities for the use of resources
  o Justice-based ethics: justice is about fair distribution, making a difference between legitimate and illegitimate claims

Question 16

According to Weber healthcare organizations have three different roles, involving different commitments to healthcare managers, different tensions and different ways of dealing with these tensions. Describe these three roles in these terms.

Answer 16

1. Caregiver: Managers need to recognize individual patients as part of a community. There are also moral dilemmas about wages, salaries, downsizing etc. Commitments to:
   - Deliver high quality care
   - Respect patients’ rights
   - Stewardship responsibility for limited resources available for healthcare service: able
   to design and implement fair procedures for evaluating claims made by different stakeholders and for establishing the priorities for decisions about resources
   Managers need to recognize individual patients as art of a community of patients served. This can conflict
   Managers need to be able to design and implement fair procedures for evaluating claims made by different stakeholders and for establishing the priorities for decision about resources
2. Employer: Not unique to healthcare, the needs and interests of all relevant stakeholders are balanced on the basis of a consistent and explicit understanding of priorities. Commitments to:
   - Being fair in employing and managing staff in the organization
   Ethical tensions are numerous: for instance, related to what is fair wage; decisions about downsizing; etc.
   The ethical organization is one in which the needs and interests of all relevant stakeholders are balanced on the basis of a consistent and explicit understanding for priorities
3. Citizen: It has responsibility to promote the public good, particularly a responsibility to seek to improve the health status of the community.
   Responsibility to promote the public good, particularly a responsibility to seek to improve the health status of the community, being socially responsible
   Ethical tensions: what is best for patients or employees, may in some cases contrast the public good of health. Everyday work pressures and natural emphasis on the well being of the organization and on the well being of patients make it difficult for most managers to understand what this means let alone in place a high priority on these responsibilities

Ethical tensions: what is best for patients or employees, may in some cases contrast the public good of health. Everyday work pressures and natural emphasis on the well being of the organization and on the well being of patients make it difficult for most managers to understand what this means let alone in place a high priority on these responsibilities

Question 17

According to Weber there are two kinds of ethics concerns that need to be addressed in any organization, with two ethics related responsibilities for management. Which are these two?

Answer 17

Adherence to ethical standards, management has a responsibility to ensure that established ethical standards are known and observed, that apparent violations of these standards are investigated fairly and promptly, that confirmed violations are corrected in an appropriate manner, and that steps are taken to prevent future violations. Clear ethical standards need to be established and communicated.

Management should be sensitive to and educated about the ways that ethical values are inherent in various business decisions and management also has the responsibility to promote ethically informed and guided decisions by others in the organization (grijze gebied: hoe herken je de dilemma’s en samen bespreken ‘ hoe kunnen we als organisatie het beste hiermee om gaan?.

Question 18

Weber distinguishes four priority principles of business ethics. He also provides guidance on how to prioritize them. Which principles does he delineate, and how does he suggest to prioritize them?

Answer 18

1: Basic individual rights: what everyone, regardless of power, position or merit should have respected or provided simply because of being human (human rights) and what is due to persons because of agreements or promises
- good available care

2: Individual self-interest: the good things in life, as individuals define them, which they seek for themselves and for those close to them. What people want.

3: The interests of the organization or the institution itself: the good of the organization, normally as defined and interpreted by its leaders.
- finances
- give good quality of care to the patients.

Prioritize: 1 & 4, 3, 2

Question 19

Which four processes or methods are described in the report to foster integrity within a rule- based approach? Describe each.

Answer 19

Bij een rules-based benadering wordt gebruik gemaakt van formele en gedetailleerde regelgeving om integriteitsovertredingen te bestrijden en corruptie te voorkomen

Deze regels, wetten, normen, codes, protocollen (en de daarbij behorende sancties) functioneren als handvatten. Deze benadering kent ook beperkingen.

1. codes of conduct and protocols
2. monitoring: using objective indicators to try to find out what the state onf integrity is in an organization e.g. complaints
3. establish a whistle=blower regulation (dat iemand een klacht kan indienen, bv klachtencommitee/ anoniem, klokkenluiders regeling = als jij iets aankaart dat je beschermd wordt.)
4. sanctions (straffen als codes of conduct niet wordt nageleefd)

Hier is vaak minder over te vinden.

Question 20

The CEG report also describes a value-based approach to fostering integrity. Which three processes or methods are described in the report to foster integrity within a value based approach? Describe each.

Answer 20

1. Sturen op kernwaarden: mission, vision and explicit core values
2. Sturen op openheid en bespreekbaarheid: communicating desired behavior
3. Zelf het goede voorbeeld geven: message through your own behaviour about what is acceptable or not

Healthcare organisations have more weight on the value-based approaches.
- Jaarverslag.

Question 21

Which limitations are mentioned managers are faced with when fostering integrity in their organization?

Answer 21

Ruimte en vertrouwen (ongelijke informatie tussen client en professioneel,, dus je moet bepaalde ruimte hebben om goed te kunnen handelen)

beleid vanuit de beroepsgroep (veel policies komen vanuit de professies. Ze vinden die ethische values more important then the things you maybe want to implement as a manager).

beleid vanuit de overheid. (hier kan je als manager ook niet veel aan veranderen)

Question 22

2How would you organize such moral deliberation in your organization?

Answer 22

• Findings of article molewijk : ze hebben belangrijke punten / elements die belangrijk zijn om adress if you want to organize moral dilaberation.
  o Client centered questions
  o Different moral questions
  o Organize it close to the day to day care (even discussie van molenwijk et eal lezen, hier staat het in).
   Belangrijk dat je meer onderzoek doet naar hoe het de kwaliteit van care beinvloed. Invest more in research om te kijken of deze moral deliberation have affect on the quality of care.

Question 23

moral disagreement what to do?

Answer 23

• Objective factual information
• Unambiguous terminology
• Acceptance of common framework of moral norms (principles)
  o This is developed after clinical trials which went extremely wrong. So which norms has to be followed  Autonomy, beneficence, non-malifecence, justice.
• Use of (counter) examples
• Analyses of arguments (logic)
  o Working with examples and counterexamples.
  o You have to have a correct understanding of your facts.

Question 24

5 features of ethics of care:

Answer 24

Care is central: care is about meeting the needs of particular others for whom we take responsibility. Je bent op verschillende stadia van je leven afhankelijk van de zorg van anderen.
- Everything is care. : care is also: the way you treat the things around you.

2 Zorgethiek waardeert emotie in plaats van deze af te wijzen.
- Why is this so important?
- Not all emotion is valued, of course, but in contrast with the dominant rationalist approaches, such emotions as sympathy, empathy, sensitivity, and responsiveness are seen as the kind of moral emotions that need to be cultivated not only to help in the implementation of the dictates of reason but to better ascertain what morality recommends.3 Even anger may be a component of the moral indignation that should be felt when people are treated unjustly or inhumanely, and it may contribute to (rather than interfere with) an appropriate interpretation of the moral wrong.
-  Emotions are important to feel what is morally right. Its not they say you always have to follow your emotion, but emotion learns you how a relationship is. (And which parts should be reshaped/ if a relationship is good, what you should cultivate more).

4: Blurring of boundary between the private domain (household) and the public domain/ care is important in the public domain.
- Traditionele visie: the government should not interfere in the household/private sfeer, its all up to you.
- Ethics of care: Private domain is important. Otherwise we miss a very imporant part of morality. We have to take a very close look also at the situation in the household (f.e. imbalance/impower between gender).  So: ethics of care does not see the distinction between public and private.

5: Relational conception of persons: interdepence
- Person as relational instead of self-sufficient independent individuals.

Question 25

What, according to Held, is autonomy within the Ethics of Care?

Answer 25

Autonomy = kritiek op de liberale individualistische opvatting: de liberale visie geeft de illusie dat de samenleving bestaat uit vrije, gelijke en onafhankelijke individuen die ervoor kunnen kiezen om al dan niet met elkaar om te gaan. Het verdoezelt de zeer reele feiten van afhankelijkheid voor iedereen als ze jong zijn, de meeste mensen in verschillende periode in hun leven waarin ze ziek of oud zijn, voor sommige die gehandicapt zijn, en voor iedereen die zich bezig houd met onbetaald vrijwilligerswerk

Autonomy in ethics of care: Relational autonomy:
How we can positively contribute in each others lives. Taking responsibility for others. Identity is formed within social relationships.
- Not about: leaving people alone, but to actually feel responsible + what is needed. (our own identity is also shaped by the other person).

Question 26

Overeenkomsten tussen Kant en utilitarianism:

Answer 26

• Universal principles are central, such as the categorical imperative or the principle of utility
• Reasoning (rationalistic, abstract, universal)  what would be the rationalistic thing to do?
  o Beide theorieen zijn rationalistisch. (ze berusten op 1 heel eenvoudig common morality, waar iedereen altijd naar zou moeten handelen.
• Impartiality (reject emotion)  you have to come to universal norms. (can be through ci or principle of utility)
  o Beide vragen ons om volledig onpartijdig te zijn en emoties te verwerpen bij het bepalen wat we moeten doen.
• Public domain (market, state)  Starting point is the conception of the State, What strangers should do when they live together. (They base morality / rules from morality from the idea market place/state, waar mensen geen emotionele atachement hebben met elkaa, maar ze interacten on a basis ‘buying a product on the market, no emotions, just rational beings).
  o Ze negeren ‘real community’.
  o These dominant moral theories can be seen to be modeled on the experience of men in public life and in the marketplace.
• Liberal – individualistic conception of persons: self-sufficient, independent.

Deze theorieen kijken naar mensen die dominant zijn in de wereld zoals bijvoorbeeld men, en ze houden geen rekening met kwetsbare groepen zoals vrouwen/ zieken mensen. De universal rules are made by the dominant male perspective, and the viewpoint of women f.e. aren’t integrated in the way of reasoning. (Is a miss change because there are so many values in these ways of practices.)

Question 27

. In the first chapter of Care in Practice, Mol et al. develop and account of care practices that aligns with and Ethics of Care. What definition of good care do they give?

Answer 27

Good care: De auteurs omschrijven goede zorg als: “aanhoudend sleutelen in een wereld vol complexe
ambivalentie en wisselende spanningen.” Het gaat dus om het voortdurend zoeken naar oplossingen om een bepaalde situatie te verbeteren, terwijl we alle verschillende aspecten van de zorg in ogenschouw nemen,
die met elkaar in conflict kunnen komen. Het gaat niet om het op een rijtje zetten van principes. Verschillende goederen en waarden zijn relevant. Deze waarden moeten worden gewogen.

Good care: “persistent tinkering in a world full of complex ambivalence and shifting tensions.” Its about experimenting and testing, looking for improvement. Different aspects can be in conflict when looking for solutions. Relevant values have to be weighted.
- Er is een hele wijde range, waar je allemaal rekening mee houd. Not only talk / moral delibarate. Go and try.
- Involvement of materiality (also: its about how we handle the objects in a nursey home for example. Alles is met elkaar verbonden In deze theorie. Ook bijvoorbeeld technology. )

Question 28

What are the 5 rationing mechanisms? (Hunger, 1997)

Answer 28

• Deterrence:
  o Try to discourage the use of care  user co-payment
• Delay:
  o Waiting lists. first come, first served
• Deflection:
  o Try to push someone in another direction (mostly cheaper)  gatekeeper
  o Co-payment for GP outside regular hours
• Dilution
  o Shortening the stay in the hospital
• Denial
  o Meest extreme manier
  o Welke zouden niet in insurance package zitten.
  o Vraag: wordt dit vaak gebruikt?
  o (setting priorities)

Question 29

How does hilll look at balancing the interest of the individual and society?

Answer 29

Assumptions:
- Individuals are responsible for their health-related behaviour
- Personal responsibility cannot be absolute
o A lack of education, deep-seeted cultural traditions.

4 formulations of distributive justice (van wijd naar steeds meer afgebakend)
- Equal share of treatment
o But unfiar: some pt need more treatment then others
- Similar treatment for similar cases
o Alcohol related decease similar to non alcohol related decease? Is alcohol abuse a moral condition.
- According to personal effort
o In proportion to their own responsibility for their medical condition. This desease is a concequence of a lifestyle. What is personal effort?
o Problem: we not always have control over our lifestyle. To what extend can you control your own lifestyle?
- According to the (in)ability to pay for it
o Have the financial opportunity to prevent alcoholism. If help is not reimbursed, poor patients have a stronger claim then rich patients.

Question 30

3 theories of value in utilitarianism:

Answer 30

Classic (or hedonistic) utilitarianism
-  The only thing that is valuable is happiness and the absence of suffering in all those affected by the action.
 Value is based on the amount of happiness it provides or the amount of pain it prevents.
 Two famour representatives: Jeremy bentham en john stuart mill.

o Classic utilitarianism was critized for posing that happiness is the only thing that is valuable in its own right.

Pluralistic utilitarianism
- o Everything that has intrinsic value holds utility (bv”: beauty, knowledge, love, courage, friendship, health) ,
o The morally right course of action is not the action that maximizes happiness, but the action that maximizes composite goods (total value produced by the combination of all things that hold intrinsic value)
o Although pluralistic utilitarianism broadens the view on the things that hold intrinsic value, it does not solve the issue of how to measure and quantify value, and how to compare the total value that is generated by different actions
o Bv: being health more valuable than having friends?)

Preference utilitarianism (de meest moderne theory)
o Things hold utility based on the extent to which an action meets the preferences of those affected by the action.
o What are considered good and bad consequences of an action solely depends on individual (subjective) preferences, nothing is good or bad in itself.
o The morally right action is the action that maximizes individual (subjective) preferences.

Question 31

• 3. Two level utilitarianism (not discussed by B|&C)

Answer 31

Intuitive level; act according to moral rules (e.g. do not lie)
o Moral rules = intuitive level. If they conflict and do not reach utility then its good to look at the critical level.

Critical level: reassess rules in specific situations in case they conflict (e.g. save a life by lying).

Fear: to rigid. Thats why two level utilitarianism: You should be able to override the moral rules if that maximilzes the total utility

Question 32

3 criteria fleck for a well contrstucted, rational democratic deliberation proces:

Answer 32

• Impartiality (veil of ignorance, immune for interest group politics. –> impartial outcome)
• Reciprocity (Consistent, self-constructed and self-imposed, it has to implied to everyone).
• Reliance on public reason
• Impartiality (veil of ignorance, immune for interest group politics. –> impartial outcome)
• Reciprocity (Consistent, self-constructed and self-imposed, it has to implied to everyone).
• Reliance on public reason

Question 33

Critique in response to preference utilitarianism

Answer 33

1. How to measure, compare, and weigh the different preferences of all those affected by an action?
2. How to take the preferences into account of those who cannot state them (e.g. babies, comatose patients)? Do these preferences receive an equal weight as those of people who can? Is there a risk of double counting when proxies are used?
3. How to deal with irrational, (socially) undesirable, or immoral preferences (e.g. high time-preferences, preferences that discriminate against some groups in society, and sadistic preferences)?

Many preference utilitarians argue that irrational, (socially) undesirable, or immoral preferences should receive a lower rank than other preferences or that they should be ‘laundered’ or discarded.
This suggests that individual preferences should meet a certain—externally posed (paternalistic?)—standard in order to be included in the assessment of good and bad consequences of an action.

Question 34

3 types of utilitarianism

Answer 34

act utilitarianism
rule utilitarianism
two level utilitarianism

Question 35

Tronto: phases of care:

Answer 35

Caring about: recognize the needs for care: attentiveness

caring for: taking responibilithy to meet that need

Care giving: the actual work of care, conducted with competence (practical solution finding)
- the skill with which the care is given. . The manager needs to make sure his personell hase the right skills to be attentive to the needs of people with …

Care receiving: evaluating how care is received, responsiveness (nodding)
- follow up

Question 36

The policy paradox (Stone)

Answer 36

Paradoxes violate the most elementary principle of logic: something can’t be two different things at once. A policy paradox is about a set of rules trying to regulate something, causing another set of rules not to be followed, while those rules are also important/good/true.
For example: during a fire drill, there is a set of rules and regulations. One of them is ‘no talking’. This prevents a kid from telling a teacher that someone has been bullied, which is intrinsically good behavior but prohibited by the policy frame at that time.

Question 37

critique stone on the rationalisation project:

Answer 37

Its paradoxical because: Frames and underlying norms are not debated, they are presented as a rational analysis of a objective problem. This is the rationalization project
- Rationalisation project: pretending that policy questions are rational, technical questions which can be solved in a rational and neutral way
- Dominant way of thinking, also reflected in discussions on evidence based policy making (example of OMT in corona policy making)
o We moesten OMT vertrouwen, alleen ze zijn een expert of specifiek vakgebied, wat betekent dat er specifiek bepaalde normen dominant zijn.

Instead
- The rationality project misses the point of politics which is in essence normative
- Categories used in rational policy analysis themselves are informed by political struggle (partly about values as well)
o ‘ the rational decision-making model ignores our emotional feelings and moral institutions, both powerful parts of human motivation and precious parts of our life experience. (Stone, 2012, p.13)

Question 38

Definition of care (Tronto)

Answer 38

a species activity that includes everything we do to maintain, continue and repair our ‘world’ so that we can live in its as well as possible. That world includes our bodies, our selves and our environment, all of which we seek to interweave in a complex, life-sustaining web

• everything should be seen as care

Question 39

Relational autonomy in the face of ‘ethics of care

Answer 39

main concern = not how we can leave each other alone, instead how we can positively contribute in each others lives.
- Harm from abondonment is more a concern than interference.

So autonomy is important, but it gets another meaning: relational autonomy
- Interdependece, vulnerability is not exceptional
- taking responsibility for others
- identity is formed within social relationships

Question 40

Ethics of care vs virtue ethics

Answer 40

can can be virtue, however it is alos a practice (day-today- work, labor). This aspect remains under addressed in virtue ethics.

Virtue ethics focusses on individuals while care ethics focusses on relationship.

Question 41

Imporant things of libetarian justice perspective:

Answer 41

• A libertarian argument could be that it is not unacceptable for the rich to profit from research that they themselves pay for without others also profiting. They can do as they please with their own money, as long as the same procedures and rules apply to everyone regarding the transaction, for example the rates should applied equally.
• According to libertarians we don’t have to correct unfortunate disadvantages, only unfair disadvantages should be corrected. There’s a difference between unfortunate and unfair opportunities. The fact that some patients cannot pay for contribution as a result of the fact that they are poorer does not constitute grounds for compensation. As long as everyone choose it freely and has the same starting position, there is no problem according to the libertarian.
• Students could also argue that state funded research is not necessary at all: free market for participation in research is even a better solution since citizens can then negotiate about the price or share in the profits from any resulting drug as a result of the study or other conditions regarding the transaction (for example, they will get their money back when the study isn’t successful).