Health, Justice, and Fairness

In this study I will endeavor to show that the American system of health care violates any conception of distributive justice understood as equality of opportunity. This system fails to provide equal access through a lack of universal insurance, a consumer driven conception of quality, and a system wide focus on cost control, leaving millions of Americans exposed to the ravages of disease. However, if health is understood as an antecedent for one's ability to function across a number of categories that have been objectively deemed as vital to engage in a life that is fully human than the commitment our nation has to the protection of fair equality of opportunity, established by our adoption of a Rawlsian conception of justice, necessitates a revision of our nation's conception of quality to encapsulate health outcomes as well as the advent of a system of universal coverage. Quality care will come to be understood as care that returns to the patient the ability to function across those categories of functioning that illness has jeopardized, and this conception of quality will precipitate system wide reform geared at the creation of positive health outcomes. This paper will articulate this argument by reconstructing and synthesizing precepts from the contemporary philosophical sources and then applying these to the practical workings of our healthcare system, while concurrently demonstrating that a system of distributive justice is compatible with the creation of a universal system of healthcare.

Capuchin Monkeys (Cebus apella) Fail to Be Equitable in an Ultimatum Game

The ultimatum game is a commonly used economics game testing humans' sense of fairness. In the game, a "proposer" is given a sum of money and is told they can split it however they want with another human partner. The partner can then either accept the division and both proposer and responder receive the proposed amounts, or the responder can reject the offer and neither player will get anything. Human subjects from most western cultures typically share almost half of an allotted amount, but it remains unknown whether our close primate relatives share this generosity. Recent attempts to present chimpanzees with the ultimatum game have provided inconclusive results, with some studies finding the animals share humans' disposition to behave 'fairly' and others concluding that chimpanzees act selfishly to maximize their own rewards. Capuchin monkeys are known to share many human and chimpanzee social and cooperative behaviors, and this study was the first to present capuchin monkeys with a version of the ultimatum game. Subjects were presented with two differently colored tokens representing different qualitative reward contingencies, one equitable and the other inequitable in favor of the subject proposer. Subjects could select and place one of the tokens in a transfer container. The capuchins were first tested with a "dictator game" where, after the subject monkey selected a token, the rewards (equitable or inequitable) were distributed to the subject and a nearby partner monkey that was not an active participant. The capuchins were then tested on an ultimatum game in which after the subject selected and placed a token in the container, the container was moved to the partner. The partner needed to remove the token and transfer it back to the experimenter for the rewards to be distributed. As such, the partner could reject the subject's offer by refusing to participate and neither would receive a reward. The experiment was conducted to determine if the subject monkey would select the equitable reward option rather than the selfish option in order to maintain the partner's cooperation in the task. Capuchin subjects behaved selfishly and selected the inequitable token significantly more often than the equitable token in both the dictator and ultimatum game with no significant difference in preference between the two games. Interestingly, despite the occasional occurrence of rejection by the partner monkeys (resulting in no reward for the subject), subjects never altered their strategy, continuing to prefer the selfish token. The study may indicate that capuchin monkeys have an inability to judge the effect of their behavior on a conspecific's reward outcome, or an indifference to the outcome if there is an individual cost associated with behaving prosocially.