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.

Diminishing reciprocal fairness by disrupting the right prefrontal cortex.

Humans restrain self-interest with moral and social values. They are the only species known to exhibit reciprocal fairness, which implies the punishment of other individuals' unfair behaviors, even if it hurts the punisher's economic self-interest. Reciprocal fairness has been demonstrated in the Ultimatum Game, where players often reject their bargaining partner's unfair offers. Despite progress in recent years, however, little is known about how the human brain limits the impact of selfish motives and implements fair behavior. Here we show that disruption of the right, but not the left, dorsolateral prefrontal cortex (DLPFC) by low-frequency repetitive transcranial magnetic stimulation substantially reduces subjects' willingness to reject their partners' intentionally unfair offers, which suggests that subjects are less able to resist the economic temptation to accept these offers. Importantly, however, subjects still judge such offers as very unfair, which indicates that the right DLPFC plays a key role in the implementation of fairness-related behaviors.

Fairness

Die Fairnessnorm wird als eine der grundlegenden gesellschaftlichen Regeln für menschliches Entscheidungsverhalten betrachtet. Im folgenden Beitrag werden nach einer kurzen Einführung zunächst klassische moralphilosophische Auffassungen skizziert und grundlegende Vorstellungen über Gerechtigkeit und Fairness präsentiert. Dabei werden insbesondere distributive Fairnessprinzipien erläutert. Die empirische Evidenz zeigt, dass die Auswahl von Fairnessprinzipien und die Entscheidung, ob eine Fairnessnorm befolgt wird, kontextabhängig ist. Im Beitrag wird daher auch auf die Frage eingegangen, welche Motive von Akteuren ursächlich für die Befolgung einer Fairnessnorm sind. Es werden in diesem Zusammenhang Geltungsbedingungen und Entstehungsmechanismen für prosoziales Verhalten erörtert. Zur theoretischen Fundierung normorientierten Verhaltens wurden in den letzten beiden Dekaden Erweiterungen nutzentheoretischer Konzepte vorgeschlagen, die neben selbstinteressierten Präferenzen von Akteuren auch soziale Präferenzen berücksichtigen. Vorgestellt werden dabei nutzentheoretische Modelle, die sich mit egalitären Verteilungsprinzipien beschäftigen. Im Anschluss wird empirische Evidenz zur Fairnessnorm präsentiert, wobei insbesondere auf die Evidenz distributiver Fairnessprinzipien eingegangen wird und auf die Robustheit der Fairnessnorm im Rahmen experimenteller und feldexperimenteller Studien.