PhiA 2.4
The Moral Compass of Contemporary Health Researchers
and Professionals
Lecture 1: Theories of justice and health
Day 1
Justice and Health
o Parks & Wike
o Rawls
o Daniels
Day 2
Social identities and the stories we tell
o Appiah
o Lamont
Day 3
Critical strategies
o Comparing different approaches to ethics
Introduction about the assignment and books in next philosophy week
Changes PhiA-week based on evaluations last year
Different selection of literature and philosophers
More overlap between literature and lectures (to help getting used to English)
Two (instead of 1) working-lectures (in groups of ca 15)
Assignments as a 4-step reflection
o How to understand an ethical question with theories of justice and stories on social
identity
Assignment & working lectures
Assignment: write a reflection in 4 stages about an ethical question within the field of your
study-track (see course-book)
Read the complete course-book and literature and make the reading questions to prepare for
the working lecture
Prepare a 2-minute pitch about your work in progress in Thursday’s working lecture
To get started to look at the topic list and literature suggestions in appendix 1 in the course
book
Lecture set up
Justice and health today and in 24 centuries of debate
Justice as fairness, John Rawls
Justice and Health, Norman Daniels
What is justice?
Central question in ethics from Plato & Aristotle until today
o A virtue and character trait: a person can be just or unjust
, o A characteristics of social institutions, a society or international organizations
“Giving each person his or her due…” (Parks & Wike 2010) how do you know what each persons
is due?
Due = what kind of obligation you have to another person
Formal principle of justice
Aristotle: “Treat equal cases equally and unequal cases unequally”
o The crucial question is how to do the comparisons between cases, what criteria to use?
Social contract theories (17th century)
In social contract theories justice is about rights and obligations within a country or
community
Thomas Hobbes (1651) & John Locke (1689)
o People give up part of their freedom and accept to be ruled by a government in return for
protection
o People thus leave ‘the state of nature’ behind
Negative and positive rights
Negative rights: physical integrity, freedom from violence, freedom of speech, freedom of
movement, religious freedom, personal property…
o Obliged the government/other people from doing something
Positive rights: rights to food, housing, education, healthcare, public health, protection, social
inclusion…
o Obliged the government/other people to do something
Negative and positive rights in political theories
Right side: theories who plays
more value on the negative
rights (freedom rights) and
wants the governments to play
a very small role and not to
interfere too much.
Left side: theories who plays
more value on the positive
rights (healthcare, education)
and wants the government to
plat a big role and to interfere.
How to take a justice perspective
Aristotle’s formal principle of justice
o Think about equality and difference
Social contract theory
o Think about rights and obligations
o Think about relations between negative and positive rights
o Think about relations between individual and government-actors
Contemporary questions in health
, o Seek ways of balancing conflicting (positive & negative) rights and obligations
Justice and Fairness (John Rawls)
Wrote ‘A theory of justice’ in 1971
A lot of discussion: a lot of people were using and criticizing this theory
Rewrote his theory in 2001: most of the theory stayed the same, but he engaged in some
discussions with his critics and reformulated some things a little bit
Died in 2002
Social liberalism he played really high value on freedom and equality
Context of building Rawls’ theory
In the 60’s and 70’s there was a lot of activist movements going on
Civil right movement: end of segregation systems that were still there in America, labor
unions asking for better working conditions and payment & a lot of discussion about the
Vietnam war
John Rawls: it was really difficult to think clearly, because everyone is thinking only from
their own perspective
Rawls had problems with the labor unions: yes they can make people more powerful in the
face of the owners/people with big money, but they also take some of the freedom of their
laborors away people were not asked to speak for themselves, but for the group
John Rawls: ‘Veil of ignorance’
An original position in which people do not know who they are (men/woman, black/white,
rich/poor, intelligent/not intelligent, etc.) they are behind ‘a veil of ignorance’
Rawls: from this ‘original position’ with ‘a veil of ignorance’ we can start thinking about a
just society, because we don’t know how the lottery will fall (we know there will be some
inequalities, but we will try to organize it in the best way possible)
If I don’t know that I will be disabled and will be born in a poor family I will try to think of
arrangements that make even the worst of groups better off in some way
Justice is for Rawls not only the outcome of an agreement, but also about the process (how
you come to an agreement)
https://www.youtube.com/watch?v=_KefNcPFUDo
Criteria for distributive justice
Distributive justice: deals with the question who gets what in society and how this is decided
Equality
o A: Give all an equal share (e.g. cake)
o B: Give all an equal opportunity (e.g. to bake their own cake)
Equality has a different meaning, so people should have an equal opportunity to get
somewhere.
Utility
o Allocate resources in such way that overall happiness of the greatest number of people is
maximized (e.g. people where very unhappy about a quarter of the cake and would be
much more happy if they got a bigger piece, so it would be justified to say 3 people get a
very big piece of the cake and 1 person gets nothing)
Downside of utilitarian thinking: it can be very unjust to small minorities, because the
majority plays such a big role.
Utility is sometimes seen as a more just criteria (e.g. donor transplantation: we give the
live to someone who is more fit, a child, and who has better chances of surviving and
getting utility/benefit out of the donor liver)
Merit
o Give each what they deserve based on ‘merit’ (e.g. if you work harder, you get more)
