Conflicting demands on a modern healthcare service: Can Rawlsian justice provide a guiding philosophy for the NHS and other socialized health services?

Abstract:

:We explore whether a Rawlsian approach might provide a guiding philosophy for the development of a healthcare system, in particular with regard to resolving tensions between different groups within it. We argue that an approach developed from some of Rawls' principles - using his 'veil of ignorance' and both the 'difference' and 'just savings' principles which it generates - provides a compelling basis for policy making around certain areas of conflict. We ask what policies might be made if those making them did not know if one was patient, doctor, nurse or manager - in this generation or the next. We first offer a brief summary of Rawls' approach and how we intend to extrapolate from it. We examine how this adapted Rawlsian framework could be applied to specific examples of conflict within healthcare; we demonstrate how this framework can be used to develop a healthcare service which is both sustainable (in its training and treatment of staff, and in encouraging research and innovation) and open (to protect the powers and opportunities of those using the health service). We conclude that while Rawls' approach has previously been rejected as a means to address specific healthcare decisions, an adapted veil of ignorance can be a useful tool for the consideration of how a just health service should be constructed and sustained. Turning the theoretical into the practical (and combining Rawls' thought experiment with Scanlonian contractarianism), managers, doctors, patients, carers and nurses could come together and debate conflicting issues behind a hypothetical veil.

journal_name

Bioethics

journal_title

Bioethics

authors

Fritz Z,Cox C

doi

10.1111/bioe.12568

subject

Has Abstract

pub_date

2019-06-01 00:00:00

pages

609-616

issue

5

eissn

0269-9702

issn

1467-8519

journal_volume

33

pub_type

杂志文章
  • Wrongs, preferences, and the selection of children: a critique of Rebecca Bennett's argument against the principle of procreative beneficence.

    abstract::Rebecca Bennett, in a recent paper dismissing Julian Savulescu's principle of procreative beneficence, advances both a negative and a positive thesis. The negative thesis holds that the principle's theoretical foundation - the notion of impersonal harm or non-person-affecting wrong - is indefensible. Therefore, there ...

    journal_title:Bioethics

    pub_type: 杂志文章

    doi:10.1111/j.1467-8519.2010.01870.x

    authors: Herissone-Kelly P

    更新日期:2012-10-01 00:00:00

  • The injustice of fat stigma.

    abstract::Fatness stigma is pervasive. Being fat is widely regarded a bad thing, and fat persons suffer numerous social and material disadvantages in virtue of their weight being regarded that way. Despite the seriousness of this problem, it has received relatively little attention from analytic philosophers. In this paper, I s...

    journal_title:Bioethics

    pub_type: 杂志文章

    doi:10.1111/bioe.12560

    authors: Nath R

    更新日期:2019-06-01 00:00:00

  • Our brains are not us.

    abstract::Many neuroscientists have claimed that our minds are just a function of and thus reducible to our brains. I challenge neuroreductionism by arguing that the mind emerges from and is shaped by interaction among the brain, body, and environment. The mind is not located in the brain but is distributed among these three en...

    journal_title:Bioethics

    pub_type: 杂志文章

    doi:10.1111/j.1467-8519.2009.01727.x

    authors: Glannon W

    更新日期:2009-07-01 00:00:00

  • Reciprocity-based reasons for benefiting research participants: most fail, the most plausible is problematic.

    abstract::A common reason for giving research participants post-trial access (PTA) to the trial intervention appeals to reciprocity, the principle, stated most generally, that if one person benefits a second, the second should reciprocate: benefit the first in return. Many authors consider it obvious that reciprocity supports P...

    journal_title:Bioethics

    pub_type: 杂志文章

    doi:10.1111/bioe.12039

    authors: Sofaer N

    更新日期:2014-11-01 00:00:00

  • Racist organ donors and saving lives.

    abstract::This paper considers what should be done about offers of organs for transplant that come with racist strings attached. Saving lives or improving their quality seem powerful reasons to accept the offer. Fairness, justice, and rejecting racism seem like powerful reasons against. This paper argues that conditional alloca...

    journal_title:Bioethics

    pub_type: 杂志文章

    doi:10.1111/j.1467-8519.2007.00526.x

    authors: Wilkinson TM

    更新日期:2007-02-01 00:00:00

  • Empirical ethics and its alleged meta-ethical fallacies.

    abstract::This paper analyses the concept of empirical ethics as well as three meta-ethical fallacies that empirical ethics is said to face: the is-ought problem, the naturalistic fallacy and violation of the fact-value distinction. Moreover, it answers the question of whether empirical ethics (necessarily) commits these three ...

    journal_title:Bioethics

    pub_type: 杂志文章,评审

    doi:10.1111/j.1467-8519.2009.01710.x

    authors: de Vries R,Gordijn B

    更新日期:2009-05-01 00:00:00

  • The debate over risk-related standards of competence.

    abstract::This discussion paper continues the debate over risk-related standards of mental competence which appears in Bioethics 5. Dan Brock there defends an approach to mental competence in patients which defines it as being relative to differing standards, more or less rigorous depending on the degree of risk involved in pro...

    journal_title:Bioethics

    pub_type: 杂志文章

    doi:10.1111/1467-8519.00081

    authors: Wilks I

    更新日期:1997-10-01 00:00:00

  • Ethics and drug resistance.

    abstract::This paper reviews the dynamics behind, and ethical issues associated with, the phenomenon of drug resistance. Drug resistance is an important ethical issue partly because of the severe consequences likely to result from the increase in drug resistant pathogens if more is not done to control them. Drug resistance is a...

    journal_title:Bioethics

    pub_type: 杂志文章,评审

    doi:10.1111/j.1467-8519.2006.00542.x

    authors: Selgelid MJ

    更新日期:2007-05-01 00:00:00

  • Moral Philosophy, Moral Expertise, and the Argument from Disagreement.

    abstract::Several recent articles have weighed in on the question of whether moral philosophers can be counted as moral experts. One argument denying this has been rejected by both sides of the debate. According to this argument, the extent of disagreement in modern moral philosophy prevents moral philosophers from being classi...

    journal_title:Bioethics

    pub_type: 杂志文章

    doi:10.1111/bioe.12173

    authors: Cross B

    更新日期:2016-03-01 00:00:00

  • The Ties that Undermine.

    abstract::Do biological relations ground responsibilities between biological fathers and their offspring? Few think biological relations ground either necessary or sufficient conditions for responsibility. Nevertheless, many think biological relations ground responsibility at least partially. Various scenarios, such as cases co...

    journal_title:Bioethics

    pub_type: 杂志文章

    doi:10.1111/bioe.12213

    authors: Beverley J

    更新日期:2016-06-01 00:00:00

  • Adolescent and parental perceptions of medical decision-making in Hong Kong.

    abstract:OBJECTIVES:To investigate whether Chinese adolescents in Hong Kong share similar perceptions with their Western counterparts regarding their capacity for autonomous decision-making, and secondarily whether Chinese parents underestimate their adolescent children's desire and capacity for autonomous decision-making. MET...

    journal_title:Bioethics

    pub_type: 杂志文章

    doi:10.1111/j.1467-8519.2010.01803.x

    authors: Hui E

    更新日期:2011-11-01 00:00:00

  • Family refusal of emergency medical treatment in China: An investigation from legal, empirical and ethical perspectives.

    abstract::This paper is an analysis of the limits of family authority to refuse life saving treatment for a family member (in the Chinese medical context). Family consent has long been praised and practiced in many non-Western cultural settings such as China and Japan. In contrast, the controversy of family refusal remains less...

    journal_title:Bioethics

    pub_type: 杂志文章

    doi:10.1111/bioe.12728

    authors: Jin P,Zhang X

    更新日期:2020-03-01 00:00:00

  • Political legitimacy and research ethics.

    abstract::In democratic theory, "legitimacy" refers to the set of conditions that must be in place in order for the claims to authority of somebody to be deemed appropriate, and for their claims to compliance to be warranted. Though criteria of legitimacy have been elaborated in the context of democratic states, there is no rea...

    journal_title:Bioethics

    pub_type: 杂志文章

    doi:10.1111/bioe.12489

    authors: Smith MJ,Weinstock D

    更新日期:2019-03-01 00:00:00

  • Trading with the waiting-list: the justice of living donor list exchange.

    abstract::In a Living Donor List Exchange program, the donor makes his kidney available for allocation to patients on the postmortal waiting-list and receives in exchange a postmortal kidney, usually an O-kidney, to be given to the recipient he favours. The program can be a solution for a candidate donor who is unable to donate...

    journal_title:Bioethics

    pub_type: 杂志文章

    doi:10.1111/j.1467-8519.2008.00684.x

    authors: den Hartogh G

    更新日期:2010-05-01 00:00:00

  • Advance directives in the Netherlands: an empirical contribution to the exploration of a cross-cultural perspective on advance directives.

    abstract:RESEARCH OBJECTIVE:This study focuses on ADs in the Netherlands and introduces a cross-cultural perspective by comparing it with other countries. METHODS:A questionnaire was sent to a panel comprising 1621 people representative of the Dutch population. The response was 86%. RESULTS:95% of the respondents didn't have ...

    journal_title:Bioethics

    pub_type: 杂志文章

    doi:10.1111/j.1467-8519.2009.01788.x

    authors: van Wijmen MP,Rurup ML,Pasman HR,Kaspers PJ,Onwuteaka-Philipsen BD

    更新日期:2010-03-01 00:00:00

  • Finding A Seat at the Table Together: Recommendations for Improving Collaboration between Social Work and Bioethics.

    abstract::Social work and bioethics are fields deeply committed to cross-disciplinary collaboration to do their respective work. While scholars and practitioners from both fields share a commitment to social justice and to respecting the dignity, integrity and the worth of all persons, the overlap between the fields, including ...

    journal_title:Bioethics

    pub_type: 杂志文章

    doi:10.1111/bioe.12106

    authors: Brazg T,Dotolo D,Blacksher E

    更新日期:2015-06-01 00:00:00

  • Compensation for cures: Why we should pay a premium for participation in 'challenge studies'.

    abstract::Antibiotic resistance is one of the most pressing public health problems humanity faces. Research into new classes of antibiotics and new kinds of treatments - including risky experimental treatments such as phage therapy and vaccines - is an important part of improving our ability to treat infectious diseases. In ord...

    journal_title:Bioethics

    pub_type: 杂志文章

    doi:10.1111/bioe.12596

    authors: Anomaly J,Savulescu J

    更新日期:2019-09-01 00:00:00

  • The German debate on male circumcision and Habermas' model of post-secularity.

    abstract::This paper considers Habermas' model of a post-secular political order in the light of the debate on male circumcision that arose in Germany after a court ruled that male circumcision was an unjustifiable act of bodily harm. Central to this model is the idea that religious reasons can only become effective in central ...

    journal_title:Bioethics

    pub_type: 杂志文章

    doi:10.1111/bioe.12526

    authors: Greve J

    更新日期:2019-05-01 00:00:00

  • The conjoined twins and the limits of rationality in applied ethics.

    abstract::In this article I consider the case of the surgical separation of conjoined twins resulting in the immediate and predictable death of the weaker one. The case was submitted to English law by the hospital, and the operation permitted against the parents' wishes. I consider the relationship between the legal decision an...

    journal_title:Bioethics

    pub_type: 杂志文章

    doi:10.1111/1467-8519.00322

    authors: Cowley C

    更新日期:2003-02-01 00:00:00

  • Who gets the gametes? An argument for a points system for fertility patients.

    abstract::This paper argues that the convention of allocating donated gametes on a 'first come, first served' basis should be replaced with an allocation system that takes into account more morally relevant criteria than waiting time. This conclusion was developed using an empirical bioethics methodology, which involved a study...

    journal_title:Bioethics

    pub_type: 杂志文章

    doi:10.1111/bioe.12411

    authors: Jenkins S,Ives J,Avery S,Draper H

    更新日期:2018-01-01 00:00:00

  • Care and the problem of pity.

    abstract::In recent years philosophers and bioethicists have given considerable attention to the concept of care. Thus we have seen important work on questions such as: whether there is a uniquely female approach to ethics, whether ethics should be partial or impartial, and whether care must be supplemented by justice. Despite ...

    journal_title:Bioethics

    pub_type: 杂志文章

    doi:10.1111/1467-8519.00318

    authors: Boleyn-Fitzgerald P

    更新日期:2003-02-01 00:00:00

  • Does human genome editing reinforce or violate human dignity?

    abstract::Germline genome editing is often disapproved of at the international policy level because of its possible threats to human dignity. However, from a critical perspective the relationship between this emerging technology and human dignity is relatively understudied. We explore the main principles that are referred to wh...

    journal_title:Bioethics

    pub_type: 杂志文章

    doi:10.1111/bioe.12607

    authors: Segers S,Mertes H

    更新日期:2020-01-01 00:00:00

  • 'Aching to be a boy': A preliminary analysis of gender assignment of intersex persons in India in a culture of son preference.

    abstract::Intersexuality, particularly in the global South, remains an under-researched field of study. In my in-progress doctoral research project, I explore the cultural, social, and medical discourses that influence how key stakeholders such as healthcare providers make decisions about the sex and gender assignment of the in...

    journal_title:Bioethics

    pub_type: 杂志文章

    doi:10.1111/bioe.12750

    authors: Das A

    更新日期:2020-07-01 00:00:00

  • Gender and ethics committees: where's the 'different voice'?

    abstract::Prominent international and national ethics commissions such as the UNESCO International Bioethics Committee rarely achieve anything remotely resembling gender equality, although local research and ethics committees are somewhat more egalitarian. Under-representation of women is particularly troubling when the subject...

    journal_title:Bioethics

    pub_type: 杂志文章

    doi:10.1111/j.1467-8519.2006.00485.x

    authors: Dickenson D

    更新日期:2006-06-01 00:00:00

  • Overstating values: medical facts, diverse values, bioethics and values-based medicine.

    abstract::Fulford has argued that (1) the medical concepts illness, disease and dysfunction are inescapably evaluative terms, (2) illness is conceptually prior to disease, and (3) a model conforming to (2) has greater explanatory power and practical utility than the conventional value-free medical model. This 'reverse' model em...

    journal_title:Bioethics

    pub_type: 杂志文章

    doi:10.1111/j.1467-8519.2011.01902.x

    authors: Parker M

    更新日期:2013-02-01 00:00:00

  • An Eliminativist Approach to Vulnerability.

    abstract::The concept of vulnerability has been subject to numerous different interpretations but accounts are still beset with significant problems as to their adequacy, such as their contentious application or the lack of genuine explanatory role for the concept. The constant failure to provide a compelling conceptual analysi...

    journal_title:Bioethics

    pub_type: 杂志文章

    doi:10.1111/bioe.12144

    authors: Wrigley A

    更新日期:2015-09-01 00:00:00

  • Hit but not down. The substance view in light of the criticism of Lovering and Simkulet.

    abstract::In his article 'The substance view: A critique', Rob Lovering argues that the substance view -according to which a human person comes into existence at the moment of conception - leads to such implausible implications that this view should be abandoned. I responded to his reductio arguments in 'A critique of Rob Lover...

    journal_title:Bioethics

    pub_type: 杂志文章

    doi:10.1111/bioe.12450

    authors: Friberg-Fernros H

    更新日期:2018-07-01 00:00:00

  • Regret, shame, and denials of women's voluntary sterilization.

    abstract::Women face extraordinary difficulty in seeking sterilization as physicians routinely deny them the procedure. Physicians defend such denials by citing the possibility of future regret, a well-studied phenomenon in women's sterilization literature. Regret is, however, a problematic emotion upon which to deny reproducti...

    journal_title:Bioethics

    pub_type: 杂志文章

    doi:10.1111/bioe.12431

    authors: Lalonde D

    更新日期:2018-06-01 00:00:00

  • The doctor-patient relationship: a survey of attitudes and practices of doctors in Singapore.

    abstract::This article reports the results of a survey, by mailed questionnaire, of the attitudes, values and practices of doctors in Singapore with respect to the doctor-patient relationship. Questionnaires were sent to a random sample of 475 doctors (261 general practitioners and 214 medical specialists), out of which 249 (52...

    journal_title:Bioethics

    pub_type: 杂志文章

    doi:10.1111/1467-8519.00180

    authors: Chan D,Goh LG

    更新日期:2000-01-01 00:00:00

  • Artificial reproductive technologies: the Israeli scene.

    abstract::In 1991, the Israeli Minister of Health and the Minister of Justice jointly nominated a commission to consider the subject of IVF in all its aspects. Heyd summarizes the commission's recommendations on the following issues as put forth in an interim report: access to fertility treatments, financing of treatment, couns...

    journal_title:Bioethics

    pub_type: 杂志文章

    doi:10.1111/j.1467-8519.1993.tb00293.x

    authors: Heyd D

    更新日期:1993-04-01 00:00:00