Rawlsian justice in healthcare: a response to Cox and Fritz

Cox and Fritz state the central problem as the absence of a framework for healthcare policy decisions; but, they overlook the theoretical underpinnings of public law. In response, they propose a two-step procedure to guide fair decision-making. The first step relies on Thomas Scanlon’s ‘contractualism’ for stakeholders to consider whether, or not, they could reasonably reject policy proposals made by others; then in the second step, John Rawls’s principles of justice are applied to these proposals; a fair policy requires to pass both steps. I argue that Cox and Fritz misinterpret Rawls. His theory has two stages: first, public reason is used to generate principles of justice; second, public reason is used to interpret and apply these principles. The second stage requires that proposals are based on the principles of justice from the first stage, and these proposals have to be acceptable to reasonable persons. Thus, Rawls’s theory does not need Scanlonian supplementation. Moreover, the application of Rawls’s theory in Cox and Fritz’s model is confusing. In any case, the problems with applying Rawlsian justice to healthcare can be located elsewhere. First, Rawls’s theory would treat healthcare simply as a ‘primary good’ or resource. Social justice ought to, instead, consider healthcare as an opportunity, in the manner conceived by Amartya Sen. Second, Rawlsian justice rests, ultimately, on the conception of a reasonable person; until and unless the characteristics of reasonable stakeholders are clarified, any model of health justice will remain hostage to the unreasonable.

Fair allocation of potential COVID-19 vaccines using an optimization-based strategy

The fair allocation of resources among multiple stakeholders in any area is a complex challenge for decision-making. This paper presents an optimization strategy for the allocation of COVID-19 vaccines, when they are available, through different fairness schemes (social welfare, Nash, Rawlsian justice, and social welfare II scheme). The applicability of the proposed model is illustrated using the case study of Mexico, including the states of the country as stakeholders. We involve several parameters to guide the allocation, such as the size, risk profiles, and fraction of vulnerable groups in the population. Furthermore, different scenarios of the availability of potential COVID-19 vaccines were evaluated. The social welfare approach is the most commonly used scheme for the allocation of resources. However, we demonstrate that this scheme yields non-unique or multiple solutions (through the social welfare II approach). These social welfare approaches provide inequalities in the allocations that become critical when resources are scarce. Specifically, the social welfare scheme favors large stakeholders (greater population) in all scenarios. We also observe how the complexity of the allocation increases with the higher availability of vaccines. Hence, it is important to consider allocation schemes to identify fair solutions.

Extending Rawlsian Justice to Nonhuman Animals

Rawls’s theory does not, as many philosophers assume, rule out the possibility of justice for nonhuman animals. A careful reading of Rawls shows that the issue hinges on the answer to this question: would it be reasonable for moral agents to agree to terms of social cooperation that include protections for animals? To establish that it is reasonable, one must make an argument for these legal protections that is grounded in public reason alone. Such arguments exist and, indeed, dominate discussions of the status of animals. Accordingly, a Rawlsian framework can be used to argue for justice for animals.

The “black box” at work

An oversized reliance on big data-driven algorithmic decision-making systems, coupled with a lack of critical inquiry regarding such systems, combine to create the paradoxical “black box” at work. The “black box” simultaneously demands a higher level of transparency from the worker in regard to data collection, while shrouding the decision-making in secrecy, making employer decisions even more opaque to the worker. To access employment, the worker is commanded to divulge highly personal information, and when hired, must submit further still to algorithmic processes of evaluations which will make authoritative claims as to the workers’ productivity. Furthermore, in and out of the workplace, the worker is governed by an invisible data-created leash deploying wearable technology to collect intimate worker data. At all stages, the worker is confronted with a lack of transparency, accountability, or explanation as to the inner workings or even the logic of the “black box” at work. This data revolution of the workplace is alarming for several reasons: (1) the “black box at work” not only serves to conceal disparities in hiring, but could also allow for a level of “data-laundering” that beggars any notion of equal opportunity in employment and (2) there exists, the danger of a “mission creep” attitude to data collection that allows for pervasive surveillance, contributing to the erosion of both the personhood and autonomy of workers. Thus, the “black box at work” not only enables worker domination in the workplace, it deprives the worker of Rawlsian justice.

Moral Objectivity and Property: The Justice of Liberal Socialism

This paper restates the thesis of ‘The Requirements of Justice and Liberal Socialism’where itwas argued that liberal socialism best meets Rawlsian requirements of justice. The recent responses to this article by Jan Narveson, Jeppe von Platz, and Alan Thomas merit examination and comment. This reply shows that if Rawlsian justice is to be met, then non-personal property must be subject to public control. If just outcomes merit the public control of non-personal property and this control is not utilized, then justice has been subordinated to the objectively less important institution of private property.

Property-owning democracy as an alternative to capitalism

Alan Thomas’ Republic of Equals: Predistribution and Property-Owning Democracy sets itself the ambitious task of synthesising neo-republican political theory and Rawlsian justice as fairness. It is an important and challenging work that will set the stage for a great deal of the discussion not only on justice and republicanism, but also on property-owning democracy, market socialism and broader discussions of alternative economic institutions to come. After reconstructing the argument of the book, this review article turns to some specific points it raises that warrant further discussion. More precisely, it examines Thomas’ critique of market socialism, arguing that it fails to do what it sets out to do: show that market socialism is incompatible with justice as fairness. Having discussed and rejected his critique of the main other model that Thomas considers, I then turn to questions of the feasibility of POD as a feasible alternative to familiar forms of capitalism.