In this paper we ask whether liberal egalitarians can endorse workfare policies that require that welfare recipients should work in return for their welfare benefits. In particular, we focus on the fairness-based case for workfare, which holds that people should be responsible for their own welfare since they would otherwise impose unfair costs on others. Two versions of the fairness-based case are considered: The first defends workfare on the grounds that it would form part of an unemployment insurance scheme that (...) individuals would endorse under certain hypothetical conditions that are salient for the purposes of determining just public policy. The second appeals to the notion of reciprocity in order to justify the requirement that people work for their benefits. We cast doubt on both of these arguments for workfare. Neither argument shows that the unconditional provision of welfare benefits is unjust; hence, the fairness case for workfare is inconclusive. (shrink)

A number of schemes have been attempted, both in public health and more generally within social programmes, to pay individuals to behave in ways that are presumed to be good for them or to have other beneficial effects. Such schemes are normally regarded as providing a financial incentive for individuals in order to outweigh contrary motivation. Such schemes have been attacked on the basis that they can ‘crowd out’ intrinsic motivation, as well as on the grounds that they are in (...) some sense ‘corrupt’. In response, they have been defended on the grounds that they can ‘crowd in’ improved motivation. I will argue that these debates have tended to overlook the difficulties individuals can have when attempting to behave against peer group norms. In some cases, financial payments can allow individuals to defend their actions on the grounds that ‘I am only doing it for the money’ in circumstances when it would be difficult to defend their action on their real motivations. Examples of paying children to read books, and paying women to give up smoking in pregnancy, will be discussed. (shrink)

Many legal scholars well recognize that, in some instances, support for a law or policy may be primarily because of its expressive function, i.e. the statements it makes about underlying values. In these cases, the expressive content of a law or policy may actually overshadow its central purpose. Examples of this phenomenon, according to Cass Sunstein, include, for example, regulations against hate speech in the USA. He suggests that achieving the consequence (prohibiting hateful speech against certain groups) may not be (...) the real focus (central purpose) of the law. Rather, the real focus is on the social meaning of these regulations—that bigotry is unacceptable in a liberal society. In this way, a particular law or policy can operate on many levels—while aiming to achieve a particular objective or behavior, it can also be a valuable tool for achieving other important social goals through its expressive function. This article applies this insight to the realm of public health policy, with particular attention to the case of pandemic planning, and suggests that public health policy and its overall goals may be well-served by deliberate regard for, and appropriate utilization of, the expressive function. (shrink)

When viewed as a question of distributive justice the evaluation of workfare typically reflects exclusively on the distribution of income: do the physically capable have a justified claim for state support, or is it fair to demand from those who do work to subsidise this support? Rarely is workfare appraised in terms of how it affects other parties such as employers or other workers, and on the structural effects the pattern of incentives it generates brings about, or as an issue (...) of distributive justice related to a more extensive range of objects of distribution such as access to pleasing jobs. -/- We propose to evaluate workfare by looking at its effects more broadly: (1) we discuss and dismiss on empirical grounds the two most common arguments in favour of workfare, namely that workfare develops self-reliance among participants and it is more economical in the use of altruism among taxpayers. (2) We suggest that workfare focuses on work as a burden and as a means to income, ignoring other beneficial aspects that are conducive to the worker’s self expression. These other benefits are distributed unevenly between two main groups: the privileged well off and the disadvantaged. (3) we argue that workfare functions as a mechanism to preserve these privileges to one class of workers at the expense of another. Or, to put it the other way, the payment of unconditional welfare to the long term unemployed might be justified as one method of mitigating unjustified privileges. (shrink)

Background: Giving money as a direct incentive for patients in exchange for depot medication has proved beneficial in some clinical cases in assertive outreach . However, ethical concerns around this practice have been raised, and will be analysed in more detail here.Method: Ethical concern voiced in a survey of all AO teams in England were analysed regarding their content. These were grouped into categories.Results: 53 of 70 team managers mentioned concerns, many of them serious and expressing a negative attitude towards (...) giving money for depot adherence. Four broad categories of ethical concern following Christensen’s concept were distinguished: valid consent and refusal , psychiatric paternalism , resource allocation , organisational relationships , with a residual category others and unspecified .Discussion: The main concerns identified are discussed on the background of existing ethical theories in healthcare and the specific problems of community mental health and AO. Points for practice are derived from this discussion. A way forward is outlined that includes informed consent and an operational policy in the use of incentives, further randomised controlled trials and qualitative studies, and continuing discussions with all stakeholders, especially service users. (shrink)

abstract This paper considers the question of whether unemployed individuals have a duty of fairness to accept retraining as a condition of receiving unemployment benefit. It is argued, in response to Stuart White, that, although there are some circumstances where individuals do have such a moral duty, for an egalitarian it is never the case that there is sufficient reason for enforcing such a duty by means of the law.