This report by the WHO Consultative Group on Equity and Universal Health Coverage addresses how countries can make fair progress towards the goal of universal coverage. It explains the relevant tradeoffs between different desirable ends and offers guidance on how to make these tradeoffs.

What would be a fair model for flood insurance? Catastrophic flooding has become increasingly frequent in the UK and, with climate change, is likely to become even more frequent in the future. With the UK's current flood insurance regime ending in 2013, we argues that: -/- - there is an overwhelming case for rejecting a free market in flood insurance after 2013; - this market-based approach threatens to leave many thousands of properties uninsurable, leading to extensive (...) social blight; - there are a number of possible flood insurance models that would be fairer and more sustainable. -/- We outline three approaches to 'fairness' in flood insurance, and argues that the second and third of these would be the most 'solidaristic' – i.e. those at lower risk of flooding would contribute to the support of people at higher risk: -/- 'pure actuarial fairness' – insurance costs directly reflect the level of risk faced by individuals; 'choice-sensitive fairness' – insurance costs should reflect only those risks that result from each individual's choices; 'fairness as social justice' – insurance should be provided independently of individuals' risks and choices when covering basic requirements of social justice. (shrink)

We offer a summary of the WHO Report "Making Fair Choices on the Path to Universal Health Coverage".

In actuarial parlance, the price of an insurance policy is considered fair if customers bearing the same risk are charged the same price. The estimate of this fair amount hinges on the expected value obtained by weighting the different claims by their probability. We argue that, historically, this concept of actuarial fairness originates in an Aristotelian principle of justice in exchange (equality in risk). We will examine how this principle was formalized in the 16th century and shaped (...) in life insurance during the following two hundred years, in two different interpretations. The Domatian account of actuarial fairness relied on subjective uncertainty: An agreement on risk was fair if both parties were equally ignorant about the chances of an uncertain event. The objectivist version grounded any agreement on an objective risk estimate drawn from a mortality table. We will show how the objectivist approach collapsed in the market for life annuities during the 18th century, leaving open the question of why we still speak of actuarial fairness as if it were an objective expected value. (shrink)

I critically examine a common liberal egalitarian view about the justification for, and proper content of, mandatory health insurance. This view holds that a mandate is justified because it is the best way to ensure that those in poor health gain health insurance on equitable terms. It also holds that a government should mandate what a representative prudent individual would purchase for themselves if they were placed in fair conditions of choice. I argue that this common justification (...) for a mandate is incomplete. A further reason for mandated insurance is that it helps secure social egalitarian public goods that would be underprovided if insurance were optional. I also argue that rather than mandating what a representative individual would choose for themselves, we should design the mandatory package by appealing to a pluralistic egalitarian view, which cares about improving people’s well-being, reducing unfair inequality, and maintaining egalitarian social relations. (shrink)

Is drastic action against global warming essential to avoid impoverishing our descendants? Or does it mean robbing the poor to give to the rich? We do not yet know. Yet most of us can agree on the importance of minimising expected deprivation. Because of the vast number of future generations, if there is any significant risk of catastrophe, this implies drastic and expensive carbon abatement unless we discount the future. I argue that we should not discount. Instead, the rich countries (...) should stump up the funds to support abatement both for themselves and the poor states of the world. Yet to ask the present generation to assume all the costs of drastic mitigation.is unfair.Worse still, it is politically unrealistic.We can square the circle by shifting part of the burden to our descendants. Even if we divert investment from other parts of the economy or increase public debt, future people should be richer, so long as we avert catastrophe. If so, it is fair for them to assume much of the cost of abatement.What we must not do is to expose them to the threat of disaster by not doing enough. (shrink)

We defend, from a contractarian perspective, that the fair price of an insurance policy is the amount that the contracting parties agree when they are both equally uncertain about the insured event. Drawing on the approach developed by R. Sugden in _The Community of Advantage_, we answer two standard objections raised against contractarianism in the actuarial sciences: (1) people are not wise enough to assess their actuarial risks; (2) they are not rational enough to decide which insurance (...) policy suits them better. We show under which circumstances people can make fair actuarial agreements, without presupposing any objective risk or rationality benchmarks. (shrink)

In this article I explore two accounts of the Fallacy of Many Questions made famous by the question "Have you stopped beating your wife?" The accounts are from the works of Lennart Aqvist and Noel Belnap, and the two authors differ in their accounts of the fallacy. Then I give my own account based on understanding a facet of erotetic logic, i. e., the logic of questions.

Three recent research reports by Topping and Trickey, by Fair and colleagues, and by Gorard, Siddiqui and Huat See have produced data that support the conclusion that a Philosophy for Children program of one-hour-per-week structured discussions has a marked positive impact on students. This article presents data from a follow up study done three years after the completion of the study reported in Fair et al.. The data show that the positive gains in scores on the Cognitive Abilities (...) Test were still present and had not faded after three years. Given the strength of these confirmations of the positive durable impact of the P4C program of structured discussions and given the relatively low cost of implementing the P4C program, it is recommended that it become a standard part of the school curriculum. (shrink)

Offers a commentary on the Report 'A Fair Path to Universal Health Coverage' from the perspective of the Director of the Ethiopian Ministry of Health.

The paper analyses six ethical challenges posed by cloud computing, concerning ownership, safety, fairness, responsibility, accountability and privacy. The first part defines cloud computing on the basis of a resource-oriented approach, and outlines the main features that characterise such technology. Following these clarifications, the second part argues that cloud computing reshapes some classic problems often debated in information and computer ethics. To begin with, cloud computing makes possible a complete decoupling of ownership, possession and use of data and this helps (...) to explain the problems occurring when different providers of cloud computing retain or relinquish the right to use or own users‘ data. The problem of safety in cloud computing is coupled to that of reliability, insofar as users have to trust providers to preserve their data, applications and content in a reliable manner. It is argued that, in this context, data insurance could play an important role. Regarding fairness, the paper argues that cloud computing is already reshaping the nature of the Digital. Responsibility, accountability and privacy close the ethical analysis of cloud computing. In this case, the thesis is that the necessity to account for the actions of cloud computing users imposes delicate trade-offs between users‘ privacy and the traceability of their operations. (shrink)

Background: Smart sensors have been developed as diagnostic tools for rehabilitation to cover an increasing number of geriatric patients. They promise to enable an objective assessment of complex movement patterns. -/- Objective: This research aimed to identify and analyze the conflicting ethical values associated with smart sensors in geriatric rehabilitation and provide ethical guidance on the best use of smart sensors to all stakeholders, including technology developers, health professionals, patients, and health authorities. -/- Methods: On the basis of a systematic (...) literature search of the scientific databases PubMed and ScienceDirect, we conducted a qualitative document analysis to identify evidence-based practical implications of ethical relevance. We included 33 articles in the analysis. The practical implications were extracted inductively. Finally, we carried out an ethical analysis based on the 4 principles of biomedical ethics: autonomy, beneficence, nonmaleficence, and justice. The results are reported in categories based on these 4 principles. -/- Results: We identified 8 conflicting aims for using smart sensors. Gains in autonomy come at the cost of patient privacy. Smart sensors at home increase the independence of patients but may reduce social interactions. Independent measurements performed by patients may result in lower diagnostic accuracy. Although smart sensors could provide cost-effective and high-quality diagnostics for most patients, minorities could end up with suboptimal treatment owing to their underrepresentation in training data and studies. This could lead to algorithmic biases that would not be recognized by medical professionals when treating patients. -/- Conclusions: The application of smart sensors has the potential to improve the rehabilitation of geriatric patients in several ways. It is important that patients do not have to choose between autonomy and privacy and are well informed about the insights that can be gained from the data. Smart sensors should support and not replace interactions with medical professionals. Patients and medical professionals should be educated about the correct application and the limitations of smart sensors. Smart sensors should include an adequate representation of minorities in their training data and should be covered by health insurance to guarantee fair access. (shrink)

Racial discrimination uses race as grounds to discriminate in the treatment owed to others; sexual discrimination uses people’s sexual features as grounds for determining how they should be treated compared to others. Analogously, statistical discrimination treats statistical inferences about the groups to which individuals belong as grounds for discriminating amongst them in thought, word and deed. Examples of statistical discrimination include the employer who won’t hire women of childbearing age, because they are likely to take maternity leave at some point (...) in their careers; or insurers who wish to charge more to young drivers than to more experienced ones, because they are more likely to have accidents than the latter – or to favour women over men in the cost of premiums for similar reasons. Finally, a famous – infamous – example of statistical discrimination is racial profiling for police purposes, where statistical evidence of differential propensities to crime are used to justify preventive police measures, such as ‘stop and search’, which mainly target young black men, and other racialized minorities. The philosophical appeal of the concept of statistical discrimination is fairly easy to see: it draws our attention to the way that probabilistic claims figure, or might figure, in the distribution of social costs and benefits such as jobs, security, insurance. It therefore gives us a way to test our moral intuitions across different cases, enables us to see how far our moral judgements can be generalised, and whether they have been affected by particularly emotive examples, or by the particular features of a real or hypothetical case. But does that mean that statistical discrimination is unproblematic? This article takes issue with some arguments of Kasper Lippert Rasmussen on the topic. (shrink)

Inspired by recent breakthroughs in predictive modeling, practitioners in both industry and government have turned to machine learning with hopes of operationalizing predictions to drive automated decisions. Unfortunately, many social desiderata concerning consequential decisions, such as justice or fairness, have no natural formulation within a purely predictive framework. In efforts to mitigate these problems, researchers have proposed a variety of metrics for quantifying deviations from various statistical parities that we might expect to observe in a fair world and offered (...) a variety of algorithms in attempts to satisfy subsets of these parities or to trade o the degree to which they are satised against utility. In this paper, we connect this approach to fair machine learning to the literature on ideal and non-ideal methodological approaches in political philosophy. The ideal approach requires positing the principles according to which a just world would operate. In the most straightforward application of ideal theory, one supports a proposed policy by arguing that it closes a discrepancy between the real and the perfectly just world. However, by failing to account for the mechanisms by which our non-ideal world arose, the responsibilities of various decision-makers, and the impacts of proposed policies, naive applications of ideal thinking can lead to misguided interventions. In this paper, we demonstrate a connection between the fair machine learning literature and the ideal approach in political philosophy, and argue that the increasingly apparent shortcomings of proposed fair machine learning algorithms reflect broader troubles faced by the ideal approach. We conclude with a critical discussion of the harms of misguided solutions, a reinterpretation of impossibility results, and directions for future research. (shrink)

This article presents a fairness principle for evaluating decision-making based on predictions: a decision rule is unfair when the individuals directly impacted by the decisions who are equal with respect to the features that justify inequalities in outcomes do not have the same statistical prospects of being benefited or harmed by them, irrespective of their socially salient morally arbitrary traits. The principle can be used to evaluate prediction-based decision-making from the point of view of a wide range of antecedently specified (...) substantive views about justice in outcome distributions. (shrink)

Some moral principles require agents to do more than their fair share of a common task, if others won’t do their fair share – each agent’s fair share being what they would be required to do if all contributed as they should. This seems to provide a strong basis for objecting to such principles. For it seems unfair to require agents who have already done their fair share to do more, just because other agents won’t do (...) their fair share. The philosopher who has written most about this issue, however, Liam Murphy, argues that it is not unfair to do so, at least in the standard sense of that term. In this paper, I give Murphy’s reasons for saying this, explain why I think he’s wrong, and then say a little about why this issue might be important. (shrink)

Holm (2022) argues that a class of algorithmic fairness measures, that he refers to as the ‘performance parity criteria’, can be understood as applications of John Broome’s Fairness Principle. We argue that the performance parity criteria cannot be read this way. This is because in the relevant context, the Fairness Principle requires the equalization of actual individuals’ individual-level chances of obtaining some good (such as an accurate prediction from a predictive system), but the performance parity criteria do not guarantee any (...) such thing: the measures merely ensure that certain population-level ratios hold. (shrink)

Glucagon-like peptide-1 (GLP-1) receptor agonists, such as semaglutide, and dual GLP-1 and glucose-dependent insulinotropic polypeptide (GIP) receptor agonists, such as tirzepatide, have been found to be effective for treating obesity and diabetes, significantly reducing weight and the risk or predicted risk of adverse cardiovascular events. There is a global shortage of these medications that could last several years and raises questions about how limited supplies should be allocated. We propose a fair-allocation framework that enables evaluation of the ethics of (...) current practices and could guide governments, professional societies, and physicians in allocation decisions. (shrink)

What level of government subsidy of higher education is justified, in what form, and for what reasons? We answer these questions by applying the hypothetical insurance approach, originally developed by Ronald Dworkin in his work on distributive justice. On this approach, when asking how to fund and deliver public services in a particular domain, we should seek to model what would be the outcome of a hypothetical insurance market: we stipulate that participants lack knowledge about their specific resources (...) and risks, and ask what insurance contracts they would take out to secure different types of benefit and protection in the domain in question. The great benefit of the hypothetical insurance approach is that it allows us to take apparently intractable questions about interpersonal distribution and transform them into questions about intrapersonal distributions: that is, questions about how an individual would choose to distribute risks and resources across the various lives that they might end up living, in light of their individual ambitions and preferences. Applying this approach to higher education, we argue that the UK model of higher education funding in which the costs of an individual's higher education are shared between general taxation and the individual herself, with the latter element to be paid retrospectively through an income-contingent state-backed loan, is vindicated as just. In particular, we argue that it is more just than alternatives such as a graduate tax, full funding through general taxation, and full privatisation. (shrink)

John Broome has proposed a theory of fairness according to which fairness requires that agents’ claims to goods be satisfied in proportion to the relative strength of those claims. In the case of competing claims for a single indivisible good, Broome argues that what fairness requires is the use of a weighted lottery as a surrogate to satisfying the competing claims: the relative chance of each claimant's winning the lottery should be set to the relative strength of each claimant's claim. (...) In this journal, James Kirkpatrick and Nick Eastwood have objected that the use of weighted lotteries in the case of indivisible goods is unacceptable. In this article, I explain why Kirkpatrick and Eastwood's objection misses its mark. (shrink)

In his paper “Fairness, Political Obligation, and the Justificatory Gap” (published in the Journal of Moral Philosophy), Jiafeng Zhu argues that the principle of fair play cannot require submission to the rules of a cooperative scheme, and that when such submission is required, the requirement is grounded in consent. I propose a better argument for the claim that fair play requires submission to the rules than the one Zhu considers. I also argue that Zhu’s attribution of consent to (...) people commonly thought to be bound to follow the rules by a duty of fair play is implausible. (shrink)

This research investigates 3- and 5-year-olds' relative fairness in distributing small collections of even or odd numbers of more or less desirable candies, either with an adult experimenter or between two dolls. The authors compare more than 200 children from around the world, growing up in seven highly contrasted cultural and economic contexts, from rich and poor urban areas, to small-scale traditional and rural communities. Across cultures, young children tend to optimize their own gain, not showing many signs of self-sacrifice (...) or generosity. Already by 3 years of age, self-optimizing in distributive justice is based on perspective taking and rudiments of mind reading. By 5 years, overall, children tend to show more fairness in sharing. What varies across cultures is the magnitude of young children's self-interest. More fairness (less self-interest) in distributive justice is evident by children growing up in small-scale urban and traditional societies thought to promote more collective values. (shrink)

Typically, fair machine learning research focuses on a single decision maker and assumes that the underlying population is stationary. However, many of the critical domains motivating this work are characterized by competitive marketplaces with many decision makers. Realistically, we might expect only a subset of them to adopt any non-compulsory fairness-conscious policy, a situation that political philosophers call partial compliance. This possibility raises important questions: how does partial compliance and the consequent strategic behavior of decision subjects affect the allocation (...) outcomes? If k% of employers were to voluntarily adopt a fairness-promoting intervention, should we expect k% progress (in aggregate) towards the benefits of universal adoption, or will the dynamics of partial compliance wash out the hoped-for benefits? How might adopting a global (versus local) perspective impact the conclusions of an auditor? In this paper, we propose a simple model of an employment market, leveraging simulation as a tool to explore the impact of both interaction effects and incentive effects on outcomes and auditing metrics. Our key findings are that at equilibrium: (1) partial compliance by k% of employers can result in far less than proportional (k%) progress towards the full compliance outcomes; (2) the gap is more severe when fair employers match global (vs local) statistics; (3) choices of local vs global statistics can paint dramatically different pictures of the performance vis-a-vis fairness desiderata of compliant versus non-compliant employers; (4) partial compliance based on local parity measures can induce extreme segregation. Finally, we discuss implications for auditors and insights concerning the design of regulatory frameworks. (shrink)

Theorists of the welfare state increasingly recognize that social insurance programs are not well-justified by distributive egalitarianism—meaning concern for equality considered as a pattern in the distribution of some good. However, recent work by several relational egalitarian theorists suggests that these programs may be justified on relational egalitarian grounds. Relational egalitarians hold that the proper object of egalitarian concern is the way that citizens relate to one another. In this paper, I review the problems facing a distributive egalitarian justification (...) for social insurance before considering and rejecting three relational egalitarian justifications. I close by offering a justification for these programs grounded in efficiency, not equality. (shrink)

This paper comes out of a panel honoring the work of Anne Donchin (1940-2014), which took place at the 2016 Congress of the International Network on Feminist Approaches to Bioethics (FAB) in Edinburgh. My general aim is to highlight the contributions Anne made to feminist bioethics, and to feminist reproductive ethics in particular. My more specific aim, however, is to have a kind of conversation with Anne, through her work, about whether reproductive justice could demand insurance coverage for in (...) vitro fertilization. I quote liberally from Anne’s work for this purpose, but also to shower the reader with her words, reminding those of us who knew her well what a wonderful colleague she was. (shrink)

This essay explores a conception of responsibility at work in moral and criminal responsibility. Our conception draws on work in the compatibilist tradition that focuses on the choices of agents who are reasons-responsive and work in criminal jurisprudence that understands responsibility in terms of the choices of agents who have capacities for practical reason and whose situation affords them the fair opportunity to avoid wrongdoing. Our conception brings together the dimensions of normative competence and situational control, and we factor (...) normative competence into cognitive and volitional capacities, which we treat as equally important to normative competence and responsibility. Normative competence and situational control can and should be understood as expressing a common concern that blame and punishment presuppose that the agent had a fair opportunity to avoid wrongdoing. This fair opportunity is the umbrella concept in our understanding of responsibility, one that explains it distinctive architecture. (shrink)

From the school yard to the workplace, there’s no charge more damning than “you’re being unfair!” Born out of democracy and raised in open markets, fairness has become our de facto modern creed. The very symbol of American ethics—Lady Justice—wears a blindfold as she weighs the law on her impartial scale. In our zealous pursuit of fairness, we have banished our urges to like one person more than another, one thing over another, hiding them away as dirty secrets of our (...) humanity. In Against Fairness, polymath philosopher Stephen T. Asma drags them triumphantly back into the light. Through playful, witty, but always serious arguments and examples, he vindicates our unspoken and undeniable instinct to favor, making the case that we would all be better off if we showed our unfair tendencies a little more kindness—indeed, if we favored favoritism. Conscious of the egalitarian feathers his argument is sure to ruffle, Asma makes his point by synthesizing a startling array of scientific findings, historical philosophies, cultural practices, analytic arguments, and a variety of personal and literary narratives to give a remarkably nuanced and thorough understanding of how fairness and favoritism fit within our moral architecture. Examining everything from the survival-enhancing biochemistry that makes our mothers love us to the motivating properties of our “affective community,” he not only shows how we favor but the reasons we should. Drawing on thinkers from Confucius to Tocqueville to Nietzsche, he reveals how we have confused fairness with more noble traits, like compassion and open-mindedness. He dismantles a number of seemingly egalitarian pursuits, from classwide Valentine’s Day cards to civil rights, to reveal the envy that lies at their hearts, going on to prove that we can still be kind to strangers, have no prejudice, and fight for equal opportunity at the same time we reserve the best of what we can offer for those dearest to us. Fed up with the blue-ribbons-for-all absurdity of "fairness" today, and wary of the psychological paralysis it creates, Asma resets our moral compass with favoritism as its lodestar, providing a strikingly new and remarkably positive way to think through all our actions, big and small. (shrink)

Countermeasures for mpox (formerly known as monkeypox), primarily vaccines, have been in limited supply in many countries during outbreaks. Equitable allocation of scarce resources during public health emergencies is a complex challenge. Identifying the objectives and core values for the allocation of mpox countermeasures, using those values to provide guidance for priority groups and prioritisation tiers, and optimising allocation implementation are important. The fundamental values for the allocation of mpox countermeasures are: preventing death and illness; reducing the association between death (...) or illness and unjust disparities; prioritising those who prevent harm or mitigate disparities; recognising contributions to combating an outbreak; and treating similar individuals similarly. Ethically and equitably marshalling available countermeasures requires articulating these fundamental objectives, identifying priority tiers, and recognising trade-offs between prioritising the people at the highest risk of infection and the people at the highest risk of harm if infected. These five values can provide guidance on preferable priority categories for a more ethically sound response and suggest methods for optimising allocation of countermeasures for mpox and other diseases for which countermeasures are in short supply. Properly marshalling available countermeasures will be crucial for future effective and equitable national responses to outbreaks. (shrink)

This article discusses how the concept of a fair finite lottery can best be extended to denumerably infinite lotteries. Techniques and ideas from non-standard analysis are brought to bear on the problem.

If dangerous climate change is to be avoided, it is vital that carbon sinks such as tropical rainforests are protected. But protecting them has costs. These include opportunity costs: the potential economic benefits which those who currently control rainforests have to give up when they are protected. But who should bear those costs? Should countries which happen to have rainforests within their territories sacrifice their own economic development, because of our broader global interests in protecting key carbon sinks? This essay (...) develops an argument from the “principle of fairness,” which seeks to establish that outsiders should pay states with rainforests so as to share the costs of protection. If they do not, they can be condemned for free-riding on forest states. The argument is, I suggest, compelling and also capable of enjoying support from adherents of a wide variety of positions on global justice. (shrink)

The debate over whether ‘fair-play’ can serve as a justification for legal punishment has recently resumed with an exchange between Richard Dagger and Antony Duff. According to the fair-play theorist, criminals deserve punishment for breaking the law because in so doing the criminal upsets a fair distribution of benefits and burdens, and punishment rectifies this unfairness. Critics frequently level two charges against this idea. The first is that it often gives the wrong explanation of what makes crime (...) deserving of punishment, since the wrongfulness of murder is not primarily about unfairness. The second is that it implies that all crimes deserve the same degree of punishment, because all crimes create the same degree of unfairness. These objections are viewed as revealing fatal flaws in the theory. Although Dagger attempts to meet these objections by drawing on political theory, Duff responds that this still draws upon the wrong kind of resources for meeting these objections. This paper argues that these two objections rest on a crucial mistake that has been overlooked by both the defenders and critics of fair-play. This mistake results from failing to distinguish between what justifies punishment as a response to crime (which requires a common element to all crime) and what justifies attaching particular penalties to crimes (which requires making distinctions in the severity of crime). The arguments presented will give reasons to consider fair-play as a viable justification for legal punishment. (shrink)

Among the most popular strategies for justifying political obligations are those that appeal to the principle of fairness. These theories face the challenge, canonically articulated by Robert Nozick, of explaining how it is that persons are obligated to schemes when they receive goods that they do not ask for but cannot reject. John Simmons offers one defense of the principle of fairness, arguing that people could be bound by obligations of fairness if they voluntarily accept goods produced by a cooperative (...) scheme. Simmons, however, thinks that such a theory will do little work in justifying political obligations, since virtually no one voluntarily accepts state goods. This paper attempts to advance just such a theory by arguing that states are in fact genuine cooperative schemes and that Simmons is overly pessimistic in his appraisal of whether the majority of citizens accept the goods provided by their states. (shrink)

Many widely divergent accounts of luck have been offered or employed in discussing an equally wide range of philosophical topics. We should, then, expect to find some unified philosophical conception of luck of which moral luck, epistemic luck, and luck egalitarianism are species. One of the attempts to provide such an account is that offered by Duncan Pritchard, which he refers to as the modal account. This view commits us to calling an event lucky when it obtains in this world, (...) but fails to obtain in a wide class of nearby possible worlds. In support of this account, Pritchard argues that a theory of luck ought to capture the fact that luck comes in degrees and that luck is closely associated with risk. I argue against this claim by suggesting that an understanding of luck grounded in considerations of probability is better able to satisfy these demands, and that the probability theory better explains exemplary cases of luck like those brought up by Pritchard. (shrink)

Severe poverty is a major global problem about risk and inequality. What, if any, is the relationship between equality, fairness and responsibility in an unequal world? I argue for four conclusions. The first is the moral urgency of severe poverty. We have too many global neighbours that exist in a state of emergency and whose suffering is intolerable. The second is that severe poverty is a problem concerning global injustice that is relevant, but not restricted, to questions about responsibility. If (...) none were responsible, this does not eliminate all compelling claims to provide assistance. The third is that severe poverty represents an inequality too far; it is a condition of extremity with denial of basic needs. The fourth is that there is a need for an approach that captures all relevant cases – and the capabilities approach and the connection theory of remedial responsibilities are highlighted as having special promise. (shrink)

Although existing work draws attention to a range of obstacles in realizing fair AI, the field lacks an account that emphasizes how these worries hang together in a systematic way. Furthermore, a review of the fair AI and philosophical literature demonstrates the unsuitability of ‘treat like cases alike’ and other intuitive notions as conceptions of fairness. That review then generates three desiderata for a replacement conception of fairness valuable to AI research: (1) It must provide a meta-theory for (...) understanding tradeoffs, entailing that it must be flexible enough to capture diverse species of objection to decisions. (2) It must not appeal to an impartial perspective (neutral data, objective data, or final arbiter.) (3) It must foreground the way in which judgments of fairness are sensitive to context, i.e., to historical and institutional states of affairs. We argue that a conception of fairness as appropriate concession in the historical iteration of institutional decisions meets these three desiderata. On the basis of this definition, we organize the insights of commentators into a process-structure map of the ethical territory that we hope will bring clarity to computer scientists and ethicists analyzing Fair AI while clearing some ground for further technical and philosophical work. (shrink)

Rawlsian justice as fairness is neither fundamentally luck egalitarian nor relational egalitarian. Rather, the most fundamental idea is that of society as a fair system of cooperation. Collective pensions provide a case study which illustrates the fruitfulness of conceiving justice in these latter terms. Those who have recently reached the age of majority do not now know how long they will live in retirement or how well any investments they try to save up for their retirement would fare. From (...) the perspective of the beginning of their working lives, it is therefore rational for each to enter into an agreement with others, who also do not yet know their fates, that, if one turns out to be among the unfortunate whose private pension pots would not have yielded enough for one’s retirement, one will receive much more in retirement, whereas those whose pension pots would have overflowed their retirements will receive somewhat less. These terms are to each person’s expected advantage, which is made possible by a fair sharing of the fruits of social cooperation which arise through the efficiencies reaped by the pooling of the risk of outliving what one could save for one’s retirement on one’s own. It is rational for each to agree to share one another’s fates by pooling risks across both space and time, on fair terms of social cooperation for mutual advantage. Even when collective pensions arise from, and are proportional to, a baseline of unequal income, they can be defended on grounds of reciprocity involving regard for one another as equals. (shrink)

There is an emerging consensus among political philosophers that state legitimacy involves something more than—or perhaps other than—political obligation. Yet the principle of fair play, which many take to be a promising basis for political obligation, has been largely absent from discussions of the revised conception of legitimacy. This paper shows how the principle of fair play can generate legitimate political authority by drawing on a neglected feature of the principle—its stipulation that members of a cooperative scheme must (...) reciprocate specifically by submitting to the scheme's rules. (shrink)

Distribution of responsibility is one of the main focus areas in discussions about climate change ethics. Most of these discussions deal with the distribution of responsibility for climate change mitigation at the international level. The aim of this paper is to investigate if and how these principles can be used to inform the search for a fair distribution of responsibility for climate change adaptation on the local level. We found that the most influential distribution principles on the international level (...) were in turn built on one or more of seven basic principles: (P1) equal shares, (P2) desert, (P3) beneficiary pays, (P4) ability, (P5) self-help, (P6) limited responsibility for the worst off, and (P7) status quo preservation. It was found that all the basic principles, but P1, P3, and P7, are to some extent translatable to local climate adaptation. Two major problems hamper their usefulness on the local level: (1) several categories of agents need to take on responsibility; and (2) emissions do not work as a base for all principles. P4, P5, and P6 are applicable to local adaptation without changes. P4 is of particular importance as it seems to solve the first problem. P2 is applicable only if the second problem is solved, which can be achieved by using risk of harm instead of emissions as the basis for desert. (shrink)

Universal health coverage (UHC) is at the center of current efforts to strengthen health systems and improve the level and distribution of health and health services. This document is the final report of the WHO Consultative Group on Equity and Universal Health Coverage. The report addresses the key issues of fairness and equity that arise on the path to UHC. As such, the report is relevant for every actor that affects that path and governments in particular, as they are in (...) charge of overseeing and guiding the progress toward UHC. (shrink)

To address the rising concern that algorithmic decision-making may reinforce discriminatory biases, researchers have proposed many notions of fairness and corresponding mathematical formalizations. Each of these notions is often presented as a one-size-fits-all, absolute condition; however, in reality, the practical and ethical trade-offs are unavoidable and more complex. We introduce a new approach that considers fairness—not as a binary, absolute mathematical condition—but rather, as a relational notion in comparison to alternative decisionmaking processes. Using US mortgage lending as an example use (...) case, we discuss the ethical foundations of each definition of fairness and demonstrate that our proposed methodology more closely captures the ethical trade-offs of the decision-maker, as well as forcing a more explicit representation of which values and objectives are prioritised. (shrink)

Several philosophers who argue that forgiveness is an important virtue also wish to maintain the moral value of retributive emotions that forgiveness is meant to overcome. As such, these accounts explicate forgiveness as an Aristotelian mean between too much resentment and too little resentment. I argue that such an account ends up making forgiveness superfluous: it turns out that the forgiving person is not praised for a greater willingness to let go of her resentment, but rather for her fairness or (...) good judgment. I conclude by arguing that the virtue of fair-mindedness is more compatible with maintaining the value of the retributive emotions than the virtue of forgiveness. (shrink)

Garrett Cullity contends that fairness is appropriate impartiality (See Cullity (2004) Chapters 8 and 10 and Cullity (2008)). Cullity deploys his account of fairness as a means of limiting the extreme moral demand to make sacrifices in order to aid others that was posed by Peter Singer in his seminal article ‘Famine, Affluence and Morality’. My paper is founded upon the combination of (1) the observation that the idea that fairness consists in appropriate impartiality is very vague and (2) the (...) fact that psychological studies show the self-serving bias is especially likely to infect one’s judgements when the ideas involved are vague. I argue that Cullity’s solution to extreme moral demandingness is threatened by these findings. I then comment on whether some other theories of fairness are vulnerable to the same objection. (shrink)

Although the principle of fair subject selection is a widely recognized requirement of ethical clinical research, it often yields conflicting imperatives, thus raising major ethical dilemmas regarding participant selection. In this paper, we diagnose the source of this problem, arguing that the principle of fair subject selection is best understood as a bundle of four distinct sub-principles, each with normative force and each yielding distinct imperatives: (1) fair inclusion; (2) fair burden sharing; (3) fair opportunity; (...) and (4) fair distribution of third-party risks. We first map out these distinct sub-principles, and then identify the ways in which they yield conflicting imperatives for the design of inclusion and exclusion criteria, and the recruitment of participants. We then offer guidance for how decision makers should navigate these conflicting imperatives to ensure that participants are selected fairly. (shrink)

Social movements often impose nontrivial costs on others against their wills. Civil disobedience is no exception. How can social movements in general, and civil disobedience in particular, be justifiable despite this apparent wrong-making feature? We examine an intuitively plausible account—it is fair that everyone should bear the burdens of tackling injustice. We extend this fairness-based argument for civil disobedience to defend some acts of uncivil disobedience. Focusing on uncivil environmental activism—such as ecotage (sabotage with the aim of protecting the (...) environment)—we argue that some acts of uncivil disobedience can be morally superior to their civil counterparts, when and because such acts target people who are responsible for environmental threats. Indeed, insofar as some acts of uncivil disobedience can more accurately target responsible people, they can better satisfy the demands of fairness compared to their civil counterparts. In some circumstances, our argument may require activists to engage in uncivil disobedienceeven whencivil disobedience is available. (shrink)

Objectives The study aims to evaluate the impact of the Revised Health Insurance Law 2014 on the utilisation of outpatient and inpatient care services, healthcare services utilisation at different levels of providers, types of providers and types of visits across different entitlement groups. Design/setting Secondary data from two waves of the Vietnam Household Living Standard Survey (VHLSS) 2016, VHLSS 2014 were used. A cross-sectional study applying propensity score matching was conducted. Participants A total of 4900 individuals who reported using (...) healthcare services are analysed. Outcomes measure Numbers of outpatient and inpatient visits, frequency of healthcare service utilisation at commune health stations, district hospitals, provincial hospitals, public and private health facilities, number of visits at health facility for medical treatment and health checks per year. Results The result indicates that health insurance (HI) policy increased the number of outpatient visits for the enrolled between 0.87 and 1.29. The greatest impact was found on participants of heavily subsidised health insurance (HSHI) programmes with 1.29 visits per person per year. Similarly, an increase between 0.08 and 0.16 in the number of inpatient admissions was because of participation in HI. With regard to type of healthcare providers, the study found that participation in HI has the most effect on the use of healthcare services at district hospitals. However, the study demonstrated that the impacts of HI on the increase in the frequency of visiting commune health stations, number of visits at the provincial hospital for HSHI groups, and number of visits at health facilities for health check and consultation were sensitive to unobserved characteristics. Conclusion Our findings imply that policy-makers in Vietnam could continue expanding health insurance coverage to increase access to healthcare services for citizens, especially vulnerable groups. In addition, the government should draw more attention to primary healthcare level. (shrink)

Every year, hundreds of patients in England die whilst waiting for a kidney transplant, and this is evidence that the current system of altruistic-based donation is not sufficient to address the shortage of kidneys available for transplant. To address this problem, we propose a monopsony system whereby kidney donors can opt-in to receive financial compensation, whilst still preserving the right of individuals to donate without receiving any compensation. A monopsony system describes a market structure where there is only one ‘buyer’—in (...) this case the National Health Service. By doing so, several hundred lives could be saved each year in England, wait times for a kidney transplant could be significantly reduced, and it would lessen the burden on dialysis services. Furthermore, compensation would help alleviate the common disincentives to living kidney donation, such as its potential associated health and psychological costs, and it would also help to increase awareness of living kidney donation. The proposed system would also result in significant cost savings that could then be redirected towards preventing kidney disease and reducing health disparities. While concerns about exploitation, coercion, and the ‘crowding out’ of altruistic donors exist, we believe that careful implementation can mitigate these issues. Therefore, we recommend piloting financial compensation for living kidney donors at a transplant centre in England. (shrink)

Algorithms can now identify patterns and correlations in the (big) datasets, and predict outcomes based on those identified patterns and correlations with the use of machine learning techniques and big data, decisions can then be made by algorithms themselves in accordance with the predicted outcomes. Yet, algorithms can inherit questionable values from the datasets and acquire biases in the course of (machine) learning, and automated algorithmic decision-making makes it more difficult for people to see algorithms as biased. While researchers have (...) taken the problem of algorithmic bias seriously, but the current discussion on algorithmic fairness tends to conceptualize ‘fairness’ in algorithmic fairness primarily as a technical issue and attempts to implement pre-existing ideas of ‘fairness’ into algorithms. In this paper, I show that such a view of algorithmic fairness as technical issue is unsatisfactory for the type of problem algorithmic fairness presents. Since decisions on fairness measure and the related techniques for algorithms essentially involve choices between competing values, ‘fairness’ in algorithmic fairness should be conceptualized first and foremost as a political issue, and it should be (re)solved by democratic communication. The aim of this paper, therefore, is to explicitly reconceptualize algorithmic fairness as a political question and suggest the current discussion of algorithmic fairness can be strengthened by adopting the accountability for reasonableness framework. (shrink)

In a paper recently published in this journal, Navin and Largent argue in favour of a type of policy to regulate non-medical exemptions from childhood vaccination which they call ‘Inconvenience’. This policy makes it burdensome for parents to obtain an exemption to child vaccination, for example, by requiring parents to attend immunization education sessions and to complete an application form to receive a waiver. Navin and Largent argue that this policy is preferable to ‘Eliminationism’, i.e. to policies that do not (...) allow non-medical exemptions, because Inconvenience has been shown to maintain exemption rates low while not harming parents by forcing them to do something that goes against their beliefs. We argue that it is at least doubtful that Inconvenience is ethically preferable to Eliminationism: while the latter disregards the value of liberty, Inconvenience disregards the value of fairness in the distribution of the burdens entailed by the preservation of a public good like herd immunity. We propose a variant of Inconvenience, which we call ‘Contribution’, which we think is preferable to the versions of Inconvenience discussed by Navin and Largent in that it successfully strikes a balance between the values of parents’ liberty, fairness and expected utility. (shrink)

This chapter argues that governments have a duty to take reasonably effective and humane steps to minimize the occurrence of unauthorized migration and stay. While the effects of unauthorized migration on a country’s citizens and institutions have been vigorously debated, the literature has largely ignored duties of fairness to would-be immigrants. It is argued here that failing to take reasonable steps to prevent unauthorized migration and stay is deeply unfair to would-be immigrants who are not in a position to bypass (...) visa regulations. Importantly, the argument here is orthogonal to the debate as to how much and what kinds of immigration ought to be allowed. (shrink)