{"title":"Climate Justice and Informal Representation.","authors":"Colin Hickey","doi":"10.1017/S0892679422000193","DOIUrl":"https://doi.org/10.1017/S0892679422000193","url":null,"abstract":"<p><p>What would constitute just representation for the climate vulnerable? My purpose in this essay is to provide a critique of the default frame for approaching this question, as well as to offer a suggestion for expanding our conception of what an adequate answer should include. The standard frame conceives of representing vulnerable climate interests largely in terms of formal mechanisms of representation in technocratic and bureaucratic institutions. I show the limits of that standard approach and caution against the discussion of climate representation being overly confined to the level of \"formal\" representation. I go on to detail the importance of thinking about more \"informal\" modes of representing vulnerable climate interests. In order to pursue both of these aims, I draw on lessons in meaningful representation and inclusion during postconflict peacebuilding.</p>","PeriodicalId":11772,"journal":{"name":"Ethics & International Affairs","volume":"36 2","pages":"179-198"},"PeriodicalIF":1.3,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7613931/pdf/EMS144875.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10363570","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"哲学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Personal and Social Responsibility for Health","authors":"Daniel Wikler","doi":"10.1111/j.1747-7093.2002.tb00396.x","DOIUrl":"10.1111/j.1747-7093.2002.tb00396.x","url":null,"abstract":"<p>Everyone wants to be healthy, but many of us decline to act in healthy ways. What bearing, if any, should these choices have on the ethics of clinical practice and health policy? Should risk-takers have the same claim on scarce resources, such as organs for transplant, as those whose plight is due to no choices of their own? And is there any reason not to impose fees and taxes on risk-takers, be they smokers or mountain climbers, to defray the added expense of the care they may need? In health resource allocation aimed at reducing the burden of disease, should we regard certain burdens as individual responsibilities: for example, dealing with stigma, or caretaking for family members?</p><p>Socioeconomic status (SES) and health expectancy are strongly linked. To the extent that this results from risk-taking by the poor, is reduction of SES-linked health inequalities a morally important social goal? International public health aims at improving health on a population level. The World Health Organization has been criticized for failing to distinguish genuine health risks from personal lifestyle choices, as when it speaks of a tobacco-related “epidemic” as if cigarette use were a contagious disease like malaria. Should personal responsibility for health be taken into account in setting the agenda for global public health, and in measuring progress by countries in improving health. This paper addresses applications of the notions of personal and social responsibility for health. It also looks at the vulnerability of the notion of personal responsibility for health to intentional manipulation by self-interested parties in health policy debates.</p>","PeriodicalId":11772,"journal":{"name":"Ethics & International Affairs","volume":"16 2","pages":"47-55"},"PeriodicalIF":1.3,"publicationDate":"2006-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1111/j.1747-7093.2002.tb00396.x","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"24956811","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"哲学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Responsibilities for Poverty-Related Ill Health","authors":"Thomas W. Pogge","doi":"10.1111/j.1747-7093.2002.tb00398.x","DOIUrl":"10.1111/j.1747-7093.2002.tb00398.x","url":null,"abstract":"<p>In a democratic society, the social rules are imposed by all upon each. As “recipients” of the rules, we tend to think that they should be designed to engender the best attainable distribution of goods and ills or quality of life. We are inclined to assess social institutions by how they affect their participants. But there is another, oft-neglected perspective which the topic of health equity raises with special clarity: As imposers of the rules, we are inclined to think that harms we inflict through the rules have greater moral weight than like harms we merely fail to prevent or to mitigate. What matters morally is not merely how we affect people, but how we treat them through the rules we impose. While current (consequentialist and Rawlsian) theorizing is dominated by the first perspective and thus supports purely recipient-oriented moral conceptions, an adequate approach to social justice requires a balancing of both. Such balancing results in a relational conception of justice, which distinguishes various ways in which an institutional scheme may causally affect the quality of life of its participants.</p><p>This essay argues that the strength of our moral reason to prevent or mitigate particular medical conditions depends not only on what one might call distributional factors, such as how badly off the people affected by these conditions are in absolute and relative terms, how costly prevention or treatment would be, and how much patients would benefit from given treatment. Rather, it depends also on relational factors, that is, on how we are related to the medical conditions they suffer. It then discusses some implications of this view for understanding responsibilities for international health outcomes.</p>","PeriodicalId":11772,"journal":{"name":"Ethics & International Affairs","volume":"16 2","pages":"71-79"},"PeriodicalIF":1.3,"publicationDate":"2006-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1111/j.1747-7093.2002.tb00398.x","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"24956813","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"哲学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Toward Establishing a Universal Basic Health Norm","authors":"Arnab K. Acharya","doi":"10.1111/j.1747-7093.2004.tb00477.x","DOIUrl":"10.1111/j.1747-7093.2004.tb00477.x","url":null,"abstract":"<p>where the poorest face considerably higher mortality and morbidity rates than wealthier groups do. Yet most of these wealthier groups enjoy health levels that are far below those of people in the industrial countries. The most prominent normative response to this situation has been an equality-demanding norm, stipulating that we strive to make health outcomes more equal even within the developing countries. In this article, I argue that under current resource constraints, institutional arrangements seeking to ensure commonly accepted egalitarian goals would engender the decrease of health status of many who do not currently enjoy particularly high levels of health. Although an alternative view, the prioritarian view, can avoid some of the negative implications of the egalitarian view, it too is untenable given the current resource constraints. We should instead develop a threshold norm that characterizes <i>minimally adequate health status</i>. An institutional order is just with respect to health to the extent that participants in this order do not (avoidably) fail to reach this threshold. One implication is that redistribution of resources is limited within any developing country, and thus redistribution must take place from industrialized to poorer nations.</p>","PeriodicalId":11772,"journal":{"name":"Ethics & International Affairs","volume":"18 3","pages":"65-78"},"PeriodicalIF":1.3,"publicationDate":"2006-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1111/j.1747-7093.2004.tb00477.x","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25214130","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"哲学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Public Health or Clinical Ethics: Thinking beyond Borders","authors":"Onora O'Neill","doi":"10.1111/j.1747-7093.2002.tb00395.x","DOIUrl":"10.1111/j.1747-7093.2002.tb00395.x","url":null,"abstract":"Most work in medical ethics across the last twenty-five years has centered on the ethics of clinical medicine. Even work on health and justice has, in the main, been concerned with the just distribution of (access to) clinical care for individual patients. By contrast, the ethics of public health has been widely neglected. This neglect is surprising, given that public health interventions are often the most effective (and most cost-effective) means of improving health in rich and poor societies alike. In this essay I explore two sources of contemporary neglect of public health ethics. One source of neglect is that contemporary medical ethics has been preoccupied—in my view damagingly preoccupied—with the autonomy of individual patients. Yet individual autonomy can hardly be a guiding ethical principle for public health measures, since many of them must be uniform and compulsory if they are to be effective. A second source of neglect is that contemporary political philosophy has been preoccupied—in my view damagingly preoccupied—with the requirements for justice within states or societies, and (until very recently) has hardly discussed justice across borders. Yet public health problems often cross borders, and public health interventions have to measure up to the problems they address.","PeriodicalId":11772,"journal":{"name":"Ethics & International Affairs","volume":"16 2","pages":"35-45"},"PeriodicalIF":1.3,"publicationDate":"2006-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1111/j.1747-7093.2002.tb00395.x","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"24956810","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"哲学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Access to Medicines and the Rhetoric of Responsibility","authors":"Christian Barry, Kate Raworth","doi":"10.1111/j.1747-7093.2002.tb00397.x","DOIUrl":"10.1111/j.1747-7093.2002.tb00397.x","url":null,"abstract":"<p>There is no cure or vaccine for HIV/AIDS. The only life-prolonging treatment available is antiretroviral (ARV) therapy. WHO estimates, however, that less than 5 percent of those who require treatment in developing countries currently enjoy access to these medicines. In Africa fewer than 50,000 people–less than 2 percent of the people in need–currently receive ARV therapy. These facts have elicited strongly divergent reactions, and views about the appropriate response to this crisis have varied widely.</p><p>The intensity of the debate concerning access to life-prolonging medicines for the treatment of HIV/AIDS, and the heated rhetoric with which they are often conducted, suggest that these disagreements may be rooted in deeper disagreements of value. It is not obvious, however, what disagreements of value are at stake in this debate. By analyzing the statements of scholars, public officials, activist organizations, and private sector representatives, each of whom may endorse very different policy recommendations on access to HIV/AIDS drugs, we have identified and created a typology of the different sources of disagreement in the debate. We conclude that the central disagreements concerning access to medicines arise from competing understandings of how responsibilities for bringing remedy to hardships should be allocated to different agents and institutions. A central lesson that emerges from our analysis is that thinking about “health equity” must extend beyond the explanation and justification of goals, values, and ideals, and engage more honestly with the difficult question of how responsibilities for bringing remedy to health crises should be allocated in complex social contexts.</p>","PeriodicalId":11772,"journal":{"name":"Ethics & International Affairs","volume":"16 2","pages":"57-70"},"PeriodicalIF":1.3,"publicationDate":"2006-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1111/j.1747-7093.2002.tb00397.x","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"24956812","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"哲学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"International Justice and Health: A Proposal","authors":"Gopal Sreenivasan","doi":"10.1111/j.1747-7093.2002.tb00399.x","DOIUrl":"10.1111/j.1747-7093.2002.tb00399.x","url":null,"abstract":"<p>This paper discusses obligations of international distributive justice-specifically, obligations rich countries have to transfer resources to poor countries. It argues that the major seven OECD countries each have an obligation to transfer at least one percent of their GDP to developing countries.</p><p>The strategy of the paper is to defend this position without having to resolve the many debates that attend questions of international distributive justice. In this respect, it belongs to the neglected category of nonideal theory. The key to the strategy is to show that a significant amount of good would be accomplished by a one percent transfer, despite the fact that one percent is quite a small amount.</p><p>To make this showing, the paper takes health as a fundamental measure of individual well-being and examines the improvement in life expectancy that would likely result from devoting the one percent transfer to the major determinants of health. It adduces data indicating that substantial progress towards raising life expectancy in developing countries to the global average of 64.5 years can be expected from expenditures of $125 per capita, divided between health care, education, and basic nutrition and income support. A one percent transfer from the major seven is enough to cover expenditures on that scale for the poorest fifth of the world's population.</p>","PeriodicalId":11772,"journal":{"name":"Ethics & International Affairs","volume":"16 2","pages":"81-90"},"PeriodicalIF":1.3,"publicationDate":"2006-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1111/j.1747-7093.2002.tb00399.x","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"24956814","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"哲学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"International Obligation and Human Health: Evolving Policy Responses to HIV/AIDS","authors":"Paul G. Harris, Patricia Siplon","doi":"10.1111/j.1747-7093.2001.tb00357.x","DOIUrl":"10.1111/j.1747-7093.2001.tb00357.x","url":null,"abstract":"The world is in the early stages of what will be the greatest health crisis since the advent of modern medical technologies. Millions of people—particularly people in many of the world's poor countries—are infected with HIV. The vast majority of these people will go without modern medical intervention or substantial treatment, and will rapidly develop AIDS. The extent of this problem presents profound moral and ethical questions for the world's wealthy people and countries, for it is they who are most able to assist the poor in managing and reversing this human tragedy.","PeriodicalId":11772,"journal":{"name":"Ethics & International Affairs","volume":"15 2","pages":"29-52"},"PeriodicalIF":1.3,"publicationDate":"2006-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1111/j.1747-7093.2001.tb00357.x","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"24956809","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"哲学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"AIDS and International Ethics","authors":"Brenda Almond","doi":"10.1111/j.1747-7093.1988.tb00532.x","DOIUrl":"10.1111/j.1747-7093.1988.tb00532.x","url":null,"abstract":"<p>The pervasiveness and magnitude of AIDS require that it be addressed on an international, global scale. However, the issues of testing for the virus, and controlling its propagation raise questions of civil rights. Brenda Almond examines different countries' policies and ways of attempting to deal with AIDS, focusing on their positions in regard to rights. Almond makes the case that while discrimination should be avoided and fought, that recognition of the primary right, that of life, demands that public health and civil rights be considered in a less oppositional way. Ultimately, however, the possibility of defeating AIDS lies not in law and regulation but in moral education.</p>","PeriodicalId":11772,"journal":{"name":"Ethics & International Affairs","volume":"2 1","pages":"139-154"},"PeriodicalIF":1.3,"publicationDate":"1988-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1111/j.1747-7093.1988.tb00532.x","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"24980336","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"哲学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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