Ethics Classes


  • Ethical Issues in International Health Research(Dan Wikler)

Ethics Questions

  • Maximization vs Distributive Fairness
  • Why is health especially important?
  • When is health inequality unjust?
  • How can we meet health care needs fairly when we cannot meet them all?
  • Individual vs Social Responsibility

Maximization vs Distribution Fairness

  • Utilitarian
    • Objective vs Subjective
    • CEA vs CBGA
    • Rule vs Act based
    • future-oriented, do not need to look back right and duty in the past
  • Egalitarian Liberal
    • Rawls
    • Daniels
    • Wikler
      • voluntary vs socially embedded choice
  • Libertarian
    • Nozick
    • Friedman
    • Paternalism
      • Hard Paternalism
        • inspected vs unispected meat
      • Libertarian Paternalism(Sunstein and Thaler)
        • framing, starting point, default rule modify rational choice
    • inquality is unjust if it is due to somebody's intentional violation of other people's right or property.
  • (Commutarian)

Ageism(Tsuchiya et. al (2003))

  • Health maximization ageism’ claims that because older people have little of their life left, then the benefits of health-care interventions
  • 'Productivity ageism’ suggests that because older people are less likely than younger adults to be economically productive, then investment in their care has reduced returns.
  • Fair-innings ageism’ is based on the idea that everyone reaches an age at which they have been able to achieve most of their goals, and that prolonging life beyond this is an unfair intervention.

Two ways of conflict solution between maximization and fairness

  • ethically weighted CEA
  • CEA as one input to fair deliberative process
    • 9 Benchmark fairness fall into 3 category of fairness
      • efficiency
      • equality
      • accountability


    • Class
    • Racial
    • Gender
    • International Disparities
  • When is an inequality unjust?

Benchmarks of Fairness

Benchmarks of Fairness are a generic matrix for assessing the fairness of health sector reform in developing countries. “Fairness” is taken to include equity (in risk factors, access to services, and financing), accountability, and efficiency.

Four unsolved issue

(2)best outcome-fair chance
(3)priority to worst off
(4)democracy problem

Responsibility: Individual vs Social

  • individual choice is important
  • cannot completely separate truely informed and voluntary behavior from socially embedded behavior.

Priority to Health Care Worker

It is justified from objective utilitarian perspective, because we expect positive externality that health care worker create. The degree of positive externality is measured by number of life saved or reduction of DALY by health worker who we save. Priority on health worker does not mean that health worker always has priority. We still have to decide whom we save by intervention based on cost-effectiveness analysis after adjusting positive externality that health care worker provides to rest of the society if he/she is saved by us.


  • Kidney Transplant
  • Oregon
  • MDG/Gwatkin
  • Mexico
  • Prevention vs Treatment in HIV/AIDS
  • WHO 3 by 5 Program


[From PIH272]
Wikler, D and R. Cash(2003)
Bobadilla, J et. al.(1994)