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Ali Afroz's avatar

I think what you’re picking up on here is that you need an account of appropriate equitable treatment in order to determine what discrimination is unjust. This is why, for example, people do not object to depriving people below the age of 18 of a bunch of legal rights but would object if the age in question was 50. In fact, most legal formulations of the disparate impact standard effectively state that there is an exception for when something is a good idea. Indeed, they generally amount to saying that disadvantage a group beyond what would be a good idea is discriminatory, which of course makes total sense on your view. Criticism of things like QALYs implicitly rely on the different and controversial and contestable conception of equality where it is considered equal treatment to give you the same medical resources, even if it will only extend your life by a few days, whereas it will extend somebody else’s life by much longer. Obviously, you can and should contest whether this is in fact, equitable on moral reflection.

To be clear, I am not suggesting that you cannot determine what is unjust discrimination without a full fledged theory of justice, as you can definitely rely on intuition to some extent, but often in the absence of additional reflection, you will notice that your intuitions on particular cases are either self-contradictory or sensitive to framing. So you need additional theorising, and of course you have to balance it against the intuitive appeal of certain general principles. So you cannot use particular judgements to shortcut the need for a broad investigation of what is just and also in many of the particular cases you highlight while I’m sure there are many people who genuinely found them counterintuitive. However, I also think many of the people objecting to such cases are just picking up on a family resemblance between these situations and situations that they find objectionable instead of actually having a direct intuition about the case.. ultimately like with the full of moral philosophy, there is no silver bullet that avoids all conflicting intuitions and you have to balance your intuitions and pick the bullets you’re willing to bite while acknowledging that your answers may depend on hard to obtain empirical information.

Allan Olley's avatar

It occurs to me that in terms of triaging on the basis of social value, a flaw would be that this might encourage people to lie and deceive in ways that are socially inefficient (and would invalidate the utility of the practice). I can almost see it in my mind "We can only save one of these two patients, according to their charts this one has 5 Nobel prizes, is gifted neurosurgeon and runs a charity that feeds the hungry around the world, this one has 10 Nobel prizes and is a cardiac specialist at the Mayo clinic and has developed 10 highly deployed life saving vaccines for communicable diseases common in the developing world. Amazing how many Nobel laureates we see come through here."

If one limits judgements of social utility to cases were it would be easy to gather reliable evidence (hard to fake credentials etc.), I suspect the number of situations where it could matter would be reduced significantly, if not entirely.

In terms of the prioritizing treating health care workers, doesn't that more follow the logic of putting your own oxygen mask first in the plane emergency before helping your neighbour put on their mask? Healthcare workers who are sick (enough to benefit from treatment) are not providing care, usually social utility is indirect relative to the crisis in question, should you save the engineer now versus the ditch digger, but neither's utility is directed at an immediate current crisis but at a remove. Whereas treating healthcare workers is about treating the people who are currently under a crisis of manpower to deal with the very disaster that has laid them low. Also, there is the morale consideration, if you know the person you just worked with his waiting in the hall on a gurney because they are low priority it probably erodes motivation, leads to more burnout etc. Also, also assessing whether the hospital worker in front of you who you worked with his in fac a healthcare workers is an easier task of discrimination and harder to fake ("I only faked working with you for the last 20 years by coming in an actually doing the assigned work so I could secure this hospital bed you fool!"). A similar issue would be giving special treatment to the ill pilot landing the plane during a food poisoning incident at 40 000 feet (why did he have the fish?) this is not so much social utility as immediate necessary load baring utility.

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