Overlapping consensus in pluralist societies: simulating Rawlsian full reflective equilibrium.

The fact of reasonable pluralism in liberal democracies threatens the stability of such societies. John Rawls proposed a solution to this problem: The different comprehensive moral doctrines endorsed by the citizens overlap on a shared political conception of justice, e.g. his justice as fairness. Optimally, accepting the political conception is for each citizen individually justified by the method of wide reflective equilibrium. If this holds, society is in full reflective equilibrium. Rawls does not in detail investigate the conditions under which a full reflective equilibrium is possible or likely. This paper outlines a new strategy for addressing this open question by using the formal model of reflective equilibrium recently developed by Beisbart et al. First, it is argued that a bounded rationality perspective is appropriate which requires certain changes in the model. Second, the paper rephrases the open question about Rawlsian full reflective equilibrium in terms of the model. The question is narrowed down by focusing on the inferential connections between comprehensive doctrines and political conception. Rawls himself makes a demanding assumption about which connections are necessary for a full reflective equilibrium. Third, the paper presents a simulation study design that is focused on simplicity. The results are discussed, they fit with Rawls's assumption. However, because of the strong idealisations, they provide a useful benchmark rather than a final answer. The paper presents suggestions for more elaborate study designs.

COVID-19 y Justicia Social. Un enfoque sindémico de la resistencia a la vacunación / COVID-19 i Justícia social: un enfocament sindèmic de la resistència a la vacunació / COVID-19 and Social Justice: A syndemic approach to vaccine hesitancy

The effects of COVID-19 pandemic depend on socio-cultural determinants that shield some individuals or groups from the most severe effects or make others more vulnerable to suffering harms to their health, social position, or economic stability. The case of vaccination is symptomatic of how specific groups suffer a higher degree of vulnerability due to socioeconomic inequalities and cultural determinants. Consequently, vaccine hesitancy among these groups might deepen the vulnerabilities, which is why it is necessary to design strategies that, while confronting vaccine hesitancy, do not ignore those structural inequalities which could continue feeding skepticism and resistance to vaccination, if unattended. In this work we claim that public health policies focused on promoting vaccination may benefit from a syndemic approach that considers the synergies between diseases and socioeconomic and cultural determinants. This implies introducing social justice issues into the planning of public health strategies. By critically analyzing the work of bioethicist Norman Daniels —who goes over the moral importance of public health from an interpretation of John Rawls’ theory of justice—we explore the criticism to justice as fairness made by the communitarian and the politics of difference standpoints (specifically, I. M. Young), to show that a syndemic approach to public health is essential to achieve complete vaccination: the design of strategies will have to consider the specific contexts of vaccine hesitant groups, to achieve efficiency vaccinating in the short, medium and long term.(AU)

Las afectaciones por la pandemia de COVID-19 dependen de determinantes socio-culturales que blindan a algunos individuos o grupos de los efectos más severos o vuelven a otros más susceptibles de sufrir daños a su salud, posición social o estabilidad económica. El caso de la vacunación es sintomático de cómo grupos específicos sufren mayor vulnerabilidad por inequidades socioeconómicas y determinantes culturales. Consecuentemente, la resistencia a la vacunación entre estos grupos puede profundizar la vulnerabilidad, por lo que es necesario diseñar estrategias que, al confrontar la resistencia a la vacunación, no dejen de lado aquellas inequidades estructurales que, de no atenderse, seguirán alimentando la suspicacia y renuencia a vacunarse. En este trabajo sostenemos que las políticas de salud pública enfocadas a promover la vacunación pueden beneficiarse de un enfoque sindémico que considere las sinergias entre enfermedades y determinantes socioeconómicas y culturales. Esto implica introducir problemas de justicia social en la planificación de estrategias de salud pública. Haciendo un análisis crítico del trabajo del bioeticista Norman Daniels —quien aborda la importancia moral de la salud pública desde una interpretación de la teoría de la justicia de John Rawls—retomamos las críticas a la justicia como imparcialidad de las posturas comunitarista y delas políticas de la diferencia (específicamente I. M. Young), para mostrar que un enfoque sindémico de la salud pública es indispensable para lograr una vacunación completa: el diseño de estrategias tendrá que considerar los contextos específicos de grupos renuentes a vacunarse para lograr eficiencia a corto, mediano y largo plazo.(AU)

Les afectacions per la pandèmia de COVID-19 depenen de determinants socioculturals que blinden a alguns individus o grups dels efectes més severs o tornen a uns altres més susceptibles de sofrir danys a la seva salut, posició social o estabilitat econòmica. El cas de la vacunació és simptomàtic de com grups específics sofreixen major vulnerabilitat per inequitats socioeconòmiques i determinants culturals. Conseqüentment, la resistència a la vacunació entre aquests grups pot aprofundir la vulnerabilitat, per la qual cosa és necessari dissenyar estratègies que, en confrontar la resistència a la vacunació, no deixin de costat aquelles inequitats estructurals que, de no atendre's, continuaran alimentant la suspicàcia i renuència a vacunar-se. En aquest treball sostenim que les polítiques de salut pública enfocades a promoure la vacunació poden beneficiar-se d'un enfocament sindèmic que consideri les sinergies entre malalties i determinants socioeconòmiques i culturals. Això implica introduir problemes de justícia social en la planificació d'estratègies de salut pública. Fent una anàlisi crítica del treball del bioeticista Norman Daniels —qui aborda la importància moral de la salut pública des d'una interpretació de la teoria de la justícia de John Rawls—reprenem les crítiques a la justícia com a imparcialitat de les postures comunitarista i de les polítiques de la diferència (específicament I. M. Young), per a mostrar que un enfocament sindèmic de la salut pública és indispensable per a aconseguir una vacunació completa: el disseny d'estratègies haurà de considerar els contextos específics de grups renuents a vacunar-se per a aconseguir eficiència a curt, mitjà i llarg termini.(AU)

Inequitable access to healthcare in Africa: reconceptualising the "accountability for reasonableness framework" to reflect indigenous principles.

BACKGROUND: The "Accountability for Reasonableness" (A4R) framework has been widely adopted in working towards equity in health for sub-Saharan Africa (SAA). Its suitability for equitable health policy in Africa hinges, at least in part, on its considerable successes in the United States and it being among the most comprehensive ethical approaches in addressing inequitable access to healthcare. Yet, the conceptual match is yet to be examined between A4R and communal responsibility as a common fundamental ethic in SAA. METHODOLOGY: A4R and its applications toward health equity in sub-Saharan Africa were conceptually examined by considering the WHO's "3-by-5" and the REACT projects for their accounting for the communal responsibility ethic in pursuit of health equity. RESULTS: Some of the challenges that these projects encountered may be ascribed to an incongruity between the underpinning ethical principle of A4R and the communitarian ethical principle dominant in sub-Saharan Africa. These are respectively the fair equality of opportunity principle derived from John Rawls' theory, and the African communal responsibility principle. CONCLUSION: A health equity framework informed by the African communal responsibility principle should enhance suitability for SAA contexts, generating impetus from within Africa alongside the affordances of A4R.

The Extremely Preterm Infant: Ethical Considerations in Life-and-Death Decision-Making.

Care of the preterm infant has improved tremendously over the last 60 years, with attendant improvement in outcomes. For the extremely preterm infant, <28 weeks' gestation, concerns related to survival as well as neurodevelopmental impairment, have influenced decision-making to a much larger extent than seen in older children. Possible reasons for conferring a different status on extremely preterm infants include: (1) the belief that the brain is a privileged organ, (2) the degree of medical uncertainty in terms of outcomes, (3) the fact that the family will deal with the psychological, emotional, physical, and financial consequences of treatment decisions, (4) that the extremely preterm looks more like a fetus than a term newborn, (5) the initial lack of relational identity, (6) the fact that extremely preterm infants are technology-dependent, and (7) the timing of decision-making around delivery. Treating extremely preterm infants differently does not hold up to scrutiny. They are owed the same respect as other pediatric patients, in terms of personhood, and we have the same duties to care for them. However, the degree of medical uncertainty and the fact that parents will deal with the consequences of decision-making, highlights the importance of providing a wide band of discretion in parental decision-making authority. Ethical principles considered in decision-making include best interest (historically the sine qua non of pediatric decision-making), a reasonable person standard, the "good enough" parent, and the harm principle, the latter two being more pragmatic. To operationalize these principles, potential models for decision-making are the Zone of Parental Discretion, the Not Unreasonable Standard, and a Shared Decision-Making model. In the final analysis shared decision-making with a wide zone of parental discretion, which is based on the harm principle, would provide fair and equitable decision-making for the extremely preterm infant. However, in the rare circumstance where parents do not wish to embark upon intensive care, against medical recommendations, it would be most helpful to develop local guidelines both for support of health care practitioners and to provide consistency of care for extremely preterm infants.

A ideia da estrutura básica como objeto primário da justiça em uma teoria da justiça de John Rawls

O objetivo deste artigo é estabelecer uma reflexão sobre a estrutura básica da sociedade (basic structure of society) proposta por John Rawls em sua teoria da justiça como equidade, baseando-se principalmente nas obras Political Liberalism (Lecture VII) e A theory of justice (Part Two. Institutions). Nossa intenção é demonstrar ao longo do texto, que uma sociedade sustentada em princípios e com espírito de cooperação, tem maior possibilidade de atingir estabilidade e legitimidade politica ao longo do tempo.(AU)

The main purpose of this article is to provide a reflection on the basic structure of society proposed by John Rawls in his theory of justice as fairness, mainly based on the following books, Political Liberalism (Lecture VII) and A theory of justice (Part Two. Institutions). The intention is to demonstrate throughout the text, that a society which is based on principles and spirit of cooperation, is more likely to achieve political legitimacy and stability over time.(AU)

A ideia da estrutura básica como objeto primário da justiça em uma teoria da justiça de John Rawls / The idea of the basic structure as the primary object of justice in a theory of justice of John Rawls

O objetivo deste artigo é estabelecer uma reflexão sobre a estrutura básica da sociedade (basic structure of society) proposta por John Rawls em sua teoria da justiça como equidade, baseando-se principalmente nas obras Political Liberalism (Lecture VII) e A theory of justice (Part Two. Institutions). Nossa intenção é demonstrar ao longo do texto, que uma sociedade sustentada em princípios e com espírito de cooperação, tem maior possibilidade de atingir estabilidade e legitimidade politica ao longo do tempo.

The main purpose of this article is to provide a reflection on the basic structure of society proposed by John Rawls in his theory of justice as fairness, mainly based on the following books, Political Liberalism (Lecture VII) and A theory of justice (Part Two. Institutions). The intention is to demonstrate throughout the text, that a society which is based on principles and spirit of cooperation, is more likely to achieve political legitimacy and stability over time.