Allen Andrew A. Alvarez

How Rational Should Bioethics Be? The Value of Empirical Approaches

Rational justification of claims with empirical content calls for empirical and not only normative philosophical investigation. Empirical approaches to bioethics are epistemically valuable, i.e., such methods may be necessary in providing and verifying basic knowledge about cultural values and norms. Our assumptions in moral reasoning can be verified or corrected using these methods. Moral arguments can be initiated or adjudicated by data drawn from empirical investigation. One may argue that individualistic informed consent, for example, is not compatible with the Asian communitarian orientation. But this normative claim uses an empirical assumption that may be contrary to the fact that some Asians do value and argue for informed consent. Is it necessary and factual to neatly characterize some cultures as individualistic and some as communitarian? Empirical investigation can provide a reasonable way to inform such generalizations. In a multi-cultural context, such as in the Philippines, there is a need to investigate the nature of the local ethos before making any appeal to authenticity. Otherwise we may succumb to the same ethical imperialism we are trying hard to resist. Normative claims that involve empirical premises cannot be reasonable verified or evaluated without utilizing empirical methods along with philosophical reflection. The integration of empirical methods to the standard normative approach to moral reasoning should be reasonably guided by the epistemic demands of claims arising from cross-cultural discourse in bioethics.

THRESHOLD CONSIDERATIONS IN FAIR ALLOCATION OF HEALTH RESOURCES: JUSTICE BEYOND SCARCITY

Application of egalitarian and prioritarian accounts of health resource allocation in low-income countries have both been criticized for implying distribution outcomes that allow decreasing/undermining health gains and for tolerating unacceptable standards of health care and health status that result from such allocation schemes. Insufficient health care and severe deprivation of health resources are difficult to accept even when justified by aggregative efficiency or legitimized by fair deliberative process in pursuing equality and priority oriented outcomes. I affirm the sufficientarian argument that, given extreme scarcity of public health resources in low-income countries, neither health status equality between populations nor priority for the worse off is normatively adequate. Nevertheless, the threshold norm alone need not be the sole consideration when a countrys total health budget is extremely scarce. Threshold considerations are necessary in developing a theory of fair distribution of health resources that is sensitive to the lexically prior norm of sufficiency. Based on the intuition that shares must not be taken away from those who barely achieve a minimal level of health, I argue that assessments based on standards of minimal physical/mental health must be developed to evaluate the sufficiency of the total resources of health systems in low-income countries prior to pursuing equality, priority, and efficiency based resource allocation. I also begin to examine how threshold sensitive health resource assessment could be used in the Philippines.

The place of culture-based reasons in public debates

The question of how society should deal with social conflicts arising from cultural differences persists. Should we adopt an exclusivist approach by excluding reasons based on specific cultural traditions (culture-based reasons) from public debates about social policy, especially because these reasons do not appeal to the public at large? Or should we resort to an inclusivist approach by including reasons based on cultural traditions in public debate to give recognition to the diverse cultural identities of those who practice these traditions? While these two approaches assign different roles to cultural traditions in public debate, both seem to welcome compromise between conflicting parties. This paper reviews contending normative approaches for dealing with conflicts in multicultural societies and explores the place of culture-based reasons in public debates designed to resolve conflicts.

Health Equity in a Globalised World: Towards Constraining Global Greed?

“Corporate greed” has recently been denounced in several protest demonstrations in different parts of the world. In those demonstrations, corporations are called to put an end to their being too selfish and greedy for profit and to start caring for the interests of others, especially the many who are poor and unemployed. While such protest movements seem to attract less support in Asian countries than in their Western counterparts, this does not mean that people there are necessarily indifferent to denouncing “greed”. There is even a familiar quote attributed to Lao Tzu that says that there is no greater disaster than greed (or lavish desires). This may be a different kind of greed than what global protesters are denouncing. But even if people have different conceptions of what should be considered greed and how to denounce it, we could at least agree that we should not only be concerned about our own interests. In certain ways, it may also be beneficial for us to consider how others are faring. For example, we could conceive of the world of being more peaceful and stable if there is less global health inequity as we currently have. Many of the world’s poorest have a life expectancy at birth of less than 50 years in contrast to the global life expectancy at birth of 66.75 years. Ideally, much of the poverty suffered by many in the world could be remedied through ways that will not burden the world’s affluent population. But in the real world, many still avoidably fall below the world’s life expectancy average while theoretical and practical obstacles to motivating effective global action to solve the problem remains. In this article, I explore the plausibility of motivating rich countries to assist poor countries by appealing to the idea of rational constraint: is global resource transfer a rational thing to do from the point of view of any prospective donor? This is done by sketching the implications of David Gauthier’s view of rational constraint (to maximising a r t i c l e s

The Cross-Cultural Importance of Satisfying Vital Needs

Ethical beliefs may vary across cultures but there are things that must be valued as preconditions to any cultural practice. Physical and mental abilities vital to believing, valuing and practising a culture are such preconditions and it is always important to protect them. If one is to practise a distinct culture, she must at least have these basic abilities. Access to basic healthcare is one way to ensure that vital abilities are protected. John Rawls argued that access to all-purpose primary goods must be ensured. Amartya Sen and Martha Nussbaum claim that universal capabilities are what resources are meant to enable. Len Doyal and Ian Gough identify physical health and autonomy as basic needs of every person in every culture. When we disagree on what to prioritize, when resources to satisfy competing demands are scarce, our common needs can provide a point of normative convergence. Need-based rationing, however, has been criticized for being too indeterminate to give guidance for deciding which healthcare services to prioritize and for tending to create a bottomless-pit problem. But there is a difference between needing something (first-order need) and needing to have the ability to need (second-order need). Even if we disagree about which first-order need to prioritize, we must accept the importance of satisfying our second-order need to have the ability to value things. We all have a second-order need for basic healthcare as a means to protect our vital abilities even if we differ in what our cultures consider to be particular first-order needs.

Sakit and Karamdaman: Towards Authenticity in Filipino Concepts of Disease and Illness

This paper aims to highlight the value of authenticity in responding to disease and illness. The argument is that authenticity must be added to utilitarian and pragmatic considerations as a criterion of the validity of healing responses to disease and illness. Authenticity may be achieved by ensuring the alignment of treatments and remedies with the social and cultural dimensions of concepts of disease and illness. The point is that diseases and illnesses are not merely biophysical phenomena. They form part of a matrix of values, traditions and beliefs that define a cultural identity.