Questioni di giustizia in ambito sanitario
A.Y. 2022/2023
Learning objectives
This course aims to provide students with an introduction to health justice issues related to the fair allocation of healthcare resources and the universal right to healthcare. After a brief methodological introduction, the first part of the course will present the different theories of justice and their consequences for the discussion on the right to healthcare and the need to establish a public healthcare system. In this way, the ethical-political issues underlying justice issues in the healthcare system will be highlighted, i.e., the very justification of the state institution and the meaning of the notions of justice and equality. In the second part, the distinction between macro and micro-allocation problems will be presented and the criteria for the distribution of healthcare resources within a given public system will be introduced. A discussion will then be promoted aimed at personally involving the students regarding some concrete allocative issues. Specifically, the problem of allocating ventilators/beds in intensive care in emergency conditions will be explored.
Expected learning outcomes
Participation in this laboratory will allow students to acquire the knowledge and skills necessary for the development of a critical and non-dogmatic reflection regarding the complex issues of justice in healthcare. With regard to knowledge, students will be able to: distinguish and recognize competing theories of justice and their different declinations in the healthcare context; distinguish macro and micro-allocative issues; distinguish the different allocative criteria and recognize the ethical principles involved in the choice of these criteria. With regard to skills, students will be able to formulate articulated positions regarding the topics covered during the course and present their views in a coherent and well-argued way.
Lesson period: First semester
Assessment methods: Giudizio di approvazione
Assessment result: superato/non superato
Single course
This course cannot be attended as a single course. Please check our list of single courses to find the ones available for enrolment.
Course syllabus and organization
Single session
Course syllabus
· Lesson 1. Introduction to the course: justice in the healthcare
· Lesson 2. The theories of justice in the health sector/1: libertarianism and secular proceduralism
· Lesson 3. Theories of justice in the health sector/2: fair equality of opportunity and utilitarianism
· Lesson 4. Theories of justice in health care/3: priority and sufficientarism
· Lesson 5. Macro-allocative and micro-allocative problems in healthcare
· Lesson 6. Allocative criteria and decision-making in health care/1: clinical appropriateness, the lottery system and the age criterion
· Lesson 7. Allocative criteria and decision-making in health care/2: QALY and personal responsibility
· Lesson 8. Allocation of scarce resources in emergency health conditions. The Italian case during the Covid-19 pandemic: presentation and discussion
· Lesson 9. Justice, genetics, and human enhancement
· Lesson 10. Conclusions
· Lesson 2. The theories of justice in the health sector/1: libertarianism and secular proceduralism
· Lesson 3. Theories of justice in the health sector/2: fair equality of opportunity and utilitarianism
· Lesson 4. Theories of justice in health care/3: priority and sufficientarism
· Lesson 5. Macro-allocative and micro-allocative problems in healthcare
· Lesson 6. Allocative criteria and decision-making in health care/1: clinical appropriateness, the lottery system and the age criterion
· Lesson 7. Allocative criteria and decision-making in health care/2: QALY and personal responsibility
· Lesson 8. Allocation of scarce resources in emergency health conditions. The Italian case during the Covid-19 pandemic: presentation and discussion
· Lesson 9. Justice, genetics, and human enhancement
· Lesson 10. Conclusions
Prerequisites for admission
No prior knowledge is required
Teaching methods
The teaching of the "Issues of Justice in Healthcare" laboratory includes both frontal lectures and lectures in which students will have to present documents and scientific articles. In this way we intend to promote a discussion in class on the topics covered during the workshop. Lessons will be held face to face, and it is not intended to use e-learning didactic material.
Teaching Resources
As regards the laboratory "Issues of justice in the health sector", the following papers and textbooks are adopted
First Part
¡ H.T. Engelhardt Jr., Manuale di bioetica, Il Saggiatore, Milano 1996, pp. 391-427.
¡ N. Daniels, Just Health: Meeting Health Needs Fairly, Cambridge University Press, New York 2008, cap. 2, pp. 29-78.
¡ D. Parfit, Equality and Priority, Ratio, 10, 1997, pp. 202-221.
¡ T. Nagel, I paradossi dell'eguaglianza, Il Saggiatore, Milano 1998, pp. 83-96.
Second Part
¡ J. Harris, QALYfying the value of life, Journal of Medical Ethics, 13, 1987, pp. 117-123
¡ A. Williams, Intergenerational Equity: An Exploration of the Fair Innings Argument, Health Economics, 6, 1997, pp. 117-132.
¡ J. Harris, Deciding between Patients, in H. Kuhse, P. Singer (a cura di), Companion to Bioethics, 2nd ed., Wiley-Blackwell, Chichester 2012, pp. 335-350;
¡ D. Wikler, S. Marchand, Society's Allocation of Resources for Health, in H. Kuhse, P. Singer (a cura di), Companion to Bioethics, 2nd ed., Wiley-Blackwell, Chichester 2012, pp. 351-361.
¡ S. Semplici, Se non ci sono ventilatori per tutti. Covid-19 e il criterio dell'età, Dialegesthai. Rivista telematica di filosofia, 2020.
Discussion
¡ G. Persad, A. Wertheimer & E. J. Emanuel, Principles for allocation of scarce medical interventions, The Lancet, 373(9661), 2009, pp. 423-431.
¡ E. J. Emanuel, et al., Fair allocation of scarce medical resources in the time of Covid-19, , 2020, pp. 2049-2055.
¡ Società Italiana Anestesia Analgesia Rianimazione e Terapia Intensiva (SIAARTI), Raccomandazioni di etica clinica per l'ammissione a trattamenti intensivi e per la loro sospensione, in condizioni eccezionali di squilibrio tra necessità e risorse disponibili, 2020.
¡ Comitato Nazionale per la Bioetica (CNB), COVID-19: la decisione clinica in condizioni di carenza di risorse e il criterio del "triage in emergenza pandemica", 2020.
Last Part
¡ R. Goodman, Cognitive Enhancement, Cheating, and Accomplishment, Kennedy Institute of Ethics Journal, 20, 2010, pp. 145-160.
¡ J. Savuelscu, Justice, Fairness, and Enhancement, Annals of the New York Academy of Sciences, 1093, 2006, pp. 321-338.
¡ A. Buchanan, D. W. Brock, N. Daniels & D. Wickler, From chance to choice. Genetics and justice. Cambridge University Press, Cambridge 2009.
¡ M. Loi, Una teoria della giustizia, geneticamente modificata, Filosofia e questioni pubbliche, 2010.
First Part
¡ H.T. Engelhardt Jr., Manuale di bioetica, Il Saggiatore, Milano 1996, pp. 391-427.
¡ N. Daniels, Just Health: Meeting Health Needs Fairly, Cambridge University Press, New York 2008, cap. 2, pp. 29-78.
¡ D. Parfit, Equality and Priority, Ratio, 10, 1997, pp. 202-221.
¡ T. Nagel, I paradossi dell'eguaglianza, Il Saggiatore, Milano 1998, pp. 83-96.
Second Part
¡ J. Harris, QALYfying the value of life, Journal of Medical Ethics, 13, 1987, pp. 117-123
¡ A. Williams, Intergenerational Equity: An Exploration of the Fair Innings Argument, Health Economics, 6, 1997, pp. 117-132.
¡ J. Harris, Deciding between Patients, in H. Kuhse, P. Singer (a cura di), Companion to Bioethics, 2nd ed., Wiley-Blackwell, Chichester 2012, pp. 335-350;
¡ D. Wikler, S. Marchand, Society's Allocation of Resources for Health, in H. Kuhse, P. Singer (a cura di), Companion to Bioethics, 2nd ed., Wiley-Blackwell, Chichester 2012, pp. 351-361.
¡ S. Semplici, Se non ci sono ventilatori per tutti. Covid-19 e il criterio dell'età, Dialegesthai. Rivista telematica di filosofia, 2020.
Discussion
¡ G. Persad, A. Wertheimer & E. J. Emanuel, Principles for allocation of scarce medical interventions, The Lancet, 373(9661), 2009, pp. 423-431.
¡ E. J. Emanuel, et al., Fair allocation of scarce medical resources in the time of Covid-19, , 2020, pp. 2049-2055.
¡ Società Italiana Anestesia Analgesia Rianimazione e Terapia Intensiva (SIAARTI), Raccomandazioni di etica clinica per l'ammissione a trattamenti intensivi e per la loro sospensione, in condizioni eccezionali di squilibrio tra necessità e risorse disponibili, 2020.
¡ Comitato Nazionale per la Bioetica (CNB), COVID-19: la decisione clinica in condizioni di carenza di risorse e il criterio del "triage in emergenza pandemica", 2020.
Last Part
¡ R. Goodman, Cognitive Enhancement, Cheating, and Accomplishment, Kennedy Institute of Ethics Journal, 20, 2010, pp. 145-160.
¡ J. Savuelscu, Justice, Fairness, and Enhancement, Annals of the New York Academy of Sciences, 1093, 2006, pp. 321-338.
¡ A. Buchanan, D. W. Brock, N. Daniels & D. Wickler, From chance to choice. Genetics and justice. Cambridge University Press, Cambridge 2009.
¡ M. Loi, Una teoria della giustizia, geneticamente modificata, Filosofia e questioni pubbliche, 2010.
Assessment methods and Criteria
The final exam will consist of an oral discussion. A part of the final assessment will depend on students' involvement in class discussions.
- University credits: 3
Lessons: 20 hours
Professor:
Battisti Davide