Suppose multiple people with equal health profiles compete to receive a single resource. For example, a number of people with equal health prospects compete for a single transplant organ. In such circumstances it seems to many that we should decide by lottery who receives the organ. Some have argued that the lottery makes things fairer and/or that chances are valuable to individuals. But if a chance is a mere expectation of receiving a benefit, why would this be valuable? Would not the benefit itself, the organ transplant for example, be what is valuable? And if in the end one person ends up with the benefit and everyone else loses out, how does the lottery make things fairer? Whether chances are valuable and improve fairness is important for many bioethical questions. First, it matters for allocation questions between equally prioritized patients. This applies not only to the example of organ transplants, but also to rationing of ventilators, appointments at specialist doctors, and a variety of other allocation decisions in conditions of uncertainty.
Second, it has a bearing on debate about the prioritizing treatment over prevention. Prevention often lowers the chance of many people to suffer a health condition by only a moderate amount. Treatment, by contrast, focuses on a patient who no longer has any chance to avoid the condition. If we should care about the distribution of chances, does this mean that we should prefer treatment over prevention because treatment addresses patients who have the worst prospect? Should we divert resources away from HIV prevention into antiretroviral treatment? Should we spend resources on increasing ICU capacity in times of COVID to enhance our treatment capacity or should we spend the resources on procuring PPE kits to prevent future cases of COVID?
Third, the value and fairness of chances is relevant for how we should be concerned with environmental and genetic risk factors. Genetic risk factors mean that particular individuals are predetermined to be at elevated risk. Environmental risk factors, by contrast, are typically random insofar as they affect everyone in the same environment equally. Everyone is at the same objective risk of harm. Should this difference matter for the regulation of genetic versus environmental risk? Should regulations be more stringent for genetic risks than for environmental risks because in the case of environmental risks no single person is already at elevated risk? What if we know that a risk factor is genetic but do not know who in society has the relevant genetic make-up?
In this panel we will tackle these questions. Instead of focusing on a specific test case, we will discuss the value and fairness of chances across health contexts. The panel brings together four experts on the topic. Instead of presenting four distinct papers, the panel will be held in a discussion format. Each presenter will start by briefly presenting their views before we move on to a moderate exchange of the viewpoints. The presenters are chosen to reflect a variety of views on the subject. Nir Eyal will present the skeptical view that giving people chances by means of a lottery does not enhance the fairness of the distribution. Emma Curran will present a more favorable view according to which more equally distributed chances are better and that this will sometimes give us reason to accept a less optimal outcome distribution. Michael Otsuka’s discussion will distinguish between two different kinds of chances. Objective chances would make things fairer, but Otsuka will argue that in (almost) all allocation cases we can only give subjective chances, which, in his view, nevertheless can be valuable to individuals. Bastian Steuwer will give a more robust defense of the objective/subjective chance distinction and argue that often we can give objective chances. While in Steuwer’s view objective chances greatly enhances fairness, subjective chances hardly do.
Our aim in the panel is two-fold. First, we aim to illustrate how debates on the value and fairness of chances are central to thinking about health care allocation and public health measures. Second, we aim to advance the debate on how (or whether) chances should be considered by someone concerned with the equitable distribution of health care.