Advancing understanding of the mechanisms of disease point to a growing number of examples of “genetic diseases” with an infectious component, and of “infectious diseases” with a genetic component. This combination of factors creates an overlapping or merging of what had formerly been understood as separate categories of disease, an observation noteworthy for both the change it signals in the understanding of disease mechanisms and for the ethical, legal and social implications (ELSI) it seems to invoke.
This blurring and overlapping is happening between many categories relevant to ELSI research; for example, between genetic testing for health, ancestry, recreation, and law enforcement. Across areas of science and emerging technologies, previously understood silos are overlapping and merging in ways that suggest that we need new ways of assessing and developing oversight for science, technology and their use. These shifting boundaries - between infectious and genetic disease, and between uses of emerging technologies - are creating an important and, as yet, understudied area of inquiry. Specifically, what ELSI issues do such fluid boundaries raise?
This interdisciplinary panel will analyze the changing conceptualizations of the relationship between infectious and genetic disease from the historical (Alexandre White), philosophical (Eric Juengst) and legal (Anna Mastroianni) perspectives, and the ELSI of the evolving understanding(s) of this dynamic in the broader context of emerging technologies (Debra Mathews). We will highlight the particular relevance of blurring boundaries in the contexts of research, clinical care, public health, and public policy.
The emergence of artificial intelligence (AI) applications is considered one of the most promising developments for improving health care. The expectations of AI are especially high for image-based medicine (pathology and radiology), as studies have indicated that AI performs exceptionally well in image processing and may be able to equal or even outperform expert radiologists and pathologists (Bejnordi et al. 2017; Chen et al. 2017; Ghafoorian et al. 2017; Korfiatis et al. 2017, Nam et al. 2018). In spite of the impressive experimental results, concrete AI implementation is challenged by a wide variety of ethical concerns. Specifically, the possible implementation of AI asks us to evaluate its impact on ethical values such as trust, responsibility, equity and human expertise in medical practice. In this panel we focus on these concerns and scrutinize the ethics of AI implementation in image-based medicine, and will draw from both theoretical and empirical sources in support of our positions.
At the outset of the 2020-2021 COVID-19 pandemic, analysts and policy makers, the media, and many ethicists struggled, especially in the earliest days, to recognize and understand the public and global health dimensions of the pandemic, the significance of structural injustice in fueling it, and its profound implications for global health equity and justice. This still-unfurling global health emergency has made clear the limits of a bioethics that puts its emphasis on individual patients, health scientists, and health professionals, guided by a biomedical conception of health, and accompanied by a nationalist approach to thinking about health policy. Hospitals grappling with triage policies; individual autonomy vs. the public good and mask-mandates; the fair distribution of vaccines within a given (rich) country. This has been the bulk of the work of bioethics in the pandemic, especially in high-income countries. Even after the world’s experience with HIV/AIDS, the first SARS crisis, and Ebola, bioethics failed in significant respects – as a field – to provide analysis adequate to the truly transnational emergency with social and institutional norms and processes, political and economic structures exacerbating it.
This panel brings together moral and political philosophers working in global health justice to argue for the use of specific conceptual tools to guide bioethics in the future to better respond and assist health policy makers in responding to transnational health crises, especially those with roots in injustice. It consists of 3 presentations. The first will present an account of the urgent need for distinctly philosophical methods for addressing problems in global health justice, methods that reckon with non-ideal conditions and the structural roots of health inequities. The next presentation will propose an “ecological ethic” for global health justice, explaining its ontological and epistemic underpinnings, and call for more interdependent and equity-aiming health policy and planning to support the capability to be healthy around the world. The third presentation will argue that a decolonizing approach to global health is vital to respond to the field’s (some say persistent) legacy of colonialism, imperialism, and neoliberalism, and offers elements of such an approach.
We will take five minutes to introduce the symposium. Each presentation will be 15 minutes, leaving 45 minutes for discussion with session participants.
Vaccination primarily offers protection of the person who receives the vaccine. There are however several types of situations where immunization is primarily offered to protect others. It might be argued that in such cases a choice for or against immunization is much more a moral choice than in case one vaccinates to protect one's own (or one's child's) health. In this workshop we present various cases, like Covid19 immunization of children to protect elderly, HPV vaccination of boys to protect women against cervical cancer, and various specific vaccines for health care workers to protect their patients. We will focus on ethical justifications of nudging and more coercive strategies, explore social contract arguments, solidarity, altruism, and an expanded 'best interests' concept.
The symposium has four papers that will be presented, each of 12 minutes maximum. The chairperson will introduce the discussion by linking and contrasting key elements of the four papers, to enable a fruitful, focused and in-depth discussion with the audience.
In the coming years, a significant increase is expected in the number of extremely expensive cancer treatments that are approved for marketing. National public healthcare systems encounter difficulties in arranging or even justifying reimbursement of these treatments using collective funds. For a research project funded by the Dutch Cancer Society, we are examining ethical dilemmas that arise when newly approved expensive cancer treatments have received marketing authorization but are not (yet) reimbursed within the national healthcare system. When patients could possibly benefit from non-reimbursed cancer treatments, physicians and patients might try to arrange access to these treatments in other ways, such as asking health insurers or pharmaceutical companies for leniency, requesting the use of hospitals budgets, or letting patients pay out of pocket. Based on differing weighing of values at stake, such as beneficence, liberty, autonomy, solidarity, and justice, physicians may make different choices with respect to pursuing such routes to seek access or supporting patients in doing so. Variability in practices among individual doctors or institutions could potentially lead to unequal access to expensive medical treatments for patients. While in many European countries, equal access to healthcare is widely seen as highly valuable, denying patients to make out-of-pocket payments interferes with their liberty. In this symposium, we discuss ethical dilemmas of access to and funding of extremely expensive medical treatments that are not (yet) reimbursed under national health insurance schemes.
Programme: the symposium will start with a brief introduction by the Chair (2 min), and two short presentations (8 min) to set the scene. Then, there will be three more extensive presentations (15 min). We will have 25 minutes for a discussion with participants in the audience, moderated by the Co-Chair.
Significant attention has been paid to the impact of novel neurotechnologies on the autonomy and identity of patients with neurological and mental health conditions, privacy, and agency. Less attention has been paid, however, to issues of social justice, an area that has important ethical implications for individuals and societies globally, and vulnerable and marginalized persons in particular. Our view is that innovation in the brain sciences that occurs without a clear map for access to its products risks violating human rights. In this panel, we will discuss three arms of neuroethics research focused on novel neurotechnologies that highlight challenges of innovation in the context of geography, stigma, cost and culture. The session chairs will moderate a discussion focused on international frameworks and global priorities for addressing these important areas of biomedical and neuro ethics among the panelists, and in a dynamic question-and-answer period with the audience.
The presentations constitute complementary aspects of social issues in the context of access limitations to novel neurotechnologies. Each panelist will present for 15 minutes. We are allocating 20 minutes for the moderated discussion among the panelists with questions posed by the chairs, and 25 minutes for audience engagement.
The Epidemic Ethics Network was launched in 2020 to respond to an unmet need. Despite the existence of numerous ethics guidance documents and a growing community of bioethicists working in the area of pandemics/public health emergencies, no formal mechanisms existed globally to coordinate and support ethical decision-making in this context. This was true for ethical issues that arise not only in the operational response to public health emergencies, but also in preparedness, planning, and recovery activities, and also in the conduct of research during public health emergencies. At the time, in the light of recent experiences of Ebola and Zika, it was clear that there was a significant need to establish a network — a mechanism designed to be global and inclusive—to support ethical decision making by providing advice to researchers, practitioners, and governments. Capacity to develop and implement such support can vary significantly between affected settings locally and regionally.
Responding to these needs and opportunities, and the challenges presented by the COVID-19 pandemic, Epidemic Ethics is a global community of bioethicists and stakeholders involved in public health and research responses to public health emergencies. It brings together the expertise and resources available across the network to identify relevant ethical issues and provide real-time, trusted, contextual support to communities, policy makers, researchers, and responders in relation to ethical issues arising out of public health emergencies, with a current focus on the COVID-19 pandemic.
Epidemic Ethics is led by the World Health Organization and supported by key partners including the Fogarty International Center, Global Forum on Bioethics in Research, Global Network of WHO Collaborating Centres, The Oxford-Johns Hopkins Global Infectious Disease Ethics Collaborative (GLIDE), and Wellcome. Epidemics Ethics is supported by a Secretariat which rotates periodically, the initial host is the Ethox Centre at the University of Oxford.
At the time of launch, the intention was to pilot and grow the network through a series of outreach activities throughout 2020. However, COVID-19 took hold, the pilot was abandoned, and the network was launched in real-time. Activities to date have included a series of over twenty webinars, the establishment of four post-doc posts (in Brazil, Singapore, South Africa, and the UK/Switzerland), as well as the funding of over forty research projects focusing on some of the key ethical challenges that arose in the COVID-19 pandemic.
Going forward, key challenges for the network will focus on: how to leverage pre-existing networks to further build ethics capacity in this field; the development of a multi-national collaborative portfolio of conceptual and empirical research; and working further to embed ethics at the heart of decision-making both before and during public health emergencies.
This session will describe the achievements and challenges of the network to date and explore the future role of epidemic ethics and the World Health Organization in future public health emergencies and a post-pandemic world.
In most European countries, health care expenditure as a percentage of GDP has doubled since the 1970s. Contrary to what many may expect, the dominant driver of this increase in expenditure is not the aging population, but rather medical innovation. While precision oncology, robot surgery, immunotherapy, gene therapy and biologics may improve the quality of care for our patients, they also, unfortunately, substantially raise the bill.
Economist Clayton Christensen has therefore repeatedly argued for a different kind of innovation, which he calls disruptive innovation, to counter this untenable trend towards the derailment of public health budgets caused by so-called sustaining innovation. Whereas sustaining innovation in healthcare is aimed at curing ever more complicated diseases in ever more sophisticated ways, disruptive innovation is aimed at accessibility and convenience, oftentimes sidelining the physician.
Examples of such disruptive innovation are mHealth, wearable eHealth devices, telemedicine, clinical decision support systems, direct-to-consumer genetic testing or low-cost biomedical devices. Many of these disruptive innovations are not initiated by traditional players in the field of healthcare (such as pharmaceutical companies), but rather by established or new players in the IT sector, and several of them rely greatly on widespread sharing of health data by the users of these new technologies and on algorithms transforming those data into health advice.
At least in their early days, these innovations are unlikely to have a spectacular impact: they will not cure patients who could not be cured before or otherwise improve quality of care, but will rather serve ‘recreational’ goals, convenience and/or create a feeling of being more ‘in charge’ of one’s health. However, once these innovations start finding a broader public and once their quality is increasingly improved, they have the potential to severely change the way healthcare is traditionally administered, thereby transforming the very concept of healthcare.
The question which then arises, is whether the concepts that have traditionally taken center stage in medical ethics are sufficiently fit to deal with this new kind of healthcare. We already see shifts in key principles and concepts governing medical ethics (e.g. the concepts of informed consent or confidentiality). Are these just gradual and minor evolutions, or is there a need for a thorough re-thinking of our medical ethics toolbox, a disruption, to make it better equipped to deal with the challenges that lay ahead?
In this symposium, we want to shed a light on that central question from different angles.
During the virtual World Congress of Bioethics (WCB) held in 2020, experts from the IAB community had the opportunity to weigh in on an early draft of the World Medical Association’s International Code of Medical Ethics (ICoME), which is currently being revised by an international workgroup appointed by the World Medical Association (WMA). Adopted in 1949 in the formative years of the WMA, the ICoME, along with the Declaration of Helsinki (DoH) and the Declaration of Geneva (DoG), represents one of the core documents of the WMA and outlines the guidelines, norms and central duties of the medical profession.
Carefully taking into account the feedback gathered during the 2020 WCB meeting, as well as proposals from WMA members and medical ethics experts throughout the world received in regional conferences and a vast public consultation, the workgroup has made some substantial changes to the draft and is now nearing completion of this considerable undertaking.
In this session, participants will have the opportunity to provide a final reality check of some of the more challenging and delicate issues covered in this crucial document before it is presented to the WMA Council and General Assembly for approval and adoption.
This symposium explores a recent WHO-funded project to create practical public health tools for use in LMICs and on behalf of marginalised populations in HICs concerning ethical challenges arising during public health emergencies, specifically the Covid-19 pandemic. The question our team aimed to answer was: what is a method for systemically learning from materials produced by community-based organisations (CBOs) about their Covid-19 responses to the needs of marginalised migrant populations, including promising practices and policy ideas that could be studied and applied going forward? We will present a method and tools for identifying, collating, and analyzing unpublished “grey literature” sources, with attention to normative and practical dimensions of learning from and with CBOs.
Duration : 75 Minutes
Duration : 75 Minutes
Duration : 75 Minutes
Duration : 75 Minutes
Welcome Messages
Prof. Dr. Andrea Schenker-Wicki; President of the University of Basel
PD Dr. Tenzin Wangmo, Chair of the 16th World Congress of Bioethics; Institute for Biomedical Ethics, University of Basel
Prof. Bernice S. Elger, Co-Chair of the 16th World Congress of Bioethics; Institute for Biomedical Ethics, University of Basel
In July 2021, the World Health Organization released global recommendations for the global governance of human genome editing technologies, including somatic and germline and heritable human genome editing. In two companion reports, the WHO Expert Advisory Panel set out governance options as well as the values and principles that should guide human genome editing innovations and detailed a number of governance options. Specifically, the Panel emphasized the importance of equity in ensuring that the potential benefits of human genome editing accrue to all, and established public consultation as the anchor stone of oversight and governance. This panel, organized by the WHO Genome Editing Expert Advisory Committee, we will provide a brief overview of the recommendations for the global governance of human genome editing technologies which addressed some of the key challenges associated with implementing the potential of this technology, including: registries, intellectual property, ‘whistleblowing’, issues of medical tourism and ethics dumping. All these topics are underpinned by values which were a core feature of the Committee’s thinking and flowed through all elements of its outputs. Two presentations – one by a member of the Committee and the other by the co-lead of the WHO Ethics office, will be followed by two discrete commentaries on the proposed governance framework from two independent scholars who will reflect critically on the challenges and opportunities for the global governance of human genome editing.
Panel format (90 mins)
The WHO Genome Editing Governance Framework and Recommendations
Jantina de Vries, University of Cape Town, 20 mins
This talk will introduce the approach towards the governance of human genome editing recommended by the WHO Expert Committee and speak to ongoing work to enact those recommendations.
Implementation of the WHO Genome Editing Governance Framework
Katherine Littler, World Health Organisation, 10 mins
This talk will focus on the implementation challenges associated with such wide-ranging outputs and the importance of a more collaborative and democratized approach to implementation of new technologies.
Respondent 1: Prof Britta van Beers, Vrije Universiteit, 15 mins
Prof Beers will respond to the key recommendations made by the WHO’s Expert Advisory Panel.
Respondent 2: Prof Diane Nicol, University of Tasmania, 15 mins, TBC
Prof Nicol will speak to the early insights generated from public consultations on human genome editing that she has organized with colleagues in Australia, as part of efforts to set up a global consultation on human genome editing.
Panel discussion (30 mins) Moderator: (proposed) Prof Vardit Ravitsky, University of Montreal (TBC)
The COVID-19 pandemic spurred unprecedented global responses, from international scientific collaborations to widespread sharing of samples and data to global vaccine distributions. Nevertheless, these efforts have to date fallen short: immense inequities in distribution of diagnostics, treatments and especially vaccines persist. For example, as of 11 May, North America has distributed 51 COVID-19 vaccine doses per 100 people, compared with 20 per 100 in South America, 14 per 100 people in Asia and 1.5 per 100 people in Africa. The COVAX facility was developed to prevent just these sort of inequities, yet evidently has only had a marginal effect at preventing them.
It bears repeating that the scope and ambition of COVAX and other international responses were unprecedented, and its achievements must be understood in light of the fact that there had been no prior effort to distribute billions of newly-developed vaccines globally over such a brief time-period. However, another global pandemic at some point in the not-too-distant future is likely, perhaps even inevitable. And the next time, there will be precedent. The global community can and must learn from the shortcomings of the international response to COVID-19, in order to anticipate and take steps in advance to be better prepared for the next global pandemic.
This panel will focus on interlinked aspects of the COVID-19 response, focusing especially on the production and distribution of life-saving vaccines and drawing lessons that should inform future pandemic responses. The need to be better prepared for the next global pandemic is both a moral and practical imperative. It is a moral issue because of the sheer weight of the massive human impact of the pandemic, in terms first and foremost of lives lost and suffering caused, as well as the economic devastation and disruption to individual and community ways of life. It is also in any given country’s strong interest to ensure global pandemic response is adequate, as failure to contain and mitigate the pandemic in certain parts of the world will mean continued circulation and emergence of variants that may cause harm even in countries with high vaccination rates, limitations on international travel and trade, and contribution to global instability and economic loss.
The panel will consist of 5 interlinked talks, with 12 minutes given to each speaker. The panel will then open up to general discussion among attendees for reflection and discussion on the international COVID-19 response, and what structures/institutions should be put in place in order to better prepare for the next global pandemic.
There is a growing interest in applying the concept of digital twins for preventive medicine and personalised medicine. Originating from industrial design, the concept of digital twins capitalises on data of specific objects to simulate replicas in the virtual world. Its primary function is predictive analysis of safety risks and testing of different optimisation solutions. Applied to the healthcare sector, a digital twin can, for example, be a virtual replica of a particular patient that reflects the unique genetic make-up of the patient, or a simulated 3D model that exhibits the characteristics of a patient’s heart. With the continuous flow of health-related data, a dynamic digital twin allows medical professionals to better assess health risks, determine if early intervention is desirable, and personalise the treatment course. Ideally, these digital twins will allow clinicians to offer more personalised healthcare to individual patients.
However, this novel approach to personalised healthcare also raises new social and ethical issues. Bruynseels et al. (2018) argue that implementing digital twins into the healthcare system will redefine the notion of ‘normality’ or ‘health’ and change our understanding of treatment and enhancement. Recently, Nyholm (2021) suggests that a medical digital twin may be viewed as an extension of a patient’s body. From this perspective, a patient’s digital twin will have a radically different status from the patient’s electronic healthcare records, creating new issues beyond data ownership. From an environmental perspective (see, e.g. Richie, 2020), it is also unclear whether implementing digital twins into the healthcare system will reduce health care’s carbon emissions by promoting preventive medicine or increase carbon intensive personalised medicine.
In this panel, we aim to further explore, and promote research on, the ethical and social implications of digital twins for personalised healthcare.
References
Bruynseels, K., Santoni de Sio, F., & van den Hoven, J. (2018). Digital Twins in Health Care: Ethical Implications of an Emerging Engineering Paradigm. Front Genet, 9, 31. doi:10.3389/fgene.2018.00031
Nyholm, S. (2021). Should a medical digital twin be viewed as an extension of the patient’s body? Journal of Medical Ethics, 47(6), 401-402. doi:10.1136/medethics-2021-107448
Richie, C. (2020). Can United States healthcare become environmentally sustainable? Towards green healthcare reform. Journal of Law, Medicine & Ethics, 48(4), 643 - 652.
The typical approach to ensuring ethical research assumes a framework of institutions, laws, and regulations that together offer ethical guidance, requirements, and oversight. But in our increasingly connected world, one in which technology, information, and other resources can travel globally and rapidly, this approach is showing its age even in traditional, familiar research.
For example, international collaborations may be subject to multiple sets of regulations, and interdisciplinary research may involve many professional ethical codes that are not always cohesive. But more strikingly, some new approaches to research occur entirely outside of any framework that makes ethical demands.
In citizen science, for example, projects may involve community monitoring of local air quality; international observations of particular species; or online-only projects with no limits to participation. This kind of research often involves collaborations between research participants from multiple countries and disciplines, with varying types and levels of training, who are often working independent of institutions. Similarly, do-it-yourself (DIY) biology or medical research may occur with just one independent researcher in a home-built lab; at the local level involving small group work within community biology labs; or at international scale on platforms such as Just One Giant Lab. DIY Bio projects have ranged from at-home Covid tests, open source epinephrine autoinjectors and accessible insulin, and even pirated gene therapies.
What these dispersed, non-traditional, or “non-establishment” approaches to research have in common is that they are ill-matched to a regulatory or ethical framework that assigns the responsibility for ethical research to centralized and monolithic institutions tied to a funding source or the laws of one nation. The poor match occurs across several dimensions. First, in many cases it is simply impossible for new research approaches to take advantage of existing institutional ethical frameworks, either because those institutions will not take on the liability of reviewing independent projects, or because such projects, run on minimal funding support, cannot afford independent review or oversight. Second, because many non-establishment research approaches stretch across international boundaries, there is no one set of national laws to adhere to, and no higher source of law (such as exists in international maritime law, for example) to which to appeal. Third, contrary to popular perception, ethical codes and regulations are not universal, so interdisciplinary or international projects must often grapple with distinct sets of ethical expectations. Given the lack of funding required to dedicate time and resources to establishing ethical guidance in these circumstances, it should not be surprising that none of these new research approaches have yet resolved how to maintain ethical standards in research.
These new approaches are not mere curiosities; they are already contributing meaningfully to the fund of knowledge (de Lorenzo and Schmidt, 2017), conducting potentially groundbreaking research, and aiming to contribute even more in the future. Some recommendations for ethics in these areas have been offered (Pauwels 2018; Guerrini et al., 2018; Pearlman and Kong, under review; Rasmussen 2019), but for the most part they have had a very narrow scope and/or tried to work within existing regulatory and institutional frameworks. We are at the very beginning of building research ethics structures that can operate independently of institutions, established funding paths, and traditional ethical frameworks, This makes it increasingly important for bioethicists and research ethicists to confront the question of how to maintain ethical standards of research in these new areas.
In this presentation, we will describe the kinds of ethical issues faced in some areas of new research, and reflect on possible approaches to ensuring that this research is conducted ethically. Presenter 1 will discuss Community Biology, and explain a facilitated approach to deriving a collectively-authored ethics code for the field. Presenter 2 will discuss an international platform for DIY Biology, the ethical challenges faced as researchers on this platform raced to address the COVID-19 pandemic, and the efforts of the platform members to address ethical issues in the process. Presenter 3 examines the challenge of establishing intellectual property resulting from research that stretches across international legal boundaries, and offers a normative framework for assessing claims to intellectual property. Finally, Presenter 4 will explore conceptual approaches to ensuring ethical research, within a framework of a “trust architecture” that establishes structures and systems that facilitate trust in the process and results of the research.
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.