Diversity, equity, and inclusion (DEI) policies and programs are crucial tools for reducing social inequality within organizations. However, the recent decline in DEI practices and the inconsistencies found in existing research underscore the need for new theoretical approaches. This essay seeks to offer a fresh perspective on the strengths and limitations of DEI initiatives through the lens of granular interactions thinking theory. It posits that while DEI policies and programs generally create conditions conducive to greater value creation and improved adaptability (...) to changing environments and challenges, maintaining direction and operational certainty within an organization with high DEI demands significant energy investment. To sustain DEI and enhance its effectiveness, these policies need to go beyond simply increasing diversity and ensuring equal access to opportunities. They must also focus on empowering a diverse workforce to contribute to the organization’s success actively. Additionally, fostering a workplace culture that enhances members’ adaptive cognitive processing and skills can reduce the energy required to sustain DEI efforts, making these practices more sustainable in the long term. (shrink)

Equity in Early Modern Legal Scholarship takes the reader through the vast amount of legal writings on equity that were published in continental Europe in early modern times. The book offers the first comprehensive overview of the development of the legal concept of equity through the sixteenth and seventeenth century. During this time, equity scholarship broke with its medieval past and entered a lively debate on the nature and function of the concept. Lorenzo Maniscalco links these developments to the early (...) modern identification of equity with Aristotelian epieikeia, a conceptual shift that brought down the barrier that divided theological and legal writings on equity and led to its development as a tool for the interpretation and amendment of legal rules. (shrink)

In this response, I reiterate my argument that price gouging undercuts the goal of equity in access to essential goods whereas Zwolinski emphasizes the importance of the efficient provision of essential goods above all other goals. I agree that the efficient provision of essential goods is important as I argue for the goal of equitable access to sufficient of the goods essential to living a minimally flourishing human life. However, efficiency is a means to this goal rather than the end (...) itself. Finally, I offer additional arguments against the non-worseness claim. (shrink)

Access to education for undocumented migrant children in South Africa remains a significant challenge. While the difficulties related to their inability to access education within the country have been highlighted elsewhere, there remains a lack of clarity on an approach to how this basic human right can be achieved. In this conceptual paper, we draw on the distinction between equality and equity, and describe the various ways in which education has been conceptualised in the South African Constitution – which in (...) part contributes to the existing confusion on education for various groups, including undocumented migrant children. In this paper, we critically reflects on the need to develop an integrated approach for creating a platform that allows all undocumented migrant children access to education in South Africa. We argue that an integrated approach – which entails ways through which access to education can be delivered through the lens of equity – will enhance the right to education for undocumented migrant children in South Africa. We conclude that the South African government must urgently consider this integrated approach to enable access to education for undocumented migrant children, so that they can achieve their full educational potential. (shrink)

Since the onset of the COVID-19 pandemic, a controversial criterion for allocating scarce medical treatment has been defended and incorporated into policy: the criterion of equity. Equity-included allocation schemes prioritize, to some degree, patients from marginalized or historically disadvantaged racial/ethnic groups, or patients with low socioeconomic status, for scarce treatment. The use of such criteria has been most prominently defended in two ways: (1) as reflecting a risk factor for severe COVID-19, and thus as a way of tracking medical need, (...) and (2) as a form of remedial justice, viz. a way of redressing disparities in COVID outcomes that are caused by underlying unjust social conditions. Here, we delineate and critique those arguments. We argue that not only are such arguments unconvincing but also that there are compelling moral reasons to reject the sort of equity-included allocation schemes at issue. (shrink)

We report the results of a vignette study with an online sample of the German adult population in which we analyze the interplay between need, equity, and accountability in third-party distribution decisions. We asked participants to divide firewood between two hypothetical persons who either differ in their need for heat or in their productivity in terms of their ability to chop wood. The study systematically varies the persons’ accountability for their neediness as well as for their productivity. We find that (...) participants distribute significantly fewer logs of wood to persons who are held accountable for their disadvantage. Independently of being held accountable or not, the needier person is partially compensated with a share of logs that exceeds her contribution, while the person who contributes less is given a share of logs smaller than her need share. Moreover, there is a domain effect in terms of participants being more sensitive to lower contributions than to greater need. (shrink)

Health equity is increasingly identified as a principal goal to be achieved through public health policies and activities. However, what is to be measured in the assessment of health equity and how inequities in health ought to be redressed are among the pressing questions that must be answered if health equity is to serve as a meaningful and consistent ethical guide for measurement and intervention in public health. In this article I argue that the concept of health equity, in the (...) form it is predominantly found in public health, suffers from normative indeterminacy and is therefore unlikely to provide actionable normative guidance to public health policy-makers, practitioners and researchers. I argue that the concept of health equity, as it is commonly defined in public health, ultimately rests upon assumptions of a more fundamental, yet tacit, conception of justice to do its normative work. In this vein, I expand upon a critique of Margaret Whitehead’s oft-cited definition of health equity made by James Wilson to raise additional reasons not explored by Wilson, or others, as to why Whitehead’s definition remains inadequate in providing normative guidance to policy-makers, practitioners and researchers in public health. (shrink)

Health equity matters, but there is no universally accepted definition of this or associated terms, such as inequities, inequalities, and disparities. Given the flexibility of these terms, investigating how policymakers understand them is important to observe priorities and perhaps course correct. Accordingly, this study analyzed the perceptions high-level policymakers within the WHO African Region. An online survey was distributed to attendees of the WHO’s Fifth Health Sector Directors’ Policy and Planning Meeting for the WHO African Region by email. After responses (...) were collected, both inductive and deductive coding were applied. Inductive coding was undertaken to glean central concepts from free-form responses on understandings of health equity and deductive coding was used to assess alignment with four theories of distributive justice using a coding framework. In analyzing central concepts, three became apparent: access to health services and/or health care, financial protection, and recognizing subgroups. And when we investigated alignment with theory, most respondents’ understandings of health equity aligned with Rawls’ ‘Theory of Justice’ (95%). Of these responses, 70% were exclusively aligned with Rawls’ ‘Theory of Justice’ and 30% aligned also with another theory (this 30% was split 55% utilitarianism and 45% Sen’s Capabilities Approach). Respondent understandings of health equity showed limited alignment with other theories of distributive justice, which were: utilitarianism (n = 7/39; 17.95%), Sen’s Capabilities Approach (n = 5/39; 12.82%), and libertarianism (n = 2/39; 5.13%). Our study demonstrates that alignment with certain theories is tied to specific themes (i.e., theoretical underpinnings may guide policymakers to favour certain policy approaches). For instance, a utilitarian-minded policymaker may be focused on a widespread vaccination campaign, whereas a Rawlsian-aligned policymaker may focus on a targeted approach to reach communities that have lower vaccination rates, and a Senian-aligned policymaker may focus on health literacy programs targeted at addressing vaccine-hesitant individuals within communities with lower vaccination rates. These findings can guide high-level policymakers and international organizations to optimize decision-making by clarifying ethical alternatives. (shrink)

This book sets out to defend the claim that Equity ought to remain a separate body of law; the temptation to iron-out the differences between neighbouring doctrines on the two sides of the Equity/Common Law divide should, in most cases, be resisted. The theoretical part of the book is argues that the characteristics of Equity, namely, appeal to conscience, flexibility, retroactivity and the use of morally-freighted jargon, are essential for the implementation of a legal ideal that has been neglected by (...) the Common Law: 'Accountability Correspondence'. According to this fundamental legal ideal, liability imposed by legal rules should correspond to the pattern of moral duty in the circumstances to which the rules apply. Equity promotes this ideal in the fields of property and obligations by disallowing parties to exploit the rule-like nature of Common Law norms in a way that breaches their moral duty to the other party. By reference to various equitable doctrines, it is argued that the faults identified by critics of Equity, especially from the perspective of the Rule of Law, are highly exaggerated, and that the criticism often reflects a political belief in the supremacy of individualism and free market over empathy and social justice. The theoretical part is followed by three chapters, each dedicated to an in-depth analysis of the equitable doctrines of fiduciary duties, proprietary estoppel, and clean hands. For each doctrine, it is shown how their equitable characteristics are indispensable for achieving their social, ethical and economic purpose. (shrink)

Recent calls to address racism in bioethics reflect a sense of urgency to mitigate the lethal effects of a lack of action. While the field was catalyzed largely in response to pivotal events deeply rooted in racism and other structures of oppression embedded in research and health care, it has failed to center racial justice in its scholarship, pedagogy, advocacy, and practice, and neglected to integrate anti-racism as a central consideration. Academic bioethics programs play a key role in determining the (...) field’s norms and practices, including methodologies, funding priorities, and professional networks that bear on equity, inclusion, and epistemic justice. This article describes recommendations from the Racial Equity, Diversity, and Inclusion (REDI) Task Force commissioned by the Association of Bioethics Program Directors to prioritize and strengthen anti-racist practices in bioethics programmatic endeavors and to evaluate and develop specific goals to advance REDI. (shrink)

This paper focuses on the potential of “equitech”—AI technology that improves equity. Recently, interventions have been developed to reduce the harm of implicit bias, the automatic form of stereotype or prejudice that contributes to injustice. However, these interventions—some of which are assisted by AI-related technology—have significant limitations, including unintended negative consequences and general inefficacy. To overcome these limitations, we propose a two-dimensional framework to assess current AI-assisted interventions and explore promising new ones. We begin by using the case of human (...) resource recruitment as a focal point to show that existing approaches have exploited only a subset of the available solution space. We then demonstrate how our framework facilitates the discovery of new approaches. The first dimension of this framework helps us systematically consider the analytic information, intervention implementation, and modes of human-machine interaction made available by advancements in AI-related technology. The second dimension enables the identification and incorporation of insights from recent research on implicit bias intervention. We argue that a design strategy that combines complementary interventions can further enhance the effectiveness of interventions by targeting the various interacting cognitive systems that underlie implicit bias. We end with a discussion of how our cognitive interventions framework can have positive downstream effects for structural problems. (shrink)

We wholeheartedly agree with Schmidt and colleagues’ efforts to promote equity in intensive care unit triage. We also take issue with their characterisation of the New Jersey allocation framework for ICU beds and ventilators, which is modelled after the multi-principle allocation framework we developed early in the pandemic. They characterise it as a two-criterion allocation framework and claim—without evidence—that it will ‘compound disadvantage for black patients’. However, the NJ triage framework—like the model allocation policy we developed—actually contains four allocation criteria: (...) the two criteria that the authors mentioned and two criteria that they failed to mention which we included to promote equity: giving priority to frontline essential workers and giving priority to younger patients. These omissions are problematic both for reasons of factual accuracy and because the two criteria they failed to acknowledge would likely mitigate rather than exacerbate racial disparities during triage. (shrink)

This book presents a clear, carefully-analysed picture of the operation of equity today, across the common law world. Rather than revisit the abstract debate as to whether or not equity has 'fused' with the common law, it focuses on specific equitable principles and doctrines. Expert contributors step back and take a wider view of those doctrines, examining how they can best be understood today, and how they might develop in the future. This will prove invaluable to practitioners and courts (at (...) first instance as well as appellate level), allowing them to navigate the constantly-growing mass of case law. Drawing on expertise from across the worlds of academia, practice and the bench, this seminal collection provides the most illuminating picture available of how equity operates. (shrink)

Background: Equity in providing care is also a major value in the nursing profession. Equitable care aims to provide the entire population with safe, efficient, reliable, and quality nursing services at all levels of health. Objectives: This study was conducted to explain the process of the realization of equity in nursing care. Research design: This qualitative study uses Glaser’s approach to grounded theory. Participants and research context: Sample selection began with convenience sampling and continued with purposive sampling. A total of (...) 27 people were ultimately selected as the study subjects. Data were mainly collected through unstructured in-depth individual interviews plus observation and field notes. The data were then analyzed using the “Six C’s” coding family of Glaser. Ethical considerations: The study protocol was approved by the Tehran University of Medical Sciences (91D1302870). Written informed consent was also obtained from all subjects. Findings: According to the findings, participants’ main concern in providing equitable care is the rationing of nursing care. The identification of participants’ main concern led to the emergence of the core category of the study, that is, “nurses’ domination.” The other categories revolving around the core category were conceptualized according to the six C’s coding family: “nurses being dominated,” “nurses’ ineffective power in the health system,” “low attention to equitable care in health system,” “lack of clarity in measuring equitable care,” “the health structure’s inconsistency with equity,” and “the inefficiency of the care system.” Conclusion: There is a mutual relationship between providing fair care and nurses’ perceptions of equity. Nurses who have themselves experienced equity can provide their patients the experience of equity. This mutual relationship is actualized in a context in which fair care is clearly defined and demanded. (shrink)

Both intertemporal and intratemporal equity are central to the examination of policy towards climate change. However, many discussions of intertemporal issues have been marred by serious analytical errors, particularly in applying standard approaches to discounting; the errors arise, in part, from paying insufficient attention to the magnitude of potential damages, and in part from overlooking problems with market information. Some of the philosophical concepts and principles of Paper 1 are applied to the analytics and ethics of pure-time discounting and infinite-horizon (...) models, providing helpful insights into orderings of welfare streams and obligations towards future generations. Such principles give little support for the idea of discrimination by date of birth. Intratemporal issues are central to problematic and slow-moving international discussions and are the second focus of this paper. A way forward is to cast the policy issues and analyses in a way that keeps equity issues central and embeds them in the challenge of fostering the dynamic transition to the low-carbon economy in both developed and developing countries. This avoids the trap of seeing issues primarily in terms of burden-sharing and zero-sum games – that leads to inaction and the most inequitable outcome of all. (shrink)

Can the institutional systems that prepare Black nurse researchers question the ways their systemic pathways have impacted health equity knowledge development in nursing? We invite our readers to keep this question in mind and engage with our conversation as Black nurse researchers, scholars, educators, and clinicians. The purpose of our conversation, and this article, is to explore the transactional impact of knowledge development pathways and Black faculty retention pathways on the state of health equity knowledge in nursing today. Over a (...) series of conversations, we discuss the research exploitation of communities of color, deficit research funding, knowledge capitalization, the marginalization of diversity as a continuous process, a lack of sociocultural authority, and our thoughts on solutions. We conclude by using the wisdom of a generation to answer our initial question. (shrink)

In ethics and political philosophy, the concepts of equity, equality, need satisfaction, and justice are significant for the fulfilment of underlying requirements of human rights, and the attainment of peace in societies. Studies show these as potential frames for defining processes, distributing resources, sharing responsibilities, allocating rewards, demonstrating respect and dispensing with unequal treatments. Justice, as the ideal that impels us to impartially adjudicate between competent claims, is linked to equality. But as the moral force that propels actions for needs’ (...) satisfaction, it is linked to equity. Hence, equality and equity are two elements of the theory of justice: both are grounded on the principles of distributive justice. This ‘common grounding’ apparently obfuscates their distinctive features, and over time, has elicited their equiparation. This essay highlights the archetypal frames of the notions of equity and equality as indispensable principles of social justice. It identifies the skewed distribution of resources in Nigeria as arising from a legal framework that removes the power of personal/group autonomy from the people. The essay notes the misleading tendency in the insulated use of equality for justice, and accepts the primacy of distributive justice amongst rival pathways to national cohesive living. (shrink)

The allocation of critical care resources and triaging patients garnered a great deal of attention during the COVID-19 pandemic, but there is a paucity of guidance regarding the ethical aspects of resource allocation and patient prioritization in ‘normal’ circumstances for Canadian healthcare systems. One context where allocation and prioritization decisions are required are surgical waitlists, which have been globally exacerbated due to the COVID-19 pandemic. In this paper, we detail the process used to develop an ethics framework to support prioritization (...) for elective surgery at The Hospital for Sick Children, Toronto, a tertiary pediatric hospital. Our goal was to provide guidance for the more value-laden aspects of prioritization, particularly when clinical urgency alone is insufficient to dictate priority. With this goal in mind, we worked to capture familial, relational, and equity considerations. As part of our institution’s concerted efforts to ethically and effectively address our surgical backlog, an ethics working group was formed comprising clinicians from surgery, anesthesiology, intensive care, a hospital bioethicist, a parent advisor, and an academic bioethics researcher. A reflective equilibrium process was used to develop an ethics framework. To this end, the same methodology was used to create a support for patient prioritization that identifies clinically and morally relevant factors for prioritization among medically similar surgical cases, with a substantive goal being to identify and redress health inequities in surgical prioritization, inasmuch as this is possible. While further steps are needed to validate several aspects of the framework, our research suggests that an ethics framework grounded in the practical realities of hospital operations provides consistency, transparency, and needed support for decisions that are often left to individual clinicians, as well as an opportunity to reflect upon the presence of health inequities in all domains of healthcare delivery. (shrink)

Equity is a foundational concept for the new World Health Organization (WHO) Pandemic Treaty. WHO Member States are currently negotiating to turn this undefined concept into tangible outcomes by borrowing a policy mechanism from international environmental law: “access and benefit-sharing” (ABS).

Organs for transplantation are a scarce resource. Markedly, the transplant community’s primary challenge is the stark disparity between the number of patients awaiting deceased donor organ transplants and the rate at which organs become available. However, the allocation of a limited number of organs poses another constant challenge: maintaining an equilibrium between renal transplant utility and equity, that is, striking a balance between the utilitarian argument of medical efficiency and the principle of equity. In this comprehensive overview, the authors delve (...) into the challenge of maintaining an acceptable balance between equity and efficiency and elaborate on some of the factors that might inform a decisionmaker’s evaluation of the extent to which a given allocation scheme is efficient or equitable. (shrink)

The everyday harms of structural racism and discrimination, perpetuated through institutions, laws, policies, and practices, constitute social determinants of health, but measures that account for their debilitating effects are largely missing in genetic studies of complex diseases. Drawing on insights from the social sciences and public health, we propose critical methodologies for incorporating tools that measure structural racism and discrimination within genetic analyses. We illustrate how including these measures may strengthen the accuracy and utility of findings for diverse communities, clarify (...) elusive relationships between genetics and environment in a racialized society, and support greater equity within genomics and precision health research. This approach may also support efforts to build and sustain vital partnerships with communities and with other fields of research inquiry, centering community expertise and lived experiences and drawing on valuable knowledge from practitioners in the social sciences and public health to innovate biomedical and genomic study designs aimed at community health priorities. (shrink)

The Justice, Equity, Diversity, Inclusion, and Belonging (JEDIB) committee formed in 2022 in order to support diversity and inclusion in the Health Humanities Consortium and to advance best practices for equity and inclusion in the field of medical and health humanities. This Forum Essay describes our first year of work, including participant-led commitment statement crafting and strategic planning. Health humanities-specific JEDIB work is described in detail in essays about disability justice; gender, sex, sexuality, and reproductive justice; and Indigeneity from a (...) decolonial standpoint. The authors offer transferable techniques for other organizations and institutions with particular attention to heath care and health professions education. Another essay analyzes US institutional and demographic data to show that as an academic program, health humanities gives robust indicators of contributing significantly to student diversity and inclusive success in higher education and medical education. The Forum closes with a reflection on joining the work of equity and inclusion and what new priorities and awareness can emerge to inform health equity scholarship and epistemic justice. (shrink)

In this article, we develop a non-rights-based argument based on beneficence (i.e., the welfare of individuals and communities) and justice as the disposition to act justly to promote equity in health care resource allocation. To this end, we structured our analysis according to the following main sections. The first section examines the work of Amartya Sen and his equality of capabilities approach and outlines a framework of health care as a fundamental human need. In the subsequent section, we provide a (...) definition of health equity based on the moral imperative to guarantee that every individual ought to have the freedom to pursue health goals and well-being. In the later part of the article, we outline a non-right approach to health care based on three pillars: (1) human flourishing, (2) justice as a disposition not a process, and (3) solidarity. (shrink)

The dominance of agency theory can reduce our collective scope to analyse private equity in all its diversity and depth. We contribute to theorisation of private equity by developing a contrasting perspective that draws on a rich tradition of virtue ethics. In doing so, we juxtapose 'private equity' with 'public good' to develop points of rhetorical and analytical contrast. We develop a typology differentiating various forms of private equity, and focus on the 'take private' form. These takeovers are where private (...) equity funds are used to buy all a firm's publicly listed shares. Take private deals reduce reporting requirements and lessen the amount of public scrutiny a firm comes under. They allow greater control of a firm's assets and resources but also have effects in terms of the wider social fabric. The 'public good' and virtue ethics offer an alternative basis for theorisation of these deals. This provides a needed contrast to accounts of private equity based on agency theory. (shrink)

We report the results of a vignette experiment with a quota sample of the German population in which we analyze the interplay between need, equity, and accountability in third-party distributive decisions. We asked subjects to divide firewood between two hypothetical persons who either differ in their need for heat or in their productivity in terms of their ability to chop wood. The experiment systematically varies the persons’ accountability for their neediness as well as for their productivity. We find that subjects (...) distribute significantly fewer logs of wood to persons who are held accountable for their disadvantage. Independently of being held accountable or not, the needier person is always compensated with a share of logs that exceeds her contribution, while the person who contributes less is punished in terms of receiving a share of logs smaller than her need share. Moreover, there is a domain effect in terms of subjects being more sensitive to lower contributions than to greater need. (shrink)

Following the recommendations of the US National Academy of Sciences and the mandates of the 1987 Nuclear Waste Policy Amendments Act, the US Department of Energy has proposed Yucca Mountain, Nevada as the site of the world's first permanent repository for high-level nuclear waste. The main justification for permanent disposal (as opposed to above-ground storage) is that it guarantees safety by means of waste isolation. This essay argues, however, that considerations of equity (safer for whom?) undercut the safety rationale. The (...) article surveys some prima facie arguments for equity in the distribution of radwaste risks and then evaluates four objections that are based, respectively, on practicality, compensation for risks, scepticism about duties to future generations, and the uranium criterion. The conclusion is that, at least under existing regulations and policies, permanent waste disposal is highly questionable, in part, because it fails to distribute risk equitably or to compensate, in full, for this inequity. (shrink)

Surgery is an increasingly common and expensive mode of medical intervention. The ethical dimensions of the surgeon-patient relationship, including respect for personal autonomy and informed consent, are much discussed; but broader equity issues have not received the same attention. This paper extends the understanding of surgical ethics by considering the nature of evidence in surgery and its relationship to a just provision of healthcare for individuals and their populations.

The fusion of law and equity in common law systems was a crucial moment in the development of the modern law. In this volume leading scholars assess the significance of the fusion of law and equity from comparative, doctrinal, historical and theoretical perspectives.

_Advancing Equity and Achievement in America’s Diverse Schools _illustrates how educators, students, families and community partners can work in strategic ways to build on social, cultural, and ethnic diversity to advance educational equity and achievement. By drawing on the latest data on demographic change, constructions of culture and cultural difference, and the politics of school reform in urban, rural, and suburban school communities, this volume looks toward solutions and strategies for meaningful educational improvement. Contributors consider both the diversity of youth (...) and families served in public schools, and the culture of U.S. schooling, highlighting the influence of policy and reform agendas; students’ identities and agency; experiences and approaches of diverse educators; and the workings of effective school partnerships. Chapters also focus on those often overlooked in educational scholarship such as Native Americans, students experiencing poverty and/or homelessness, Muslim students, students with special needs, and students and educators who are lesbian, gay, bisexual, transgender, intersex, or queer. In all, this edited collection stresses the need for high quality education that is inclusive, culturally responsive and unifying so all students can experience academic success. This book is a meaningful resource for educators, policymakers, and community-based leaders interested in doing such transformative work. (shrink)

Equity in health and health care is animportant issue. It has been proposed that thepursuit of equity in health care is beinghampered by the dominance of individualism inhealth care practices. This paper explores theway in which communitarian ideals and practicesmight lend themselves to the pursuit of equity.Communitarians acknowledge, respect and fosterthe bonds that unite and identify communities.The paper argues that, to achieve equity inhealth care, these bonds need to be recognisedand harnessed rather than ignored. The notionof individual autonomy in (...) the context of thecommunity is examined. Alternative concepts ofautonomy – social autonomy and communityautonomy – are seen to be more respectful andnurturing of both the individual and thecommunity. Moreover, these concepts appeardesirable for the pursuit of health care equitygoals. The paper concludes with some thoughtsabout how equity in Australia's health caresystem can reasonably progress within acommunitarian vision. Disadvantaged communitiesare discussed throughout, in particular,Australian Aboriginal communities. (shrink)

In this book, as in various earlier studies of the author, she uses the three-dimensional method, which facilitates a stratified focus in agreement with three ...

This paper considers the ethical risks and opportunities presented by generalist medical artificial intelligence (GMAI), a kind of dynamic, multimodal AI proposed by Moor et al. (2023) for use in health care. The research objective is to apply widely accepted principles of biomedical ethics to analyze the possible consequences of GMAI, while emphasizing the distinctions between GMAI and current-generation, task-specific medical AI. The principles of autonomy and health equity in particular provide useful guidance for the ethical risks and opportunities of (...) novel AI systems in health care. The ethics of two applications of GMAI are examined: enabling decision aids that inform and educate patients about certain treatments and conditions, and expanding AI-driven diagnosis and treatment recommendation. Emphasis is placed on the potential of GMAI to improve shared decision-making between patients and providers, which supports patient autonomy. Another focus is on health equity, or the reduction of health and access disparities facing underserved populations. Although GMAI presents opportunities to improve patient autonomy, health literacy, and health equity, premature or inadequately regulated adoption of GMAI has the potential to compromise both health equity and patient autonomy. On the other hand, there are significant risks to health equity and autonomy that may arise from not adopting GMAI that has been thoroughly validated and tested. A careful balancing of these risks and benefits will be required to secure the best ethical outcome, if GMAI is ever employed at scale. (shrink)

Local food systems can have economic and social benefits by providing income for producers and improving community connections. Ongoing global climate change and the acute COVID-19 pandemic crisis have shown the importance of building equity and resilience in local food systems. We interviewed ten stakeholders from organizations and institutions in a U.S. midwestern city exploring views on past, current, and future conditions to address the following two objectives: 1) Assess how local food system equity and resilience were impacted by the (...) COVID-19 pandemic, and 2) Examine how policy and behavior changes could support greater equity and resilience within urban local food systems. We used the Community Capitals Framework to organize interviewees’ responses for qualitative analyses of equity and resilience. Four types of community capital were emphasized by stakeholders: cultural and social, natural, and political capital. Participants stated that the local food system in this city is small; more weaknesses in food access, land access, and governance were described than were strengths in both pre- and post-pandemic conditions. Stakeholder responses also reflected lack of equity and resilience in the local food system, which was most pronounced for cultural and social, natural and political capitals. However, local producers’ resilience during the pandemic, which we categorized as human capital, was a notable strength. An improved future food system could incorporate changes in infrastructure (e.g., food processing), markets (e.g., values-based markets) and cultural values (e.g., valuing local food through connections between local producers and consumers). These insights could inform policy and enhance community initiatives and behavior changes to build more equitable and resilient local food systems in urban areas throughout the U.S. Midwest. (shrink)

This paper describes the unique values of, challenges within, and opportunities presented by embedded ELSI ethnography. Drawing from our six‐year embedded ELSI study of the WISDOM (Women Informed to Screen Depending on Measures of Risk) trial, we present three examples of the variable ways we engaged with the WISDOM trial's scientific team. WISDOM is a preference‐sensitive, pragmatic, randomized controlled trial of risk‐based breast cancer screening informed by genomics. Our embedded ELSI approach included multiple modes of engagement: (a) Trial investigators sought (...) bioethics expertise; for example, we were asked to consult on traditional bioethics topics such as consent as well as more complex questions about whether to implement a specific risk‐assessment approach on only one race‐defined group of trial participants. (b) As the ELSI investigators, we identified ethical concerns in issues that surfaced via ethnography and considered them in the Bioethics Working Group; for example, there were concerns about the implementation processes that the WISDOM team viewed as logistical challenges. (c) Our presence in WISDOM working group conversations and our expertise on classic social science topics, including race and gender, offered opportunities to engage on the spot with topics such as how to include transgender participants in a trial initially focused on “women's health”; through such engagement, the value of social science became clear to the trial investigators. The paper elaborates on the dynamic relationship between our ethnographic observations, the Bioethics Working Group discussions, and the contributions of each to our real‐time ELSI interventions in these examples. The methods and experiences we describe here suggest modes of engagement that, in combination, have the potential to expand the role of ELSI to offer real‐time intervention on issues related to equity, inclusion, and justice in genetic and genomic research. (shrink)

There are growing bodies of evidence demonstrating the benefits of equity, diversity, and inclusion on academic and organizational excellence. In turn, some editors have stated their desire to improve the EDI of their journals and of the wider scientific community. The Royal Society of Chemistry established a minimum set of requirements aimed at improving EDI in scholarly publishing. Additionally, several resources were reported to have the potential to improve EDI, but their effectiveness and feasibility are yet to be determined. In (...) this commentary we suggest six approaches, based on the Royal Society of Chemistry set of requirements, that journals could implement to improve EDI. They are: adopt a journal EDI statement with clear, actionable steps to achieve it; promote the use of inclusive and bias-free language; appoint a journal’s EDI director or lead; establish a EDI mentoring approach; monitor adherence to EDI principles; and publish reports on EDI actions and achievements. We also provide examples of journals that have implemented some of these strategies, and discuss the roles of peer reviewers, authors, researchers, academic institutes, and funders in improving EDI. (shrink)

How to improve the development quality of state-owned enterprises is of great significance to the economic and social development in the transition period. And promoting the reform of mixed ownership is an important path for state-owned enterprises to achieve high-quality development. Based on the micro-data of China’s A-share listed state-owned companies, the paper explores the impact of mixed ownership reform on the high-quality development of state-owned enterprises. It clarifies the importance and moderation of equity reform and the heterogeneity of impact (...) effects from the theoretical mechanism analysis and empirical test. It also analyzes the reasons of inverted U-shape from the perspective of the transmission mechanism of the internal competition atmosphere and non-state-owned capital speculation motivation. It is found that the relationship between equity reform and state-owned enterprises’ high-quality development is inverted U-shaped with multi-dimensional heterogeneity. From the analysis of conduction mechanism, on the one hand, the equity reform can enhance the internal competitive atmosphere, stimulate the vitality of enterprises and improve the development quality for state-owned enterprises. On the other hand, it enhances the speculation motivation of enterprises and slows down the high-quality development process. (shrink)

Inequities in health and health care are one of the greatest challenges facing the international community today. This problem raises serious questions for health care planners, politicians and ethicists alike. The major world religions can play an important role in this discussion. Therefore, interreligious dialogue on this topic between ethicists and health care professionals is of increasing relevance and urgency. This article gives an overview on the positions of Islam and Christianity on equity and the distribution of resources in health (...) care. It has been written in close collaboration and constant dialogue between the two authors coming from the two religions. Although there is no specific concept for the modern term equity in either of the two religions, several areas of agreement have been identified: All human beings share the same values and status, which constitutes the basis for an equitable distribution of rights and benefits. Special provisions need to be made for the most needy and disadvantaged. The obligation to provide equitable health services extends beyond national and religious boundaries. Several areas require intensified research and further dialogue: the relationship between the individual and the community interms of rights and responsibilities, how to operationalize the moral duty to decrease global inequalities in health, and the understanding and interpretation of human rights in regard to social services. (shrink)

AgeTech involves the use of emerging technologies to support the health, well-being and independent living of older adults. In this paper we focus on how AgeTech based on artificial intelligence (AI) may better support older adults to remain in their own living environment for longer, provide social connectedness, support wellbeing and mental health, and enable social participation. In order to assess and better understand the positive as well as negative outcomes of AI-based AgeTech, a critical analysis of ethical design, digital (...) equity, and policy pathways is required. A crucial question is how AI-based AgeTech may drive practical, equitable, and inclusive multilevel solutions to support healthy, active ageing. In our paper, we aim to show that a focus on equity is key for AI-based AgeTech if it is to realize its full potential. We propose that equity should not just be an extra benefit or minimum requirement, but the explicit aim of designing AI-based health tech. This means that social determinants that affect the use of or access to these technologies have to be addressed. We will explore how complexity management as a crucial element of AI-based AgeTech may potentially create and exacerbate social inequities by marginalising or ignoring social determinants. We identify bias, standardization, and access as main ethical issues in this context and subsequently, make recommendations as to how inequities that stem form AI-based AgeTech can be addressed. (shrink)

This chapter contains sections titled: Distributive Justice Nanotechnology and the Developing World Water Purification Solar Energy Medicine Nanotechnology, the Developing World, and Distributive Justice.

The tension between equity and excellence is fundamental in science policy. This tension might appear to be resolved through the use of merit-based evaluation as a criterion for research funding. This is not the case. Merit-based decision making alone is insufficient because of inequality aversion, a fundamental tendency of people to avoid extremely unequal distributions. The distribution of performance in science is extremely unequal, and no decision maker with the power to establish a distribution of public money would dare to (...) match the level of inequality in research performance. We argue that decision makers who increase concentration of resources because they accept that research resources should be distributed according to merit probably implement less inequality than would be justified by differences in research performance. Here we show that the consequences are likely to be suppression of incentives for the very best scientists. The consequences for the performance of a national research system may be substantial. Decision makers are unaware of the issue, as they operate with distributional assumptions of normality that guide our everyday intuitions. (shrink)

Whereas using artificial intelligence (AI) to predict natural hazards is promising, applying a predictive policing algorithm (PPA) to predict human threats to others continues to be debated. Whereas PPAs were reported to be initially successful in Germany and Japan, the killing of Black Americans by police in the US has sparked a call to dismantle AI in law enforcement. However, although PPAs may statistically associate suspects with economically disadvantaged classes and ethnic minorities, the targeted groups they aim to protect are (...) often vulnerable populations as well (e.g., victims of human trafficking, kidnapping, domestic violence, or drug abuse). Thus, determining how to enhance the benefits of PPA while reducing bias through better management is important. In this paper, we propose a policy schema to address this issue. First, after clarifying relevant concepts, we examine major criticisms of PPAs and argue that some of them should be addressed. If banning AI or making it taboo is an unrealistic solution, we must learn from our errors to improve AI. We next identify additional challenges of PPAs and offer recommendations from a policy viewpoint. We conclude that the employment of PPAs should be merged into broader governance of the social safety net and audited publicly by parliament and civic society so that the unjust social structure that breeds bias can be revised. (shrink)

BackgroundUnder COVID-19 pandemic, many organizations developed guidelines to deal with the ethical aspects of resources allocation. This study describes the results of an argument-based review of ethical guidelines developed at the European level. It aims to increase knowledge and awareness about the moral relevance of the outbreak, especially as regards the balance of equity and dignity in clinical practice and patient’s care. MethodAccording to the argument-based review framework, we started our research from the following two questions: what are the ethical (...) principles adopted by the ethical guidelines produced at the beginning of the COVID-19 outbreak related to resource allocation? And what are the practical consequences in terms of 'priority' of access, access criteria, management of the decision-making process and patient care?ResultsTwenty-two ethical guidelines met our inclusion criteria and the results of our analysis are organized into 4 ethical concepts and related arguments: the equity principle and emerging ethical theories; triage criteria; respecting patient’s dignity, and decision making and quality of care.ConclusionFurther studies can investigate the practical consequences of the application of the guidelines described, in terms of quality of care and health care professionals’ moral distress. (shrink)

Intergenerational Equity: Environmental and Cultural Concerns tackles intergenerational equity from various perspectives with a view to understanding what is fair and/or just within and among generations.

Aristotelian equity has often been relegated to scholarly discussions of retributive justice. Recently, however, political theorists have recast equity as the virtue of a sympathetic democratic citizen. I build on this literature by offering a more precise explanation of equity’s internal structure and political significance. In particular, I reveal equity’s deliberative dimension. For Aristotle, equitable citizens, statesmen, and legislators correct or go beyond the law, as appropriate, not only when they render retrospective judgments about matters of punishment or distribution, but (...) also when they deliberate about future-oriented questions of legislation or political action. In addition, I show, more concretely, the role of equity in democratic citizenship. Drawing upon the Aristotelian Constitution of the Athenians, I argue that the Athenian demos exemplified equity when it brought about the reconciliation and the amnesty of 403 BC. Attention to this episode clarifies the conceptual linkages between equity, deliberation, sympathy, and democracy. (shrink)

No progress has been made over the past decade in improving equity of access to higher education for young people from low socio-economic backgrounds. New evidence indicates that both family income and cultural factors explain this situation. The cultural factor is particularly strong for boys from blue collar backgrounds. Current Government equity policy ignores these findings.

The scientific evidence is reviewed for claims that a global transition to “green” fuels and technologies by global treaty obligations is needed. The likely equity implications of these efforts are discussed, and it is argued that this evidence remains shaky. Measures based on this contested knowledge cannot be defended on grounds of either environmental effectiveness or equity. Rather, they rely on commercial expectations and promises of secondary benefits usually requiring state intervention. Poorer groups and nations are unlikely to benefit from (...) proposals to redirect energy policies to “combat global warming.” The advocated decarbonization of global energy supplies is more likely to increase political instability than prevent climatic change. To support this argument, three areas of knowledge are consulted: controversies about the causation and likely impacts of global warming, advocated technical and fiscal solutions, and the interests of technical, commercial, and political elites. (shrink)

Donation after circulatory determination of death (DCDD) is an accepted practice in the United States, but heart procurement under these circumstances has been debated. Although the practice is experiencing a resurgence due to the recently completed trials using ex vivo perfusion systems, interest in thoracoabdominal normothermic regional perfusion (TA-NRP), wherein the organs are reanimated in situ prior to procurement, has raised many ethical questions. We outline practical, ethical, and equity considerations to ensure transplant programs make well-informed decisions about TA-NRP. We (...) present a multidisciplinary analysis of the relevant ethical issues arising from DCDD-NRP heart procurement, including application of the Dead Donor Rule and the Uniform Definition of Death Act, and provide recommendations to facilitate ethical analysis and input from all interested parties. We also recommend informed consent, as distinct from typical “authorization,” for cadaveric organ donation using TA-NRP. (shrink)