Why our plan achieves fairness

One of the government’s roles is to distribute the welfare fairly. It is the government’s burden to help every citizen who is in a disadvantageous position. Thus it would be only fair if people who get sick could get the treatment at hospital. On the other hand we believe that if there is no possibility to help every person in disadvantage, some requirements should be put. We believe there is a crucial difference between a person who is sick with flu getting his treatment in hospital and an alcoholic getting his kidney transplant. And we believe that people should be judged on their merits when the circumstances require so. The argument is divided in two parts. First we prove why judging upon merit is fair in some cases, secondly we take a look on the nature of alcoholism and what is the proportion of individual’s fault in becoming one. (1) Judgment upon merit Justice is an ambiguous concept and debates about what is “fair” seem to never end. One of the definitions one could give to fairness is that all people should be given an equal right. However, in some cases there is no possibility to do so. Imagine a situation when we have one liver and two patients applying for a transplant. One of them is 50 years old and has been a heavy drinker for 20 years, which caused his liver disease, the other one is a young healthy man who has been doing sports all his lifetime and is concerned about his health condition, but got the liver disease because of bad genes. If we think in terms of fairness in this situation we have to provide them with an equal right for this liver. We cannot cut it in halves, thus the best “fair” decision we could make is to provide them with equal chances of getting the liver, i.e. to flip a coin. Although this is just, it is arguable whether the best outcome has been achieved. First we see that a young healthy man has more chances to survive after the operation, which is brought in details in our first argument. Secondly, we believe that it was mostly the fault of alcoholic himself in getting the liver disease, thus it could have been prevented if he had been more concerned about his health. This leads us to the concept of judgment upon merit, thus taking into consideration the fault of a person in getting to the disadvantageous situation he is now. There is a fundamental difference between getting flu and being treated from that and getting a liver disease because of alcoholism. In the case, a patient’s fault is negligible. For most it is his decision not to wear a scarf, otherwise it is mostly bad luck. In the second case it is mostly a decision of an individual to drink heavily and thus getting the liver disease. We believe that since the resources for treatment are scarce, it is fair to treat in the first place those who got the disease because of bad luck or bad genes, denying them who were responsible themselves in getting the disease. People know that if they drink they get the liver disease, thus they are aware of these consequences when they make the decision to drink. In this case the disease is preventable, while in the case with bad genes it is unpreventable. If a person likes fast driving he is taking the responsibility for the possible consequences of his actions. Insurance companies deny fixing a car after a driving accident caused by the driver. Government in some cases could deny in providing the treatment for free after an accident which was caused by speeding. This is done because these people break the duty of care, break their responsibilities and take actions being aware of all the harmful consequences. Moreover, if the government gives liver transplants to alcoholics it takes away it from other people. The government could try to distribute welfare in such a way that all citizens achieve the same satisfaction, thus all in need of treatment get the treatment. But it will sufficiently harm other people, since the government will end up in wasting scarce resources on people who don’t maximize their utility from these resources, people who waste their liver on heavy drinking. But there is also another approach. The government tries to equalize endowments given to people at the initial stage, and then it is up to individual’s decision how to maximize utility from that. In such a case an alcoholic initially has a healthy liver and could prevent his disease, but a person with bad genes initially has an unhealthy liver and his disease is unpreventable, thus their endowments are not equal. It is the duty of government to equalize their states by giving a liver transplant to the person with bad genes, thus giving him a priority over the alcoholic. One could say that being first in the waiting list is the fair criteria. However, we argue about whether to put heavy drinkers on this list at all. By putting them on the list, resources are taken away from other patients, thus the distribution occurs at the moment when it is decided whether to put a patient on the list. In the United States there are about 17,000 people waiting on the list, and the median time for waiting in 2006 was 321 days.[[http://www.livermd.org/waiting.html]] This illustrates the scarcity of the resource and makes the question of who should be given the liver inevitable. (2) How the choice of becoming an alcoholic is made? Some might argue that if we judge upon merit, we consider that all alcoholics have made the decision to become one only by themselves, thus no external factor was involved. Now we will try to get to the nature of alcoholism and identify any mechanisms how people become alcoholics. First people are most likely to drink for fun. It is a clear situation of free choice and no external factors are involved. Then there are people who drink to support community around them: friends, relatives, colleagues etc. While in this case there is an external factor involved to some degree, we believe it is still not worth arguing that the decision is mostly a matter of the individual. The next group of reasons for drinking we see is external community (bad neighborhood, alcoholic families etc.) and moral trauma or depression. In the first case while the external factors could put a significant pressure on the individual, so he starts drinking, it is still his free choice. To make an analogy: there is no such justification for committing a crime as pressure from external community. Also bad neighborhood of a convicted person is not a justification and by no means could reduce the punishment, since committing the crime was still a free choice decision. We believe that the same mechanism is applicable here. In the second case, people could seek for a fast solution in alcohol after they were exposed to a serious moral trauma. The proportion of individual’s decision is still pretty high, because, first of all, drinking is not the only solution and there are other means of dealing with depression; secondly, after the time has passed and the trauma has become less harmful, a person could abandon drinking. We consider a significant influence of addiction to alcohol. To deal with it there are certain programs, such as Anonymous Alcoholics, which have proven to be pretty successful ones. So, even if a person has become addicted to alcohol, he could still cure from this addiction and prevent the liver disease from happening. To sum up, we believe that when resources are scarce, it is acceptable to distribute them fairly upon merit, which allows punishing alcoholics for not taking care of their liver and giving priority to those who have the disease because of external factors. We see the decision to drink as a free decision made by an individual after a certain cost-benefit analysis, thus he is the one to take responsibility of all the consequences. Even if a person has become alcoholic due to external factors, he could still get rid of his addiction, thus preventing the liver disease. For all these reasons, we are proud of proposing the plan.