Monday, January 07, 2008

Who are the Least Advantaged?

Theories of justice strive to help elucidate what we owe to each other. What rights and opportunities (e.g. for education, healthcare, etc.) should we provide to our citizenry and why? Over the past 4 decades or so there has emerged a number of competing accounts of distributive justice that champion a range of diverse principles to govern the distribution of different goods and opportunities. A sample of the main contenders often discussed include a principle of liberty, equality, desert, democracy, sufficiency, etc.

Some argue that justice requires wealth and income to be distributed in accordance with liberty (as Robert Nozick famously argued: “From each as they choose, to each as they are chosen” ); others defend some version of equality (e.g. equality of resources, complex equality, equality of opportunity for welfare) or sufficiency.

Today was the first class for my “Genetics and Justice” seminar. In the beginning of the class I had them answer a range of questions concerning their views about justice. Here is the very first question I had them consider:

It is often claimed that a fair society should be judged by how well it treats its least advantaged members. How would you describe who the “least advantaged” members of Canadian society are?

Most students in the class identified the poor as the least advantaged. Some noted that cultural inequalities were pressing concerns and thus aboriginals formed part of the category of the least advantaged. One student mentioned people with severe cognitive impairments.

I suspect the responses from my students would probably cohere with the attitudes of most people in Canadian society. They certainly reinforce the assumptions of contemporary philosophers working in the area of distributive justice. John Rawls, who is arguably one of the most (if not the most) important political philosophers of the twentieth century, argued that justice requires (amongst other things) that we maximize the life prospects of the least advantaged. And he offered two interpretations of this group:

(1) The least advantaged are all those with approximately the income and wealth of the unskilled worker, or less.


(2) All persons with less than half of the median income and wealth.

Rawls’s theory of “justice as fairness” focuses exclusively (though in some footnotes in Political Liberalism he tries to quality this to some degree) on the distribution of what he calls the social primary goods.

These goods are: Rights and liberties, powers and opportunities, income and wealth and self-respect.

The distribution of the social primary goods, argues Rawls, are influenced by what he calls the “basic structure” of society (e.g. the Constitution, political economy, etc.). But what Rawls ignores are what he calls the “natural primary goods”- health and vigour, intelligence and imagination. These goods are not, Rawls contends, influenced by the basic structure of society. Or at least not to the same extent as the social primary goods are.

To help probe the moral sensibilities of my students, and to help steer them towards adopting a wider lens concerning what constitutes serious disadvantage in our society, I mentioned a few facts concerning the impact the genetic lottery of life has on the victims of genetic disease. How inheriting a particular genetic mutation could drastically influence one’s expected life-time acquisition of both natural and social primary goods.

I showed my class the compassionate and moving video by Ian Brown called “The Boy in the Moon”.

Rapid advances in the field of human genetics means that Rawls’s assumption that the distribution of natural endowments themselves are beyond the reach of the basic structure has to be re-evaluated. This was the subject of a paper I published 6 years ago in Bioethics. The decisions we make concerning the safety standards for gene therapy, how robust genomic intellectual property rights are, and how much to invest in basic biomedical research (among many other things) will have a profound impact on the life prospects of some of our most vulnerable citizens.

And so I believe that the interests of the genetically disadvantaged have not yet been given their due. They have largely remained absent from both theoretical/philosophical debates about justice, and in the more general public discourse concerning pressing societal priorities. If we hope to respond, in a fair and proportionate manner, to genetic disadvantage then educators must begin to take seriously the difficult, interdisciplinary research and dialogue needed to put genetic justice on the moral and political radar. In higher education this will mean transcending some of the traditional intellectual barriers that have been erected in recent decades. But in my experience it is the scholars themselves, not the students, who erect these artificial divides. Once given the opportunity to consider the pressing and important issues raised by the genetic revolution, students are inclined to approach these issues in innovative and interdisciplinary ways. And that makes teaching this course all the more enjoyable for me.

So when it comes to adopting a “big picture perspective” concerning who the least advantaged are, we cannot justify excluding those who fair the worst in terms of natural primary goods. And this thus raises the important issue of genetic justice. And then many fascinating, complex ethical, social and legal issues arise. I couldn’t think of a better topic to spend my career contemplating than these challenges, challenges that we have only begun to comprehend.