POLSC401: Ethics and Public Policy

5a. Identify ethical dilemmas that policymakers may face in dealing with issues of caring for the poor, sick, elderly, and infirm

• How do lawmakers and officials justify taking from some in the form of taxes to give to those who need assistance?
• In what ways are programs that care for the poor, sick, elderly and infirm, examples of distributive justice.
• What are the ethical and legal limitations on these programs?
• Explain the difference between entitlement programs and discretionary spending programs in the United States.
• Describe some groups in America that are most vulnerable and in need of social programs. 
• What are the main arguments for and against treating healthcare-as-a-right?

Poverty and sickness can impact anyone at any time, but they are chronically persistent among the elderly and other vulnerable populations. Do governments have a social responsibility to help individuals who are poor, suffer from medical conditions, or failed to save for retirement? This unit traces some arguments from the left and the right about the causes of and solutions to these problems.

The reading Historical Background and Development of Social Security explains that President Franklin D. Roosevelt and Congress passed the Social Security Act in 1935 to help Americans meet the economic uncertainties the elderly face "brought on by unemployment, illness, disability, death and old age." "In addition to the program we now think of as Social Security, it included unemployment insurance, old-age assistance, aid to dependent children and grants to the states to provide various forms of medical care."

We call Social Security, Medicare, and Medicaid, most Veterans' Administration programs, federal employee and military retirement plans, unemployment compensation, food stamps, and agricultural price support entitlement programs because Congress has guaranteed or mandated this spending to benefit particular groups and segments of the population. Discretionary spending programs refers to programs Congress approves every year through its appropriation process.

Opponents of these programs often argue that social security and other social government programs are too large, too expensive, and will soon be bankrupt anyway, but they rarely address the ethical basis for why society should, or should not, support these programs. On the other hand, supporters tend to argue the government has an ethical responsibility for supporting the poor, sick, elderly and infirm, but they frequently ignore the financial implications of providing these services.

In the video Social Security Myth Milton Friedman says government programs have become too large and should not be responsible for providing social services to Americans, who never demanded these programs in the first place. He argues that special propaganda groups from Madison Avenue who wanted to see an expansion in the role of government convinced Americans to demand these services in the 1930's. The video Social Security Empty? from the PBS Nightly Business Report says this government program will be bankrupt soon anyway.

Some policymakers believe government involvement is essential to addressing these problems, while others believe the private sector should provide the solutions.

Do governments have a moral duty to help the poor, sick, elderly, and infirm as a deontologist would likely argue? Do members of groups who protest the size of government speak from a different ethical framework than those who support these programs? Do you think supporters of social security and healthcare could better sway opponents if they can convince opponents they can run these programs more efficiently and effectively? In what ways are economic efficiency and costs to the taxpayer relevant to ethical policy making?

Review distributive justice in Unit 1 and in the reading Distributive Justice by Julian Lamont and Christi Favor.

These websites features opinions about whether government should provide social security to retirees Should Social Security Be Privatized? and Should All Americans Have the Right (be Entitled) to Health Care?.

Marian Wright Edelman argues that we should invest in our children for ethical, religious and practical reasons in A Course for the Next Generation.

5b. Analyze how ethical dilemmas involving issues of caring for the poor, sick, elderly, and infirm may be resolved under various ethical decision-making frameworks

• Describe a moral dilemma related to physician-assisted suicide?
• Describe a moral dilemma related to involuntary commitment?
• Describe a moral dilemma related to homelessness?
• What would someone who values distributive justice think about America's healthcare system?

Governments continue to struggle with many moral or ethical dilemmas, such as physician-assisted suicide, involuntary commitment, and homelessness.

Review these questions from the framework of someone who supports 1. virtue ethics (Aristotle), 2. deontology (Kant), 3. utilitarianism (Bentham and Mill), 4. the common good and 5. a fairness approach (Rawls).

For example, in the case of physician-assisted suicide, should governments have the right to prevent a mentally-competent adult, who is suffering from a terminal illness, from being able to follow through on a decision to end their own life, safely and painlessly in the comfort of their own home? These patients argue that their action will not infringe on the rights of others, and that they should have the right to make their own end-of-life decisions without government interference. Does the government have a moral duty to protect these individuals in any way? Do they require protection?

Review these articles which discuss different moral perspectives in Should Euthanasia or Physician-Assisted Suicide Be Legal?

In the 1960's many states began deinstitutionalizing their mental hospitals for economic and civil rights reasons. Many of these institutions were in such poor condition that they discharged their patients and closed their facilities, which meant many people with mental illnesses no longer received regular psychiatric treatment and became homeless. Many were incarcerated for committing petty crimes.

Should governments have the right to detain an adult who does not wish to stay in a hospital, even when they may be mentally incompetent? Should hospitals have the right to force individuals to take medicine that may help them? What if the patient is causing harm to themselves, but not to others? What if the patient may hurt others, but has not committed a crime?

The article Involuntary Commitment by Alicia Curtis examines whether governments should detain mentally ill patients without their consent.

Curtis describes the many U.S. veterans who are homeless and suffer from mental health issues. Does the government have a moral duty to house and treat these individuals who served their country? What if they have incurred injuries that prevent them from working in another capacity? Does the government have an equal duty to help homeless individuals who did not serve in the military?

Background and Statistics from the National Coalition for Homeless Veterans.

Unit 5 Vocabulary

• Discretionary spending
• Distributive justice
• Entitlement program
• Healthcare-as-a-right
• Homelessness
• Involuntary commitment
• Physician-assisted suicide
• Private sector
• Privatization of social security
• Social security
• Stratification
• Subsidies
• Veteran