Veatch R M
The Kennedy Institute of Ethics, Georgetown University, Washington, DC 20057, USA.
J Med Philos. 1998 Aug;23(5):456-76. doi: 10.1076/jmep.23.5.456.2570.
It is common to interpret Rawls's maximin theory of justice as egalitarian. Compared to utilitarian theories, this may be true. However, in special cases practices that distribute resources so as to benefit the worst off actually increase the inequality between the worst off and some who are better off. In these cases the Rawlsian maximin parts company with what is here called true egalitarianism. A policy question requiring a distinction between maximin and "true egalitarian" allocations has arisen in the arena of organ transplantation. This case is examined here as a venue for differentiating maximin and true egalitarian theories. Directed donation is the name given to donations of organs restricted to a particular social group. For example, the family of a member of the Ku Klux Klan donated his organs on the provision that they go only to members of the Caucasian race. While such donations appear to be discriminatory, if certain plausible assumptions are made, they satisfy the maximin criterion. They selectively advantage the recipient of the organs without harming anyone (assuming the organs would otherwise go unused). Moreover, everyone who is lower on the waiting list (who, thereby, could be considered worse off) is advantaged by moving up on the waiting list. This paper examines how maximin and more truly egalitarian theories handle this case arguing that, to the extent that directed donation is unethical, the best account of that conclusion is that an egalitarian principle of justice is to be preferred to the maximin.
将罗尔斯的正义最大化最小值理论解释为平等主义是很常见的。与功利主义理论相比，这可能是正确的。然而，在某些特殊情况下，以造福最贫困者为目的分配资源的做法实际上加剧了最贫困者与一些较富裕者之间的不平等。在这些情况下，罗尔斯的最大化最小值理论与这里所说的真正平等主义分道扬镳。在器官移植领域出现了一个需要区分最大化最小值和“真正平等主义”分配的政策问题。本文将此案例作为区分最大化最小值理论和真正平等主义理论的一个场所进行研究。定向捐赠是指将器官捐赠限制在特定社会群体的行为。例如，三K党成员的家人捐赠他的器官时规定这些器官只能给白人种族的成员。虽然这种捐赠似乎具有歧视性，但如果做出某些合理假设，它们符合最大化最小值标准。它们有选择地使器官接受者受益而不伤害任何人（假设这些器官否则将被闲置）。此外，等待名单上排名较低的每个人（因此可以被认为处境更糟）都因在等待名单上的排名上升而受益。本文研究了最大化最小值理论和更真正的平等主义理论如何处理这个案例，认为就定向捐赠不道德而言，对这一结论的最佳解释是正义的平等主义原则优于最大化最小值原则。
