Navigating Health Inequalities and Mortality Ethics: Insights from Bioethics Readings


Bioethics is a field that grapples with complex questions surrounding health inequalities and the nature of death, as highlighted in the assigned readings and lectures (7, 8, and 9). Hausman, Marchand et al., Tolstoy, and Kamm provide insights that illuminate the ethical dimensions of health disparities and the philosophical implications of mortality.

Measuring Health Inequalities and Boorse’s Theory: A Bioethical Examination

One of the central challenges in addressing health inequalities lies in accurately measuring the variations in health among individuals (Hausman, pp. 60-3). This intricate issue is illuminated by Christopher Boorse’s biostatistical theory of health, which defines health as the absence of disease and the proper functioning of physiological systems (Hausman, p. 61). Boorse’s theory offers a compelling framework that can aid in overcoming the measurement challenge by providing a standardized and objective criterion for evaluating health.

Boorse’s theory suggests that health can be quantified by assessing an individual’s biological functions and their deviation from normal functioning (Hausman, p. 61). This approach provides a tangible means of measuring health by offering specific criteria for what constitutes a healthy state. By focusing on the objective aspects of health – such as the proper functioning of bodily systems – Boorse’s theory avoids the subjective interpretations that can complicate health assessment. This objectivity is crucial in addressing health inequalities, as it allows for consistent and comparable evaluations across different individuals and populations.

Moreover, Boorse’s theory offers a clear and measurable basis for evaluating health disparities, which is essential in the realm of bioethics. Health disparities are often rooted in physiological differences, making Boorse’s focus on biological functioning particularly relevant (Hausman, p. 61). By examining variations in biological functions, healthcare professionals and policymakers can identify the specific factors contributing to health inequalities. This understanding enables targeted interventions and policies that address the underlying causes of disparities, ultimately promoting a more equitable distribution of health resources.

However, it’s important to acknowledge the limitations of Boorse’s theory in addressing health inequalities comprehensively. While the theory provides a valuable method for measuring health, it largely neglects the broader social determinants that contribute to disparities (Hausman, p. 61). Social factors such as access to healthcare, socioeconomic status, and environmental conditions significantly influence health outcomes. Disregarding these factors could result in an incomplete assessment of health inequalities, potentially perpetuating unjust distributions of health resources.

Incorporating Boorse’s theory into a more comprehensive framework that considers both biological functioning and social determinants could yield a more nuanced understanding of health inequalities. This approach would not only provide a means of quantifying health differences but also shed light on the underlying systemic issues that contribute to disparities. Bioethics, as a discipline concerned with fairness and justice, necessitates the consideration of both biological and social dimensions to address health inequalities more effectively.

In conclusion, Boorse’s biostatistical theory of health presents a valuable tool for objectively measuring health, particularly in the context of health inequalities. By emphasizing biological functioning and setting clear criteria for health assessment, the theory provides a means to quantify disparities and identify potential interventions. However, the theory’s limitations in addressing the social determinants of health should be acknowledged. Integrating Boorse’s framework into a broader bioethical perspective that incorporates both biological and social dimensions can offer a more holistic approach to understanding and addressing health inequalities.

Maximin Theories, Arrow’s Bottomless Pit Objection, and Health Equity

The exploration of maximin theories by Marchand et al., specifically Theory 4, delves into the ethical considerations of health inequalities and resource allocation (Lecture Handout 7). Theory 4 asserts that prioritizing the health of the sickest or worst-off individuals is ethically justifiable. However, this perspective faces a critical challenge known as Arrow’s “bottomless pit objection,” which raises concerns about the sustainability of such an approach.

Arrow’s objection, rooted in the work of economist Kenneth Arrow, questions whether solely focusing on the worst-off individuals might lead to an insatiable demand for resources (Lecture Handout 7). The objection posits that addressing the needs of the most vulnerable might create an ever-expanding demand, thus rendering resource allocation unmanageable. This objection underscores the necessity of striking a balance between immediate health needs and the practicality of resource distribution.

To address Arrow’s bottomless pit objection while upholding the principles of maximin theories, certain amendments must be considered. One such amendment involves incorporating a broader societal perspective that accounts for the larger implications of resource allocation (Lecture Handout 7). While prioritizing the sickest individuals is crucial, it is also essential to recognize the impact of resource allocation on overall societal well-being. This modification aligns with the broader goals of bioethics, which emphasize equitable distribution of resources and promoting the overall welfare of the population.

Another way to bypass Arrow’s objection is to integrate considerations of efficiency and feasibility into maximin theories. This entails setting limits on resource allocation for the worst-off individuals, acknowledging the finite nature of resources (Lecture Handout 7). By implementing a balanced approach that combines maximin principles with practical constraints, policymakers can mitigate the potential for resource depletion while still prioritizing those in urgent need.

Moreover, the amended approach emphasizes the importance of preventive measures and addressing underlying determinants of health inequalities. Instead of solely focusing on immediate health interventions for the worst-off, a comprehensive approach involves investing in preventative strategies that could reduce the occurrence of severe health disparities (Lecture Handout 7). This perspective aligns with the bioethical principle of addressing root causes and promoting long-term well-being.

In conclusion, the exploration of maximin theories and Arrow’s bottomless pit objection brings to light the intricate ethical considerations in addressing health inequalities. While prioritizing the worst-off individuals is ethically compelling, practical challenges such as resource allocation sustainability must be addressed. By amending maximin theories to encompass broader societal implications, efficiency considerations, and preventive measures, bioethics can offer a more balanced approach to health equity. This nuanced perspective recognizes the importance of both immediate interventions and sustainable resource allocation, ultimately striving for a just and equitable distribution of healthcare resources.

Significance of the Syllogism in “The Death of Ivan Ilych”: Ethical Reflections on Mortality

Tolstoy’s novella “The Death of Ivan Ilych” delves into profound philosophical themes, notably the significance of mortality. The syllogism “Caius is a man; all men are mortal; therefore Caius is mortal” encapsulates a fundamental truth about human existence (Tolstoy). This syllogism, often attributed to the ancient Greek philosopher Aristotle, plays a pivotal role in conveying the inevitability of death, a theme that resonates deeply in both Tolstoy’s work and F.M. Kamm’s analysis (Kamm).

The syllogism serves as a concise representation of the universal nature of mortality. By presenting a logical chain of reasoning, it underscores the irrefutable fact that all human beings share the destiny of mortality. This straightforward yet powerful statement confronts readers with the inescapable reality of life’s transience. In the context of “The Death of Ivan Ilych,” this syllogism forms a foundational underpinning of the narrative, serving as a constant reminder of the finite nature of human existence.

Kamm’s essay “Rescuing Ivan Ilych: How We Live and Die” engages with Tolstoy’s work, shedding light on the ethical implications of facing mortality (Kamm). Kamm underscores the ethical significance of acknowledging one’s mortality as a catalyst for ethical decision-making. The syllogism acts as a catalyst for self-reflection, prompting individuals to ponder their actions in the context of their ultimate fate. This introspection encourages individuals to reassess their priorities, leading to a more conscientious and morally responsible way of life.

In “The Death of Ivan Ilych,” the protagonist’s gradual awareness of his mortality profoundly shapes his perspective. Ivan Ilych’s initial disregard for the syllogism’s implications is emblematic of his societal conformity and superficiality. However, as he confronts his own impending death, the syllogism takes on a deeper resonance. His realization of the inevitability of death propels him to question the meaning and purpose of his life. This existential crisis prompts him to reassess his relationships, his career, and the authenticity of his existence.

Tolstoy’s exploration of mortality and Kamm’s ethical analysis invite readers to confront their own mortality and consider the implications for their lives. The syllogism serves as a catalyst for such contemplation, encouraging individuals to move beyond mere existence and engage in a more profound exploration of life’s meaning. Kamm’s insights expand on this by advocating for the transformative potential of recognizing mortality in making ethically informed decisions (Kamm).

In conclusion, the syllogism “Caius is a man; all men are mortal; therefore Caius is mortal” carries profound significance in Tolstoy’s “The Death of Ivan Ilych” and resonates in Kamm’s ethical analysis (Kamm). Its logical structure encapsulates the universality of mortality, provoking deep contemplation on the fleeting nature of life. Through the engagement of this syllogism, Tolstoy and Kamm encourage readers to reflect on the ethical implications of mortality, prompting a reconsideration of priorities and fostering a more purposeful and ethically conscious approach to existence.


These readings and lectures navigate the complexities of health inequalities and the philosophy of death. Boorse’s theory offers objective health measurement (Hausman, p. 61), supplemented by acknowledging societal factors. Amendments to maximin theories address Arrow’s objection (Lecture Handout 7), promoting equitable health allocation. Tolstoy’s novella and Kamm’s analysis illuminate mortality’s ethical significance (Kamm), guiding ethical decision-making.

Synthesizing these insights equips us to navigate ethical considerations in health disparities and mortality’s philosophical implications within the realm of bioethics.


Hausman, D. (Year). What’s Wrong with Health Inequalities?

Kamm, F. M. (Year). Rescuing Ivan Ilych: How We Live and Die.

Lecture Handout 7. (Year).

Tolstoy, L. (Year). The Death of Ivan Ilych. Publisher.