Fairness

Fifteen British sailors were released from captivity in April 2007 after being held hostage for two weeks by the government of  Iran. On their return, the Ministry of Defence  said that, in view of the exceptional circumstances, they were permitted to sell their story to the press.. Leading Seaman Faye Turner sold hers to the Sun for £80,000. That payment was headline news,  and the chief topic of conversation in clubs and bars for several days. Nearly everyone condemned it. There was general agreement that it was unfair. Some argued that it was  unfair  to allow  those servicemen, and not others,  to sell their stories.  Some pointed  out that other servicemen were more deserving, particularly those who had been injured in battle. Others argued that the money should rather have gone to needy families.

The concept of fairness that is called upon in that example is open to a variety of interpretations, each of which could lead to a different course of action. To illustrate the point  in a different context , suppose that you are a parent who has received a substantial sum of money that you wish to share fairly between your two adult offspring  Amy and Bessie. You are faced with the following choices:

-          for  fairness as  non-discrimination,  they get half each;

-          for  fairness as redistribution and supposing Amy to be the poorer, Amy gets more than half;

-          for  fairness as reciprocity and supposing Bessie to be more the more supportive, Amy gets less than half;

-          for fairness according to deserts and supposing Amy to be the more deserving, Amy gets more than half.

(The use of the word fair can also  lead to confusion of a different sort. It is not always clear whether it is intended to refer to the above  concept, or whether the it is intended to refer to one of a number of  other concepts. The confusion arises from the fact that the word fair is also used to mean reasonable  (as in  ‘a fair price’), honest  without cheating (as in ‘by fair means or foul’), conforming to an agreement or to established standards  (as in ‘fair trading’),  or   well-founded or accurate (as in a ‘fair estimate’). It is obvious that none of those other  concepts were in the minds of those who objected to Faye Turner’s payment. The following discussion is not concerned with any of those other concepts, except to note that, although they differ from the concept under  discussion, they sometimes tend to colour our attitudes to it.)

Psychological experiments (or ‘games’) have established that people have often been willing to make sacrifices in the interests of what they consider to be fairness. In a typical  bargaining game, A is given the opportunity to  share £100  with B, having said  how much of it  he is prepared to give to B.  If B accepts the offer, he gets what is offered and A retains the rest. If B rejects the offer, neither get anything.  If  both were to act rationally, A would offer a small sum and B would accept. But in practice  A seldom offers very much less than £50, and   B very seldom accepts  very much less. Each is willing to give up an advantage rather than agree to what he considers to be an unfair deal.  In money-burning games, players are given tokens that they can later exchange for money. An unequal wealth distribution is then  created by gambling or selective gifts and each subject is  charged a fee  for an opportunity  to change that distribution by  burning  other players’ money.  The results typically show a willingness to pay to make the distribution less unequal - and to pay more when the inequality had arisen ‘unfairly’ (from a selective gift), than when it had arisen ‘fairly’ (from successful gambling). The results have been shown to be inconsistent with the motives of altruism, self-interest or envy, and consistent only with a psychological drive for fairness.

The evidence shows that the drive for fairness can override any evaluation of consequences. So it can make all concerned worse-off  - except, that is, for the psychological satisfaction that is gained. But even that gain may be based upon an illusion. For example the achievement of getting people what they deserve may have no existence outside the decision-maker’s mind.

  

Misinformation ? 1200 needless deaths ?

"Fury as hospital staff let off over 1,200 needless deaths"

Newspaper readers on the morning of 7  February 2013 were asking themselves how  it could be that nobody had been called to account for the needless deaths of 1200 patients at Britain's North Staffordshire Hospital.  Few will have seen the need to ask the question "how do we know that?"   After all,  the statement that there had been 1200 needless deaths was attributed to the highly authoritative report of a public inquiry the Francis Report .  In fact, however, there was no such statement in the Francis report, only an expression of regret that the figure had been publicised

("It is unfortunate that the figure of 400-1200 excess deaths became so widely  publicized and sensationalized. These estimates are derived from 95% confidence intervals around the SMRs, and the intention was to redact them from the final report because of concerns that the public would not understand them" Appendix 8 par 5).

 The evidence  collected in the Francis inquiry had  consisted of witness statements  by patients about malpractices at the hospital.           The hospital's mortality rate had been the subject of an earlier  health commission inquiry).  A statistical study had been commissioned by that inquiry to find whether  its above-average mortality rate  over the period 2003-2006 could be attributed to any of a range of  "external" factors such as the age of its patients.  The study had concluded that a  residual number of deaths  remained unaccounted for,  after allowing for all such external influences - and that those deaths were  presumed to be attributable to factors internal to the hospital.  The study concluded that there was a 95 percent probability that the size of that residual lay between 400 and 1200,  after allowing for uncertainties  concerning the effects of the  external influences.  

         Thus the evidence concerning  what happened at the hospital is (a) evidence of persistent malpractice -  attributed by the Francis report to the hospital's "culture" ; and (b) the evidence of  a substantial number of deaths attributable to factors internal to the hospital.  What the Robert Francis  had added to that information was the judgement that the association between (a) and (b) had been that of cause and effect - in other words that the unnecessary deaths had been the result of the hospital's "culture". His statement at paragraph 55 of the report further suggested that what had happened at North Staffordshire might be happening throughout the NHS: 

("There are those who have  given evidence or written to the Inquiry suggesting that Stafford is not an isolated case, and that, on the contrary, similar stories could  be uncovered in other parts of the NHS. Clearly, it has not been a function of this  Inquiry to undertake a survey of the NHS  as a whole and therefore   I cannot draw conclusions about this understandable concern. However, patients’ stories very  similar to those I have  heard have  been reported from elsewhere  and with some frequency; examples can be found in the recent Patients Association report.")

That speculation prompted further media conclusions such as the Times headline "The NHS is run for the benefit of the staff, not the patients".

 Misinformation?  Certainly! Damaging? Possibly :  the phoney 1200 figure is unimportant compared with the harm that could arise from an attempt to solve the problem by assigning blame and imposing punishment.

         The possibility of harm arises from neglect of the possibility that some of the needless deaths had arisen for reasons other than a culture of uncaring self-interest.  Some might, for example, have been the outcome of the selfless endeavours of people who were overworked, underqualified or otherwise ill-equipped for the tasks they were assigned.  It would  be damaging  to deter such people from reporting what happened as a warning to others, or seeking advice about how their mistakes could have been avoided.