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sanitation and poor housing are clearly avoidable; (2) the Canadian government
clearly has the economic and technological resources to eliminate this
inequality; and (3) there is no reason to believe that the lack of these resources
among First Nations communities resulted from fully informed, freely chosen
decisions by the affected communities. From this perspective, then, this
distribution is unjust.
A third answer to the original question, rooted in the philosophical doctrine
of utilitarianism, requires us to assess the consequences of these conditions.
Utilitarians assess conditions, policies and interventions according to their
impact on the total well-being (or “utility”) of a population, with those that
maximize total utility judged superior to those that do not. This judgment
is often the result of an analysis of the costs and benefits associated with a
particular condition, policy or intervention. For example, an unequal distribution
of living conditions might be considered just if equalizing housing
conditions required such a large expenditure that it would reduce funding
for other programs that have a greater benefit for overall well being.
The case narrative argues that, during the pandemic, living conditions among
First Nations communities presented a significant impediment to adequate
response, that these communities bore a disproportionate burden of H1N1 morbidity
and that “Canada’s response to the pandemic could have been improved
had the government taken responsibility for alleviating” these conditions. The
case narrative provides strong evidence that living conditions did impede
pandemic planning and response, which in itself is a significant problem.
But a utilitarian would likely ask whether this really resulted in a measurable
negative impact on health outcomes, and in turn whether alleviating these
conditions would reduce this impact in a cost-effective manner. Answering
this question requires us to examine the evidence base for this case.
The evidence base for ethical analysis
The poor living conditions of First Nations communities in Canada are welldocumented,
as are the disproportionately high rates of a variety of health
problems, from infant mortality to diabetes to suicide. These factors alone
may justify comprehensive government action to improve Aboriginal living
conditions, health and health care. However, since this case focuses on the
relationship between living conditions and H1N1 influenza, a closer inspection
of the evidence in this specific regard is warranted.
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