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Eye on Ethics

The Challenge of Distributive Justice
By Frederic G. Reamer, PhD
January 2015

Amanda P., MSW, was the executive director of a mental health center located in a large urban area. Six months ago the agency was awarded a state-sponsored grant to provide emergency shelter services to people who are homeless and have a major mental illness. The principal goal of the program is to stabilize homeless individuals' housing needs and offer them opportunities to receive mental health and social services that may help them (including counseling, addiction, health care, education, and vocational services). Many of the clients have served time in prison, did not graduate from high school, struggle with illiteracy and learning disabilities, and have very limited employment experience. The program includes two residential sites, each accommodating 25 clients. 

Shortly after the program began, Amanda and her colleagues discovered that the demand for services greatly exceeded the available slots. The program's waiting list was lengthy. Amanda and the program's administrators quickly recognized the need to establish a protocol to govern program admission.

Social workers often encounter circumstances that require the allocation of scarce resources. In addition to program slots, social workers may need to allocate limited agency funds, employment positions, or the time available to meet with clients. 

In many social service settings decisions about allocating limited resources are made informally or without the benefit of a conceptually based protocol or clear criteria. Resources may be allocated based on an administrator's personal biases, political pressure, or agency customs. In fact, however, these decisions entail ethically complex dimensions pertaining to justice and fairness. 

The Concept of Distributive Justice
Debate about criteria for allocating scarce resources concerns what philosophers call distributive justice. Distributive justice involves the use of ethics concepts and criteria to determine how scarce resources should be divided among people, groups, organizations, and communities.

Historically, social workers and others have based their allocation decisions on four key concepts: need, equality, compensation, and contribution. Sometimes these criteria are used independent of one another and sometimes in combination. 

In many instances, social workers allocate limited resources based on need. In principle, social workers could rank-order potential recipients based on their vulnerability, a form of triage. Of course, assessing need often is difficult.

In contrast, equality is one of the most popular criteria for allocating scarce resources. On the surface the concept of equality seems straightforward and fair: individuals who are eligible for services or resources simply have an equal stake. However, equality is a much more complicated concept.

One way to define equality is in terms of equal shares. That is, when resources are in short supply, all eligible people, groups, communities, and organizations would receive an equal share of what is available. This approach emphasizes the outcome of the distribution; every recipient should receive an equal amount.

This approach may be feasible in some instances, such as when those standing in line at a food pantry receive equal portions of available commodities. This may not be the most ideal outcome, since some people may not receive what they need, but it is fair. Similarly, low-income communities might divide available community development funds into equal portions.

In many instances, however, this approach would not be feasible. Amanda and her colleagues cannot divide available shelter beds into equal "pieces" or divide up the hours or minutes during which each eligible person would occupy a shelter bed. Similarly, dividing an overwhelmed social worker's caseload into evenly sized portions for all of her clients would likely result in a meaningless amount of time for each client. 

Another way social workers sometimes think about equality is to emphasize the procedures used to allocate limited resources rather than the actual outcome. Under this arrangement resources are not necessarily distributed in equal portions; rather, potential recipients have an opportunity to compete for them equally. This could take the form of a random lottery or a first-come, first-served arrangement. Of course, not all potential recipients are in a position to compete—for example, if they are disabled or live in remote locations and would have difficulty traveling to a program to get in line early.

Some social workers argue that allocating scarce resources based on need or equality is not fair. For example, social workers sometimes advocate for the use of affirmative action criteria, with some preference given to people who have been victimized by various forms of discrimination (for example, based on race, ethnicity, sexual orientation, gender expression, or religion). 

Finally, some claim that the concept of contribution is relevant to allocation protocols. According to one interpretation of this principle, scarce resources should be distributed in proportion to the contribution that recipients have made or might make to their communities or the broader society. For example, potential recipients who have contributed to the costs associated with the resources (perhaps in the form of a copay) might receive priority. An extreme argument is that preferential consideration should be given to people who are most likely to be able to contribute to society in meaningful ways and not be a drain on society's resources. Of course, this is not a popular perspective among social workers, given the profession's longstanding commitment to serving the most vulnerable members of society. 

A Principled Approach
Social workers have a responsibility to think carefully about the moral criteria they use to allocate limited resources. In some instances the principle of equality, in one of its several forms, might seem more compelling than the principle of need or compensation. In other situations the principle of need might seem appropriate. The most important point is that social workers must be aware of, and thoughtful about, the various criteria and distributive mechanisms they use and the profoundly ethical nature of their decisions, and must be willing to justify and defend their choices in any given instance. Indeed, this key principle is reflected in the NASW Code of Ethics: "Social workers should advocate for resource allocation procedures that are open and fair. When not all clients' needs can be met, an allocation procedure should be developed that is nondiscriminatory and based on appropriate and consistently applied principles" (standard 3.07[b]).

Further, social workers should not be complacent when they encounter insufficient resources to meet the needs of clients and other vulnerable people. Ethical social workers recognize their duty to advocate for essential resources whenever possible. This, too, is an inherent element of social workers' ethical duties. As the NASW Code of Ethics says, "Social workers should engage in social and political action that seeks to ensure that all people have equal access to the resources, employment, services, and opportunities they require to meet their basic human needs and to develop fully. Social workers should be aware of the impact of the political arena on practice and should advocate for changes in policy and legislation to improve social conditions in order to meet basic human needs and promote social justice" (standard 6.04[a]).

Frederic G. Reamer, PhD, is a professor in the graduate program of the School of Social Work at Rhode Island College. He's the author of many books and articles, and his research has addressed mental health, health care, criminal justice, and professional ethics.