When I began to write this, the Beijing Winter Olympics were going on,1 and as often happens during major sporting events, the question of “fairness” was raised. Which country should an athlete be allowed to represent? Does it make a difference if the athlete is a potential champion, as opposed to a lower-ranked competitor? What substances are athletes prohibited from ingesting, and do the consequences of failing a drug test apply the same way to all competitors? Is it fair to punish individual athletes for actions taken by their coaches or countries?
These controversies always lead me to the same conclusion:
Fairness doesn’t exist.
Okay, I’m exaggerating a little. Fairness does exist, but not in the way we pretend it does. It’s not objectively measurable like temperature or mass or the mean of a series of numbers. It also doesn’t exist as a universal human concept, transcending cultures like taboos on murder and incest. Fairness is more like good art. We think we know it when we see it and we think we know it when it’s absent, but the boundaries get fuzzier as we get closer to them, and reasonable people often disagree.
Part of the problem is that we use the term quite freely, without consistency or standards. We often hear kids cry “that’s not fair,” typically in a situation in which they didn’t get what they wanted. Adults….well, adults do the same thing, but we’re better at articulating arguments as to why the only fair results are the ones that coincidentally benefit us the most. Things tend to seem fair when we win and unfair when we lose.
Seth Godin, in his excellent Akimbo podcast2 explains that we mean different things when we talk about fairness, and he describes four versions:
- Everyone is treated the same, e.g. first-come-first-served such as waiting in line at the grocery store, one per customer, etc.,
- Everyone gets what they need, e.g. adjustment for specific groups, such as disabled parking spaces, or senior discounts,
- Everyone gets what they deserve, such as the 100m hurdles, where the fastest runner wins,
- Everyone gets what they expect, or what we are accustomed to—this is the way we’ve always done it, it’s the way we should keep doing it.
We easily shift between these variations and use them in combination, not even realizing that we are doing so. Parking is first-come-first-served (type 1, everyone treated the same), unless you have a handicapped permit (type 2, people get what they need) or have purchased a parking spot (type 3, people get what they deserve). And if your need to park in this moment happens to be greater than that of someone with a handicapped permit, that doesn’t matter, because that’s just not the way we do it (type 4, what we’re accustomed to).
Type 4 at first seemed the hardest to understand, until I realized it was difficult to see because of its ubiquity; we become so used to what we call “normal” we forget that there are other ways of doing things. Boxing and wrestling sort competitors by size, for example, but basketball does not. Horse racing and rowing adjust for competitor size with weights, but track and field races do not. These rules seem perfectly normal and fair to anyone accustomed to the sports, and people will argue why the differences are objectively correct, but fundamentally it’s just tradition-based inconsistency in how we deal with body-size advantage. Type 4 in action.
These issues come up in healthcare all the time, both on the care side and on the operational side. For example, what does “fairness” look like in prioritization of patients in an emergency department? Who should be hospitalized? And recently, should personal health choices (such as choosing not to get vaccinated) be taken into account when triaging patients?3 Fairness also comes up behind the scenes in healthcare: Who should take the undesirable night shifts? Who among the team caring for this patient should be burdened with placing the orders and managing the results? How much should everyone get paid? Who should be blamed when something goes wrong?
Knowing that these different versions of fairness exist may unlock understanding and empathy, which can lead to better resolutions. The conversation might unfold better once you realize that the person you’re talking to isn’t trying to cheat, they’re just using a different definition of “fair.” Not only that, but the definition they’re using is one you’ve used and feel comfortable with, just in different circumstances. Disagreements resolve more easily once we realize we haven’t been talking about the same thing.
That said, I think there’s a limit to our ability to fairness-switch. Once we’ve settled on our story, it’s really hard to change. That feeling of being cheated can be so powerful, it can wipe away all other possibilities. That’s why it can be better to avoid the question of fairness altogether, and instead re-frame the question: Rather than dive into what’s fair, step back and ask what you’re all trying to do in the first place. This activity—whatever is it—what is it for? What is it meant to achieve? Once you clarify that, you can judge any guidelines, rules or processes by whether or not they help you reach your destination.
Let’s get back to sports as an illustration. When my kids started playing organized sports, there was a repeated disagreement around whether the coaches should play all the kids equally, or let the best ones play more in order to win more games. Parents usually support whatever they think will be best for their child. The parents of the most skilled players probably feel like their kids have earned their right to play and win, and the other parents probably feel like there should be equal opportunity for all of the players, even if it means losing more often. Instead of pitting those opinions head-to-head, it helps to re-center around the purpose for the sport, ideally before the season even starts. Is the goal to develop all the players? To achieve glory for the school by winning? To start kids on a path to professional sports? To have fun? This re-framing can also open up options for other solutions, since there are lots of ways to, for example, have fun during the season, but only so much playing time to go around. I’m not saying what the goals should be, and they may reasonably differ depending on factors like player age or the type of league.; presumably the purpose of pee-wee sports is different than at the college or professional level. What matters is that the participants share an explicit goal, that the processes are designed to achieve it, and that the rules are applied consistently. Our typical conversations tackle too much, wrapping the goals, rules, and applications of the rules into a single, impossible tangle we label as “fairness.” Better to start by deconstructing the topic.
You can apply this re-framing to many problems at different group levels: How should transgender athletes participate in sports? Who should be allowed to vote? How should household chores get divided? How do we split the restaurant bill? Should the richest people pay more taxes? The real questions involve what these specific iterations of sports, voting, doing chores, eating out together, and taxes are supposed achieve in the first place.
Fairness is almost never the goal. That’s good, since it doesn’t even really exist, except as an inconsistent, often personal and circumstantial opinion. Behind the fairness illusion, however, there often lies a true goal we might be able to agree on. Maybe we can have more success starting with that.
1I start many posts, finish few (go back)
3This question has an easy answer: no, we don’t want to take that into account. I can understand the desire to want to hold people responsible for their own health choices, but even if this should happen, it doesn’t belong at the point of care. Doctors are not equipped to and should not be thinking about whether or not a patient “deserves” to get care, or to tease apart the degree to which personal choices may have resulted in the current problem. It’s hard enough to care for patients without adding an unnecessary burden of trying to make society more fair at the individual patient level. (go back)
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