In this book by the award-winning author of Just Healthcare, Norman Daniels develops a comprehensive theory of justice for health that answers three key questions: what is the special moral importance of health? When are health inequalities unjust? How can we meet health needs fairly when we cannot meet them all? Daniels' theory has implications for national and global health policy: can we meet health needs fairly in ageing societies? Or protect health in the workplace while respecting (...) individual liberty? Or meet professional obligations and obligations of justice without conflict? When is an effort to reduce health disparities, or to set priorities in realising a human right to health, fair? What do richer, healthier societies owe poorer, sicker societies? Just Health: Meeting Health Needs Fairly explores the many ways that social justice is good for the health of populations in developed and developing countries. (shrink)

How should medical services be distributed within society? Who should pay for them? Is it right that large amounts should be spent on sophisticated technology and expensive operations, or would the resources be better employed in, for instance, less costly preventive measures? These and others are the questions addreses in this book. Norman Daniels examines some of the dilemmas thrown up by conflicting demands for medical attention, and goes on to advance a theory of justice in the distribution (...) of health care. The central argument is that health care, both preventive and acute, has a crucial effect on equality of opportunity, and that a principle guaranteeing equality of opportunity must underly the distribution of health-care services. Access to care, preventive measures, treatment of the elderly, and the obligations of doctors and medical administrations are fully discussed, and the theory is shown to underwrite various practical policies in the area. (shrink)

We all have beliefs, even strong convictions, about what is just and fair in our social arrangements. How should these beliefs and the theories of justice that incorporate them guide our thinking about practical matters of justice? This wide-ranging collection of essays by one of the foremost medical ethicists in the USA explores the claim that justification in ethics, whether of matters of theory or practice, involves achieving coherence between our moral and non-moral beliefs. Amongst the practical issues addressed in (...) the volume are the design of health-care institutions, the distribution of goods between the old and the young, and fairness in hiring and firing. In combining ethical theory and practical ethics this volume will prove especially valuable to philosophers concerned with ethics and applied ethics, political theorists, bioethicists, and others involved in the study of public policy. (shrink)

Healthcare (including public health) is special because it protects normal functioning, which in turn protects the range of opportunities open to individuals. I extend this account in two ways. First, since the distribution of goods other than healthcare affect population health and its distribution, I claim that Rawls's principles of justice describe a fair distribution of the social determinants of health, giving a partial account of when health inequalities are unjust. Second, I supplement a principled account of justice for health (...) and healthcare with an account of fair process for setting limits or rationing care. This account is provided by three conditions that comprise "accountability for reasonableness.". (shrink)

The rapidly increasing numbers of elderly people in our society have raised some important moral questions: How should we distribute social resources among different age groups? What does justice require from both the young and the old? In this book, Norman Daniels offers the first systematic philosophical discussion of these urgent questions, advocating what he calls a "lifespan" approach to the problem: Since, as they age, people pass through a variety of institutions, the challenge of caring for the (...) elderly becomes the prudent allocation of public resources among the various stages of people's lives. Using this philosophical approach, Daniels addresses specific public policy issues such as the allocation of medical funds, the adequacy of long-term care, current Medicare cost-containment measures, and the equitable distribution of income support over the lifespan and between generations. (shrink)

The treatment-enhancement distinction draws a line between services or interventions meant to prevent or cure conditions that we view as diseases or disabilities and interventions that improve a condition that we view as a normal function or feature of members of our species. The line drawn here is widely appealed to in medical practice and medical insurance contexts, as well as in our everyday thinking about the medical services we do and should assist people in obtaining.

Ackn o wledgments I owe special gratitude to Professors Hugo Adam Bedau and John Rawls for many helpful discussions of the general idea and scope, ...

Bioethics' traditional focus on clinical relationships and exotic technologies has led the field away from population health, health disparities, and issues of justice. The result: a myopic view that misses the institutional context in which clinical relationships operate and can overlook factors that affect health more broadly than do exotic technologies. A broader bioethics agenda would take up unresolved questions about the distribution of health and the development of fair policies that affect health distribution.

In A Theory of Justice, John Rawls defines a hypothetical contract situation and argues rational people will agree on reflection it is fair to contractors. He solves the rational choice problem it poses by deriving two lexically-ordered principles of justice and suggests the derivation justifies the principles. Its soundness aside, just what justificatory force does such a derivation have?On one view, there is no justificatory force because the contract is rigged specifically to yield principles which match our pre-contract moral judgments. (...) Rawls provides ammunition for this claim: “By going back and forth, sometimes altering the conditions of the contractual circumstances, at others withdrawing our judgments [about what is just] and conforming them to principle, I assume that eventually we shall find a description of the initial situation that both expresses reasonable conditions and yields principles which match our considered judgments duly pruned and adjusted.”. (shrink)

Chapter I: The Geometry of Visibles 1 . The N on- Euclidean Geometry of Visibles In the chapter "The Geometry of Visibles" in Inquiry into the Human Mind, ...

People tend to contribute more—and think they have stronger obligations to contribute more—to rescuing an identified victim rather than a statistical one. Indeed, they are often disposed to contribute more to rescuing a single identified victim than a greater number of statistical ones. By an “identified victim,” I mean Terry Q., lying injured in the passenger seat of the wrecked automobile on the corner of Main Street and Broadway, or Jessica McClure, the child who fell into the Texas well in (...) 1987 and whose family was sent $700,000 in donations for her. We need not know their names, however, and we can accept a very minimal form of identification. By a “statistical victim,” I mean the person who, extrapolating from traffic records, will be in a similar, serious car accident tomorrow (and may then be identified), or the children who will fall into wells next year if we do not cap them better than we did the well that trapped Jessica. Does this disposition (or perceived obligation) have any normative force? I initially thought there could be no such normative force, but consequentialist and nonconsequentialist arguments, pro and con, have convinced me that reasonable people can disagree with each other. This disagreement poses a problem for political philosophy: how should policy choices take such disagreement into account? (shrink)

By entering the medical profession, physicians have consented to accept a standard level of risk of infection. In most instances, the risk of contracting HIV does not exceed this level.

Many societies, and nearly all wealthy, developed countries, provide universal access to a broad range of public health and personal medical services. Is such access to health care a requirement of social justice, or is it simply a matter of social policy that some countries adopt and others do not? If it is a requirement of social justice, we should be clear about what kinds of care we owe people and how we determine what care is owed if we cannot (...) possibly meet every health need, as arguably no society can. We should be clear about what constitutes appropriate access to that care, given that there are diverse barriers to access. We must also be able to say why we owe these things as a matter of justice, and, of course, different accounts of social justice will bake and serve this cake in different ways. (shrink)

Book reviewed in this article: Just Doctoring: Medical Ethics in the Liberal State. By Troyen A. Brennan. The Ends of Human Life: Medical Ethics in a Liberal Polity. By Ezekiel J. Emanuel.

How can health plans make fair determinations about when “experimental” (and costly) treatments such as high dose chemotherapy with autologous bone marrow transplantation should be covered despite lack of clear clinical consensus about their benefits? Different models for managing “last chance” therapies evolving in some health plans offer promising examples of how issues of fairness and legitimacy in decisionmaking can be addressed.

There is a hoary tradition in moral philosophy that assumes we cannot determine which moral theory is acceptable or correct unless we have available a correct theory of human nature, or, in its more modern form, of the person. With such a theory of the person, however, we could at least narrow down the choice among competing ethical theories. A more recent tradition, at least in one of its standard interpretations, agrees it would be necessary to have a correct theory (...) of the person before we could determine an acceptable moral theory, but it denies there is a determinate nature of the person to be captured in such a theory. The plasticity of the person, according to this strand of Marxist theory, rules out the possibility of there being universal moral theory at all. In this paper, I would like to explore a view that treads an intermediate path. It agrees with the Marxist denial that there is a determinate nature of the person, a deep fact of the matter, that can be abstracted from the social matrix and made the subject of a theory of the person. And, it agrees with both traditions that moral theory depends on and embodies a theory of the person. But, by making the problem of arriving at an acceptable view of the person itself something that depends on overall theoretical considerations, including moral ones, the intermediary, view may be able to avoid the type of moral relativism associated with the Marxist view. (shrink)

Independently of any eighteenth century work on the geometry of parallels, Thomas Reid discovered the non-euclidean "geometry of visibles" in 1764. Reid's construction uses an idealized eye, incapable of making distance discriminations, to specify operationally a two dimensional visible space and a set of objects, the visibles. Reid offers sample theorems for his doubly elliptical geometry and proposes a natural model, the surface of the sphere. His construction draws on eighteenth century theory of vision for some of its technical features (...) and is motivated by Reid's desire to defend realism against Berkeley's idealist treatment of visual space. (shrink)