This chapter contains sections titled: Is There a Right to Health Care? What Does a Right to Health Care Include? Choice or Consent and the Exercise of our Right to Health Care References.

A just social arrangement must guarantee a right to health care for all. This right should be understood as a positive right to basic human functional capabilities. The present article aims to delineate the right to health care as part of an account of distributive justice in health care in terms of the sufficiency of basic human functional capabilities. According to the proposed account, every individual currently living beneath the sufficiency threshold or in (...) jeopardy of falling beneath the threshold has a legitimate claim to justice. People's entitlements to health care should not be determined on the basis of brute luck and their efforts to maintain healthy lifestyles. The prioritization of competing claim-rights of individuals is guided by two allocation principles: number and benefit-size weighted sufficiency (among people beneath the threshold) and need-weighted utilitarianism (among people above the threshold). (shrink)

From the late 1970s through the mid-1980s, a number of philosophers carefully worked out theories of justice in health care. Most of those still working on these issues have turned to clinical applications of the philosophical frameworks developed earlier. Although theories have not received much recent attention in this debate, this paper will offer a new theoretical framework for approaching issues of justice in health care. There are two reasons for thinking that (...) returning to theory would be worth- while. One concerns the fact that our society remains very far from realizing justice in health care. While there are several well-argued theories of just health care whose implementation would take us into the neighborhood of justice, it would also seem - in pluralistic spirit - that adding to the arsenal is helpful. The more good arguments there are for a given conclusion, the more likely it is to be correct and, ultimately, to persuade. -/- It will be contended that a limited right to health care can be grounded in self-respect. The argument will exploit Rawls' key insight that self-respect is a primary social good and will depend on the assumption that, at least in moderately affluent nations, one has a right to the primary social goods. This assumption is not defended here. But it should be noted that a right to the primary social goods is not of interest only to Rawlsians and other liberal deontologists; an enlightened utilitarianism might also vindicate it. The second reason for advocating a return to theory is that self-respect is especially fruitful as a focal concept for addressing issues of justice in health care (and other issues). (shrink)

This paper considers whether Rawls' theory of justice as fairness may be used to justify a human right to health care. Though Rawls himself does not discuss health care, other writers have applied Rawls' theory to the provision of health care. Ronald Green argues that contractors in the original position would establish a basic right to health care. Green's proposal, however, requires considerable relaxation of the constraints Rawls places on the original (...) position and thus jeopardizes Rawls' arguments for the two principles of justice. Norman Daniels claims that health care is best understood as a means for helping to achieve Rawls' goal of equality of fair opportunity. Daniels acknowledges, however, that his interpretation cannot justify a basic right to health care; rather, it would at best require that certain kinds of care be made available to certain kinds of individuals. Finally, in place of the notion of health care is a human right, it is suggested that the provision of health care is a social ideal which may inspire the creation of specific legal rights. On this view, social provision of health care may properly vary significantly from culture to culture. Despite this variability, social systems may still be criticized on moral grounds. Keywords: justice, right to health care, equality, fair opportunity. (shrink)

This article begins by clarifying and noting various limitations on the universal reach of the human right to health care under positive international law. It then argues that irrespective of the human right to health care established by positive international law, any system of positive international law capable of generating legal duties with prima facie moral force necessarily presupposes a universal moral human right to health care. But the language used in contemporary human (...) class='Hi'>rights documents or human rights advocacy is not a good guide to the content of this rather more modest universal moral human right to health care. The conclusion reached is that when addressing issues of justice as they inevitably arise with respect to health policy and health care, both within and between states, there is typically little to gain and much to risk by framing deliberation in terms of the human right to health care. (shrink)

The language of rights is increasingly used to regulate access to health care and allocation of resources in the health care field. The right to health has been grounded on different theories of justice. Scholars within the liberal tradition have grounded the right to health care on Rawls's two principles of justice. Thus, the right to health care has been justified as being one of the basic liberties, (...) as enabling equality of opportunity, or as being justified by the maximin principle. In this article, Filc analyzes—from a radical egalitarian standpoint—the limitations of the different attempts to ground an equal right to health on Rawls's theory of justice and offers a first approximation to a radical egalitarian formulation of the right to health. (shrink)

The language of rights is increasingly used to regulate access to health care and allocation of resources in the health care field. The right to health has been grounded on different theories of justice. Scholars within the liberal tradition have grounded the right to health care on Rawls's two principles of justice. Thus, the right to health care has been justified as being one of the basic liberties, (...) as enabling equality of opportunity, or as being justified by the maximin principle. In this article, Filc analyzes—from a radical egalitarian standpoint—the limitations of the different attempts to ground an equal right to health on Rawls's theory of justice and offers a first approximation to a radical egalitarian formulation of the right to health. (shrink)

This dissertation serves as a monograph on the moral and social implications of a utilitarian-based system of health care which recognizes and takes rights seriously. Though the design and claims are stated primarily in terms of utilitarianism, admittedly, there are elements of communitarian, deontological, and rights theories which have been incorporated. ;Such a commingling of theoretical elements, under the claim of being utilitarian, may seem ambiguous, however, it is my contention that such inclusions only serve (...) to enhance the plausible nature of this sphere-specific form of utilitarianism and the adjudication of rights. Additionally, though there are other components of theories included, the basis of utilitarianism still serves as the foundation by which all other actions, decisions, and values are judged. ;While it is true that utilitarianism offers a standard for all areas of life, the idea of examining a sphere or environment of utility, in this case, the utility associated with the sphere of health care, allows for the good to be clearly defined. One primary weakness of classical utilitarianism is that it ignores, or at least does not do full justice to, the notion of personal responsibility or sense of obligation. If the only duty or requirement is to produce some obscure sense of the "greatest good" or the "greatest happiness," the question of how the good is identified and who is to have the good remains unanswered by the traditional utilitarian construct. ;The classical view of utilitarianism is too broad in its scope of defining "the greatest good" or realm of value. But to narrow the area of value to a particular sphere or environment allows for the utility and associated rights in question to be identified, the value measured, and the success more easily interpreted. ;While maintaining the general premise of utilitarianism, that is, "the greatest good for the greatest number," the notion is not from some nebulous concept or subjective position about life or feelings in general. This sphere-specific position also acknowledges and defines the "rights" of the individual within the particular sphere being considered, in this case, the sphere of health care. (shrink)

This article tries to analyze the meaning and relevance of the concept of solidarity as compared to the concept of justice. While ‘justice’ refers to rights and duties , the concept of solidarity refers to relations of personal commitment and recognition . The article wants to answer the question whether solidarity and liberal justice should be seen as mutually exclusive or whether both approaches should be regarded as complementary to each other. The paper starts with an (...) analysis of liberal theories of justice which are followed by an analysis of the descriptive and a moral understanding of the concept of solidarity. The importance of solidarity lies in its relational aspects, particularly its emphasis on cooperation and commonality. The paper argues that while solidarity is more fundamental than justice, both concepts are important for the arrangement of health care practices. The paper gives special attention to the concept of decent care, reflective solidarity and humanitarian solidarity which is seen as fundamental for all health care policies and care practices. (shrink)

Do we have a legal and moral right to health care against others? There are international conventions and institutions that say emphatically yes, and they summarize this in the expression of “the right to health,” which is an established part of the international human rights canon. The International Covenant on Social and Economic Rights outlines this as “the right of everyone to the enjoyment of the highest attainable standard of physical and mental health,” but (...) declarations such as this remain tragically unfulfilled. According to recent figures, roughly two billion people lack access to essential drugs or to primary health care. Millions are afflicted by infections and illnesses that are easily avoidable or treatable. In the developing world many children die or grow stunted and damaged for lack of available treatments. Tropical diseases receive little or no attention by the major pharmaceutical companies’ research departments. Is this a massive violation of the right to health? And if so, why does it attract so little attention? Is it because our supposed commitment to human rights and the rule of law is hypocritical and hollow? Or is it because the right to health is a special case of a right, so that these tragedies are no violation at all? Jennifer Prah Ruger summarized this puzzle when she wrote: “one would be hard pressed to find a more controversial or nebulous human right than the right to health.” In this essay I discuss three different theories of a right to health care. I conclude by offering my own reconstruction of one such theory. (shrink)

A basic human right to the delivery of health care, even to the delivery of a decent minimum of health care, does not exist. The difficult with talking of such rights should be apparent. It is difficult if not impossible both to respect the freedom of all and to achieve their long-range best interests. -/- Rights to health care constitute claims against others for either their services or their goods. Unlike rights (...) to forbearance, which require others to refrain from interfering, rights to beneficence require others to participate actively in a particular understanding of the good life. Rights to health care, unless they are derived from special contractual agreements, depend on the principle of beneficence rather than that of autonomy, and therefore may conflict with the decisions of individuals who may not wish to participate in realizing a particular system of health care. If the resources involved in the provision of health care are not fully communal, private owners of resources may rightly have other uses in mind for their property than public care….[T]he principles of autonomy and beneficence that lie at the foundations of justice will spawn conflicts within any portrayal of a just allocation of health care resources. (shrink)

Henry Shue’s model of basic rights and their correlative duties provides an excellent framework for analysing the requirements of global distributive justice, and for theorising about the minimum acceptable standards of human entitlement and wellbeing. Shue bases his model on the claim that certain ‘basic’ rights are of universal instrumental value, and are necessary for the enjoyment of any other rights, and of any ‘decent life’. Shue’s model provides a comprehensive argument about the importance of certain (...) fundamental goods for all human lives, though he does not consider health or health care in any significant detail. Adopting Shue’s model, I argue that access to health care is of sufficient importance to the enjoyment of any other rights that it qualifies as what Shue describes as a ‘basic’ right. I also argue that the basic right to health care is compatible with the basic rights model, and is required by it in order to for it to achieve its goal of enabling right holders to enjoy any decent life. In making this claim I also explore the requirements of the basic right to health care in terms of Shue’s triumvirate of duties and with reference to several key examples. (shrink)

Discussions concerning whether there is a natural right to health care may occur in various forms, resulting in policy recommendations for how to implement any such right in a given society. But health care policies may be judged by international standards including the UN Universal Declaration of Human Rights. The rights enumerated in the UDHR are grounded in traditions of moral theory, a philosophical analysis of which is necessary in order to adjudicate the value (...) of specific policies designed to enshrine rights such as a right to health care. We begin with an overview of the drafting of the UDHR and highlight the primary influence of natural law theory in validating the rights contained therein. We then provide an explication of natural law theory by reference to the writings of Thomas Aquinas, as well as elucidate the complementary “capabilities approach” of Martha Nussbaum. We conclude that a right to health care ought to be guaranteed by the state. (shrink)

There are now over 1.1 million people overseen by Immigration and Customs Enforcement (ICE), with about 33,000 detained in jails and federal detention centers around the country at any particular time. The average detention time is two months, but some are detained for much longer periods. Since its inception, one hundred and twenty one deaths and countless cases of medical neglect have occurred. Given its secrecy, and lack of accountability and oversight, it is not clear how many of these deaths (...) are the result of grossly inadequate medical care. ICE is a branch of a government agency in a democratic country, thus the citizens on whose behalf it allegedly operates have an obligation to ensure that it operates in conformity with the fundamental principles of justice on which this nation was founded. ICE is a young and rapidly growing bureaucracy with little oversight. It operates using a mix of federal, state, local and private centers, many of which are penal institutions. It has a history of serious abuse, and even when it operates in conformity with its penal standards, it inflicts additional harm onto vulnerable people, especially asylum seekers and parents of minor children. It thus requires our constant vigilance and concern. Our immigration policies and detention practices are deeply troubling, but until we elect to reform them, we have a special obligation to the vulnerable populations that we house in ICE detention. (shrink)

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)

This collection comprises ten essays authored or co-authored by Allen Buchanan. They concern issues that are of great importance: public and private health care, the problem of rationing and the existence and scope of the right to health care, among many others. In general, Buchanan is a clear and careful analyst. He is a pluralist, not an apologist for a specific normative theory, such as utilitarianism or the Rawlsian theory of justice. He defends and practises (...) the art of producing considered judgements from a plurality of intuitively plausible normative bases, proceeding in a way that is informed by the economic context in which health care decisions arise. (shrink)

Background The world is urbanizing rapidly; more than half the world’s population now lives in urban areas, leading to significant transition in lifestyles and social behaviours globally. While offering many advantages, urban environments also concentrate health risks and introduce health hazards for the poor. In Bangladesh, although many public policies are directed towards equity and protecting people’s rights, these are not comprehensively and inclusively applied in ways that prioritize the health rights of citizens. The country (...) is thus facing many issues that raise moral and ethical concerns. Methods A narrative literature review was conducted between October 2016 and November 2017 on issues related to social justice, health, and human rights in urban Bangladesh. The key questions discussed here are: i) ethical dilemmas and inclusion of the urban poor to pursue social justice; and ii) the ethical obligations and moral responsibilities of the state and non-state sectors in serving Bangladesh’s urban poor. Using a Rawlsian theory of equality of opportunity to ensure social justice, we identified key health-related ethical issues in the country’s rapidly changing urban landscape, especially among the poor. Results We examined ethical dilemmas in Bangladesh’s health system through the rural–urban divide and the lack of coordination among implementing agencies. The unregulated profusion of the private sector and immoral practices of service providers result in high out-of-pocket expenditures for urban poor, leading to debt and further impoverishment. We also highlight policy and programmatic gaps, as well as entry points for safeguarding the right to health for Bangladeshi citizens. Conclusions The urban health system in Bangladesh needs a reform in which state and non-state actors should work together, understanding and acknowledging their moral responsibilities for improving the health of the urban poor by engaging multiple sectors. The social determinants of health should be taken into account when formulating policies and programs to achieve universal health coverage and ensure social justice for the urban poor in Bangladesh. (shrink)

This article investigates whether or not theories of justice from political philosophy, first, support the position that health research should contribute to justice in global health, and second, provide guidance about what is owed by international clinical research (ICR) actors to parties in low- and middle-income countries. Four theories—John Rawls's theory of justice, the rights-based cosmopolitan theories of Thomas Pogge and Henry Shue, and Jennifer Ruger's health capability paradigm—are evaluated. The (...) article shows that three of the four theories require the conduct of health research for justice in global health. The theories help identify the ends of justice to which ICR is to contribute, but they cannot tell us how to organize ICR to promote these ends. Aside from Ruger's health capability paradigm, the theories also lack an allocative principle for assigning specific duties to specific actors. This creates difficulties for establishing obligations for certain types of ICR actors. (shrink)

Theories of social justice are necessarily abstract, reaching beyond the particular and the immediate to the general and the timeless. Yet such theories, addressing the world and its problems, must respond to the real and changing dilemmas of the day. A brilliant work of practical philosophy, Frontiers of Justice is dedicated to this proposition. Taking up three urgent problems of social justice neglected by current theories and thus harder to tackle in practical terms and (...) everyday life, Martha Nussbaum seeks a theory of social justice that can guide us to a richer, more responsive approach to social cooperation. The idea of the social contract--especially as developed in the work of John Rawls--is one of the most powerful approaches to social justice in the Western tradition. But as Nussbaum demonstrates, even Rawls's theory, suggesting a contract for mutual advantage among approximate equals, cannot address questions of social justice posed by unequal parties. How, for instance, can we extend the equal rights of citizenship--education, health care, political rights and liberties--to those with physical and mental disabilities? How can we extend justice and dignified life conditions to all citizens of the world? And how, finally, can we bring our treatment of nonhuman animals into our notions of social justice? Exploring the limitations of the social contract in these three areas, Nussbaum devises an alternative theory based on the idea of capabilities. She helps us to think more clearly about the purposes of political cooperation and the nature of political principles--and to look to a future of greater justice for all. (shrink)

The “Father of the United States Constitution,” James Madison, once described justice as “the end” of both government and of civil society. Yet curiously, Madison said little about justice in elaborating the principles of American federalism in The Federalist Papers and elsewhere. His fundamental concerns, to the contrary, were in contriving a system of separated, countervailing powers and in establishing a first federal principle of enumerated powers — in which federal powers “are few, and defined.” This strategy, for (...) Madison, was the most feasible way of checking the innate tendency of political power to accumulate, centralize, and trample on citizens’ liberties. (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)

The objective of the paper is to explore the issue that despite the absence of adequate formal and systematic ways for the poor and disadvantaged people to get access to health benefit like in a rich liberal society, there are active social customs, feelings and individual and collective responsibilities among the people that help the disadvantaged and poor people to have access to the minimum health care facility in both liberal and non-liberal poor countries. In order to (...) explain the importance and functional contribution of the social norms in this respect, some examples will be illustrated from Bangladesh which is a poor liberal country. There will be two sections of the paper. In the first section, it will be exhibited how the naturally and socially disadvantaged people in a liberal society get benefit following Rawls‟ theory of distributive justice. In the second section, it will be showed that in a poor country where there are less resources of the government to provide enough services to the poor and disadvantaged people, the communal feelings and the informal social institutions play a vital role that helps the disadvantaged and poor people to get access to the health benefit. The traditional social norms impose indirect sanction on its people to come forward to help the worse off people of the country. It is depicted that Rawlsian theory of distribution does not work properly in these countries, rather the communitarian feelings is more welcomed for the benefit of the overall welfare of the society and this will be shown in the conclusion of the paper. (shrink)

In the Netherlands, access to healthcare has been guaranteed by social health insurance legislation. But since the introduction of the Health Insurance Act in the 1960s, the health insurance system has been in a state of flux. Numerous reforms have changed the system gradually, of which the latest is the introduction of a competitive health insurance scheme for the entire population.Cutting across the various reforms has, however, been the goal of access to healthcare services as defined (...) by international treaty law, including European Union law. In particular the leverage of Community law in strengthening the patient’s right to healthcare is remarkable. Since the European Court of Justice has accepted that healthcare should be considered as a service in terms of the EC Treaty, rights to healthcare have become inextricably linked with the free movement principles and are no longer restricted to the jurisdiction of the country of origin. (shrink)

ABSTRACTIn The Netherlands, the public funding of a number of health care services is controversial. What can we learn from this about the moral concerns that underlie these judgements? And, if there is anything to learn, can we use this improved understanding to scrutinise the adequacy of particular decisions concerning the public funding of health care services? In the present paper, I will analyse three cases: corrective surgey, In Vitro Fertilisation and liver transplantation. I will summarise (...) the arguments that have been used to support or to challenge the public funding of these services. I will then assess the merits of Daniels’fair equality of opportunity account of justice in health care. Can this account improve our understanding of the moral concerns underlying our judgements about the public funding of these services? Can it serve to scrutinise the adequacy of particular decisions that are made concerning the public funding of health care services? My answer to both questions will be a qualified yes. Daniels’account can provide guidance, but not because we can deductively infer from it what is right and what is wrong. Instead, I will argue for a more casuistic use of the concept of fair equality of opportunity. (shrink)

ABSTRACT In The Netherlands, the public funding of a number of health care services is controversial. What can we learn from this about the moral concerns that underlie these judgements? And, if there is anything to learn, can we use this improved understanding to scrutinise the adequacy of particular decisions concerning the public funding of health care services? In the present paper, I will analyse three cases: corrective surgey, In Vitro Fertilisation and liver transplantation. I will (...) summarise the arguments that have been used to support or to challenge the public funding of these services. I will then assess the merits of Daniels’fair equality of opportunity account of justice in health care. Can this account improve our understanding of the moral concerns underlying our judgements about the public funding of these services? Can it serve to scrutinise the adequacy of particular decisions that are made concerning the public funding of health care services? My answer to both questions will be a qualified yes. Daniels’account can provide guidance, but not because we can deductively infer from it what is right and what is wrong. Instead, I will argue for a more casuistic use of the concept of fair equality of opportunity. (shrink)

Linkage arguments, which defend a controversial right by showing that it is indispensable or highly useful to an uncontroversial right, are sometimes used to defend the right to health care. This article evaluates such arguments when used to defend RHC. Three common errors in using linkage arguments are neglecting levels of implementation, expanding the scope of the supported right beyond its uncontroversial domain, and giving too much credit to the supporting right for outcomes in its area. A familiar (...) linkage argument for RHC focuses on its contributions to the right to life. Among the problems with this argument are that it requires a positive conception of the right to life that is not uncontroversial and that it only justifies the subset of RHC that seeks to prevent loss of life. A linkage argument for RHC with better prospects claims that a well-realized right to health care enhances the realization of a number of uncontroversial rights. (shrink)

El derecho a migrar, como el derecho a la salud del migrante, se encuentran reconocidos en la Ley de Migraciones Nro. 25871/2003 de Argentina. Dicha ley constituye un avance legislativo en derechos humanos; resultado de un largo proceso constituyente, deliberativo, que dio lugar a un modelo inclusivo de migración sin precedentes internacionales en su momento. Sin embargo, recientemente asistimos a un giro en políticas migratorias (DNU 70/2017). Como consecuencia, se produce un retroceso en derechos sociales y políticos. En lo que (...) hace al derecho a la salud, la instauración de políticas neoconservadoras (Cobertura Universal de la Salud –CUS-) impulsó leyes provinciales (Ley 6119/2019) destinadas a exigir seguros pagos de salud para migrantes, contrarios a nuestra constitución. El objetivo del presente trabajo es analizar las raíces de éstos cambios en las normativas citadas sobre migraciones y salud; aplicando un marco de justicia social que nos permita comprender, críticamente, cómo la bifurcación de políticas distributivas y de reconocimiento en las mismas legislaciones habilitó el desarrollo de políticas neoconservadoras impuestas a través de decretos autoritarios; cuyas consecuencias trascienden la esfera de los migrantes, haciendo peligrar al mismo sistema de salud argentino como bien público. (shrink)

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)

Vulnerability is a broad concept widely addressed in recent scholarly literature. Lesbian, gay, bisexual, and transgender people are among the vulnerable populations with significant disadvantages related to health and the social determinants of health. Medical ethics discourse tackles vulnerability from philosophical and political perspectives. LGBT people experience several disadvantages from both perspectives. This article aims to justify the right to health for LGBT people and their particular claims regarding healthcare because they belong to a vulnerable group. Rawls’ (...) theory of justice and Norman Daniels’ normal functioning approach will be discussed in this context. Despite the fact that the right to health can be justified by Daniels’ normal functioning approach, there is still a theoretical gap in justifying the right to health for particular vulnerable populations such as LGBT peopleand discussing society’s duty to compensate for these disadvantages. In search of solid theoretical grounds for the justification of the right to health for LGBT people, the present author takes the opportunity to utilize Daniels’ flexible definition of normal functioning to show that normal functioning not only varies by age but also by different states of human existence, including sexual orientation and gender identity, and to propose replacing the life span approach with normal states of human existence. (shrink)

This book is a collection of essays on various problems arising in connection with John Rawls's theory of justice. Its focus is the method of wide reflective equilibrium. The first half of the book begins with Daniels's well-known essay "Wide Reflective Equilibrium and Theory Acceptance in Ethics" and ends with an excellent discussion of the role of reflective equilibrium in Rawls's Political Liberalism. The essays in the second part discuss justice in health care. They are of (...) interest in their own right, and also as illustrating Daniels's view that for those practicing the method of reflective equilibrium, applied moral philosophy is integral to the process of moral theorizing. Daniels says that the essays do not constitute a systematic treatment of wide reflective equilibrium. But they display a much higher degree of thematic coherence than is usual in a collection, and they read much like the chapters of a monograph. (shrink)

Norman Daniels' proposal to distribute health care on the basis of fair equality of opportunity is, in this writer's opinion, unworkable. His concepts of species-typical activity and normal opportunity range are unclear; so is the relationship between them. His view that justice accords disease a better claim on the health dollar than other causes of death, pain and disability, commits him unknowingly to the indefensible positions on particular sorts of health issues, such as the (...) class='Hi'>care of the aging and of pregnant women. Daniels' concept of opportunity is so inclusive, his notion of balancing opportunities so vague, that his theory loses systematic power. I offer a different account from Daniels' concerning why health care needs are objective and of special importance. I also argue for a voucher system which levels out class inequalities and which finances current medical practices more or less uncritically, but allows for change through a diversity of insurance plans available to consumers. This system is just, and more practical than rating health care needs by impact on opportunity. Keywords: justice, right to health care, equality, opportunity CiteULike Connotea Del.icio.us What's this? (shrink)

The argument has been made that future generations of human beings are being harmed unjustifiably by the actions individuals commit today. This paper addresses what it might mean to harm future generations, whether we might harm them, and what our duties toward future generations might be. After introducing the Global Health Impact (GHI) concept as a unit of measurement that evaluates the effects of human actions on the health of all organisms, an incomplete theory of human justice (...) is proposed. Having shown that the negative GHIs of our current generation cause unfair harm to future generations, I argue that each human being must be allocated a fair threshold of negative GHIs that should not be exceeded. By emphasising the need to consider all the GHIs of human actions, the theory of human justice developed here is highly relevant to evaluate human actions that might affect future generations, for example those related to climate change. (shrink)

During the COVID‐19 pandemic, national triage guidelines were developed to address the anticipated shortage of life‐saving resources, should ICU capacities be overloaded. Rationing and triage imply that in addition to individual patient interests, interests of population health have to be integrated. The transfer of theoretical and empirical knowledge into feasible and useful practice models and their implementation in clinical settings need to be improved. This paper analyzes how triage protocols could translate abstract theories of distributive justice into (...) concrete material and procedural criteria for rationing intensive care resources during a pandemic. We reconstruct the development and implementation of a rationing protocol at a German university hospital: describing the ethical challenge of triage, clarifying the aspirational norms, and summarizing specific norms of fair triage and allocation for developing an institutional policy and practice model and implementing it. We reflect on how critical topics are seen by clinicians and what helped manage the perceived burdens of the triage dilemma. We analyze what can be learned from this debate regarding the difficult issues around triage protocols and their potential implementation into clinical settings. Analyzing the ought‐to‐is gap of triage, integrating abstract ethical principles into practical concepts, and evaluating those should clarify the benefits and risks of different allocation options. We seek to inform debates on triage concepts and policies to ensure the best possible treatment and fair allocation of resources as well as to help protect patients and professionals in worst‐case scenarios. (shrink)

Health-care goods are goods with peculiar properties, and where they are scarce, societies face potentially explosive distributional conflicts. Animated public and academic debates on the necessity and possible justice of limit-setting in health care have taken place in the last decades and have recently taken a turn toward procedural rather than substantial criteria for justice. This article argues that the most influential account of procedural justice in health-care rationing, presented by Daniels (...) and Sabin, is indeterminate where concrete properties of rationing institutions are concerned. Such properties inscribe substantial norms into institutions. These norms can derive validity only from democratic majority decisions, which must be seen as an instance of pure procedural justice. We therefore have to move the discussion to a meta-level and ask how concrete properties of institutions are being chosen. I suggest four criteria for sufficiently democratic institutional design choice and conclude that as institutional properties are likely to have effects on the resulting distribution of health care, design choices should be empirically informed and taken both democratically and deliberately. (shrink)

Forty years ago, in his landmark work A Theory of Justice, John Rawls depicted a just society as a fair system of cooperation between citizens, regarded as free and equal persons. Justice, Rawls famously claimed, ought to be “the first virtue of social institutions.” Ever since then, moral and political philosophers have expanded, expounded or criticized Rawls’s main tenets, from perspectives as diverse as egalitarianism, left and right libertarianism, and the ethics of care. The most important and (...) influential views in this ‘post-Rawlsian’ era constitute the focus of this volume, which seeks to give a general picture of the main strands in contemporary justice theorizing, as well as addressing more recent developments, especially regarding methodological issues. How to build a theory of justice and how to delineate its proper scope; the relationship between justice and equality, justice and liberty, and justice and desert; and the critique of the Rawlsian paradigm especially from the feminist perspective and from the growing strand of non-ideal theory are the main topics addressed in this selection of essays. (shrink)

The further development of public health ethics will be assisted by a more direct engagement with political theory. In this way, the moral vocabulary of the liberal tradition should be supplemented—but not supplanted—by different conceptual and normative resources available from other traditions of political and social thought. This article discusses four lines of further development that the normative conceptual discourse of public health ethics might take. The relational turn. The implications for public health ethics of the new (...) ‘ecological’ or ‘relational’ interpretation that is emerging for concepts such as agency, self-identity, autonomy, liberty and justice. Governing the health commons. The framework of collective action problems is giving way to notions of democratic governance and management of common resources. The concept of membership. Membership is specified by the notions of equal respect and parity of voice and agency. The concept of mutuality. Mutuality is specified by the notions of interdependent concern and care. (shrink)

This volume offers a carefully argued, compelling theory of bioethics while eliciting practical implications for a wide array of issues including medical assistance-in-dying, the right to health care, abortion, animal research, and the definition of death. The authors' dual-value theory features mid-level principles, a distinctive model of moral status, a subjective account of well-being, and a cosmopolitan view of global justice. In addition to ethical theory, the book investigates the nature of harm and autonomous action, personal identity (...) theory, and the 'non-identity problem' associated with many procreative decisions. Readers new to particular topics will benefit from helpful introductions, specialists will appreciate in-depth theoretical explorations and a novel take on various practical issues, and all readers will benefit from the book's original synoptic vision of bioethics. This title is also available as Open Access on Cambridge Core. (shrink)

The singular message in Global Health Law is that we must strive to achieve global health with justice—improved population health, with a fairer distribution of benefits of good health. Global health entails ensuring the conditions of good health—public health, universal health coverage, and the social determinants of health—while justice requires closing today’s vast domestic and global health inequities. These conditions for good health should be incorporated into public (...) policy, supplemented by specific actions to overcome barriers to equity. A new global health treaty grounded in the right to health and aimed at health equity—a Framework Convention on Global Health —stands out for its possibilities in helping to achieve global health with justice. This far-reaching legal instrument would establish minimum standards for universal health coverage and public health measures, with an accompanying national and international financing framework, require a constant focus on health equity, promote Health in All Policies and global governance for health, and advance the principles of good governance, including accountability. While achieving an FCGH is certainly ambitious, it is a struggle worth the efforts of us all. The treaty’s basis in the right to health, which has been agreed to by all governments, has powerful potential to form the foundation of global governance for health. From interpretations of UN treaty bodies to judgments of national courts, the right to health is now sufficiently articulated to serve this role, with the individual’s right to health best understood as a function of a social, political, and economic environment aimed at equity. However great the political challenge of securing state agreement to the FCGH, it is possible. States have joined other treaties with significant resource requirements and limitations on their sovereignty without significant reciprocal benefits from other states, while important state interests would benefit from the FCGH. And from integrating the FCGH into the existing human rights system to creative forms of compliance and enforcement and strengthened domestic legal and political accountability mechanisms, the treaty stands to improve right to health compliance. The potential for the FCGH to bring the right to health nearer universal reality calls for us to embark on the journey towards securing this global treaty. (shrink)

This paper develops the traditional Jewish understanding of justice (tzedakah) and support for the needy, especially as related to the provision of medical care. After an examination of justice in the Hebrew Bible, the values and institutions of tzedakah in Rabbinic Judaism are explored, with a focus on legal codes and enforceable obligations. A standard of societal responsibility to provide for the basic needs of all, with a special obligation to save lives, emerges. A Jewish view of (...) justice in access to health care is developed on the basis of this general standard, as well as explicit discussion in legal sources. Society is responsible for the securing of access to all health care needed by any individual. Elucidation of this standard of need and corresponding societal obligations, and the significance of the Jewish model for the contemporary United States, are considered. (shrink)

This year marks the centenary of John Rawls's birth and the fiftieth anniversary of the publication of A Theory of Justice. The influence of Rawls's landmark book on the general fields of moral and political philosophy is undisputed and well-documented. It has also left a significant imprint on debates surrounding health policy, health care, and health inequalities. This article traces the changing ways in which Rawls's theory influenced debates about justice in health over (...) the last five decades. Just as Rawls's ideas have shaped debates about health, however, these debates can help us critically appraise the theory and its limitations. In that spirit, the article sketches three areas where a focus on health reveals challenges to the Rawlsian framework: the issue of priority setting among competing goods, the theory's egalitarian commitments, and its focus on the distribution of goods. (shrink)

Regulation and clinical practices regarding end of human life care differ among the nations and countries. These differences reflect the history of the development of state health systems, different societal values, and different understandings of dignity and what it means to protect or respect dignity. The result is variation in the ethical, legal, and practical approaches to end-of-life issues. The article analyzes the diversity of strategies to strengthen dignity at the end of life of terminally ill patients and (...) to highlight the legal preconditions and limitations for implementing these strategies in independent Lithuania, as a former state of the Soviet Union. It is based on the critical analysis of philosophical literature, legal national and international documents and scientific evidence related to the issue. The author argues that the legal system in Lithuania is not sufficient to ensure the patient’s dignity at the end of life and remains far behind other Western European countries. Legal regulations in Lithuania do not guarantee the right of the patient to express his or her will regarding the future treatment, including the refusal of resuscitation, do not regulate the termination of burdensome, non-viable and meaningless treatment that is undesired by the patient, and limit the accessibility of palliative care with its necessary quality and comfort. (shrink)

In recent years, there has been increasing recognition of both the philosophical questions engendered by the idea of a human right to health and the potential of philosophical analysis to help in the formulation of better policy. In this article, I attempt to locate recent work on the moral right to health in a number of historically established conceptions, with the aim of providing a map of the conceptual landscape as to the claims expressed by such a right.

If now we turn to the recent translation of the Politics by Carnes Lord we see that the language of "rights" is completely avoided. Lord prefers to speak sometimes in terms of what a person or group of persons is "entitled to" under the laws, or of what is "open" or "permitted" to them; and he usually or always sticks to "justice" or a related term to translate δίκαιον and its derivatives--whether this is justice as established by (...) the laws of a given community or type of community, or the true or correct account of what justice is and demands. It is doubtful, though, whether Lord avoids rights-talk as a matter of interpretative principle. He aims to translate key terms of the Greek with a single English translation throughout, with the result that, since in any event Aristotle uses no single Greek term where we might be tempted to speak of rights, avoiding the language of rights may have seemed to him required simply by his conception of "literal" translation. In his glossary under the heading "Justice," he explicates τὸ δίκαιον in part as "a right or rightful claim" and adds that this sense is generally rendered in his translation by "[claim to] justice." So, if we take this glossary entry as giving his full view, Lord would not object to at least interpreting Aristotle in these passages as speaking of rights or rightful claims. However, Lord is a follower of Leo Strauss and in his avoidance of the noun "right" to render anything Aristotle says, he may also have been falling in with Strauss's own considered view, which was that any attribution of a notion of "rights" to Aristotle or any other ancient thinker is so grossly anachronistic that it must be strictly avoided. In the past forty years or so I think it is fair to say that this view of Strauss's has been shared increasingly by important writers on ancient politics and political thought. Perhaps this tendency is all the more prevalent with the onset of self-described "post-modernist" thought and the historicism in all interpretation of the past that it so often connotes. Is there anything to this objection of vicious anachronism? Were Barker and other older writers making a serious error in rendering and interpreting Aristotle so as to make him hold theories about various ancient constitutions as granting political and other legal rights to people living under them, and also theories of his own about the rights people have under justice as to what their political and legal rights shall be? A major thesis of Fred Miller's recent book, Nature, Justice, and Rights in Aristotle's Politics is that they were not--at least they were not, once certain distinctions are carefully drawn, and one is careful to state what is and what is not implied by the "rights" talk they were so readily finding in Aristotle's texts. In what follows I will limit myself to discussing this thesis of Miller's and his handling of it. (shrink)

This paper reflects on Lawrence Gostin’s Global Health Law. In so doing seeks to contribute to the debate about how global health justice is best conceived and achieved. Gostin’s vision of global health is one which is communal and in which health is directly connected to other justice concerns. Hence the need for health-in-all policies, and the importance of focusing on basic and communal health goods rather than high-tech and individual ones. This (...) paper asks whether this broadly communal vision of global health justice is best served by making the right to health central to the project. It explores a number of reasons why rights-talk might be problematic in the context of health justice; namely, structurally, rights are individual and state-centric and politically, they are oppositional and better suited to single-issue campaigns. The paper argues that stripping rights of their individualist assumptions is difficult, and perhaps impossible, and hence alternative approaches, such as those Gostin endorses based on global public goods and health security, might deliver much, perhaps most, global health goods, while avoiding the problems of rights-talk. (shrink)