Abstract

Philosophers tend to construe the relation between justice and health in terms of the distribution of access to the existing health care system. However, significant patterns of injustice in the context of medicine, such as the function of health care as a form of social control, are overlooked in this approach. I employ perspectives of the AIDS and women's health movements to argue that the cultural authority of medicine must be morally evaluated, along with cultural aspects of oppression not fully captured by the distributive paradigm of justice. Medical discourse and practice contain implicit norms which stigmatize lesbians, gay men, bisexuals, and heterosexual women. I examine ways in which the epistemic principle of objectivity, conceived as detachment, is central both to medical discourse and to mainstream concepts of justice; in both discourses this principle can be seen to produce distortions and to undermine the interests of oppressed groups. Important theories of access to health care fail to adequately address the needs of women and of gay and bisexual men, replicating some of the biases found in medical discourse. The standard distinction between naturally-based and socially-based goods obscures social influences on individual health, and presents culturally constituted differences between social groups as "facts of nature." Standard theories also emphasize procreation over nonreproductive sexuality. I conclude that justice in health requires much deeper changes than access to health care; and that bioethics must attend to social group difference as a central aspect of analysis.