论丹尼尔斯医疗保健公正理论

诺曼·丹尼尔斯将罗尔斯的正义理论应用到医疗资源分配公正领域,他的理论认为医疗保健的道德重要性就在于它保护正常的功能从而保护机会,平等机会不仅提供医疗保健权利的基础,它也帮助我们确定这个权利的承诺限度。此外我们应该依靠公平的程序达到医疗保健公正的分配。     

Justice, health, and healthcare

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 of rationing care. This account is provided by three conditions that comprise "accountability for reasonableness."     

Justice as Fairness: Luck Egalitarian, Not Rawlsian

I assess G. A. Cohen’s claim, which is central to his luck egalitarian account of distributive justice, that forcing others to pay for people’s expensive indulgence is inegalitarian because it amounts to their exploitation. I argue that the forced subsidy of such indulgence may well be unfair, but any such unfairness fails to ground an egalitarian complaint. I conclude that Cohen’s account of distributive justice has a non-egalitarian as well as an egalitarian aspect. Each impulse arises from an underlying commitment to fairness. Cohen’s account of distributive justice is therefore one of justice as fairness.     

Global Distributive Justice

The paper discusses the problem of global distributive justice. It proposes to distinguish between principles for the domestic and for the global or intersocietal distribution of wealth. It is argued that there may be a plurality of partly diverging domestic conceptions of distributive justice, not all of which need to be liberal egalitarian conceptions. It is maintained, however, that principles regulating the intersocietal distribution of wealth have to be egalitarian principles. This claim is defended against Rawls's argument in The Law of Peoples that egalitarian principles of distributive justice should not be applied globally. Moreover, it is explained in detail, why Rawls's "duty of assistance to burdened societies" cannot be an appropriate substitute for a global principle of distributive justice.     

Can Norman Daniels Help You Get a Wheelchair? A Commentary on Durocher et al.

Durocher and colleagues (2019) argue that Norman Daniels’s notion of just health could provide a useful framework for decreasing inequities in access to assistive technology. I argue that it would provide limited help for two reasons. First, Daniels’s reliance on normal species functioning as the goal of health care and his assumptions regarding the impact of normal species functioning on reasonable life projects create substantial difficulties for application to assistive technology. Second, although Daniels’s requirements for distributive justice provide a critical starting point for any discussion of health equity, these requirements appear already met within current assistive technology funding schemes.     

Distributive Justice and Co-Operation in a World of Humans and Non-Humans: A Contractarian Argument for Drawing Non-Humans into the Sphere of Justice

Various arguments have been provided for drawing non-humans such as animals and artificial agents into the sphere of moral consideration. In this paper, I argue for a shift from an ontological to a social-philosophical approach: instead of asking what an entity is, we should try to conceptually grasp the quasi-social dimension of relations between non-humans and humans. This allows me to reconsider the problem of justice, in particular distributive justice. Engaging with the work of Rawls, I show that an expansion of the contractarian framework to non-humans causes an important problem for liberalism, but can be justified by a contractarian argument. Responding to Bell’s and Nussbaum’s comments on Rawls, I argue that we can justify drawing non-humans into the sphere of distributive justice by relying on the notion of a co-operative scheme. I discuss what co-operation between humans and non-humans can mean and the extent to which it depends on properties. I conclude that we need to imagine principles of ecological and technological distributive justice.     

Preferences for Online Mental Health Services Among Australian and Indian Samples: A Cross-Cultural Comparison

Online mental health services provide a point-of-access to mental healthcare that may otherwise be unavailable or limited, particularly in developing countries. Nevertheless, there is a lack of research into individual differences between those who prefer online mental health services and those who prefer traditional in-person services, and whether these differences vary as a function of culture. This study investigated differences in preferences for online or in-person mental health services on e-health literacy, age, education level, and comfort using the internet in a general community sample recruited from Australia and India. A total of 487 participants (31.6% male; mean age?=?33.55, SD?=?12.20, range 18–78), 297 Australians and 190 Indians, completed an online or paper-and-pencil survey. A significant negative relationship between age and e-health literacy was found with younger ages associated with higher e-health literacy. Furthermore, e-health literacy scores were significantly higher for the Australian sample. Age, e-health literacy, country-of-residence, education level, and comfort in using the internet did not predict mental health service preference. The results suggest that preference for in-person or online mental healthcare is independent of demographic and cultural factors and indicate that online mental health services may be acceptable to Indian health service consumers.     

Global Justice: Is Interventionalism Desirable?

In 1994, the European Parliament published a resolution on the right of humanitarian intervention. Interestingly, the declaration maintains that such intervention is not in contradiction with international law, although it formulates the concept of right in a way that is translatable into the vocabulary of individual rights. I analyze some implications of the resolution for the mutual duties of states. I thereby focus my attention on two possible applications: by way of Rawls's duty of assistance and by way of the cosmopolitan theory of global distributive justice. I conclude that the latter theory promises better results for protecting individuals' basic rights, but I also show that it is at the cost of a strongly interventionist structure requiring a powerful supranational institution. Finally, I envision the conditions under which such an increase of interventionism in favor of human rights can be acceptable.     

Précis of Justice,Luck, and Knowledge*

Justice, Luck, and Knowledge (JLK) contributes to recent developments in two areas, moral responsibility and distributive justice. Prominent luck‐neutralizing approaches to distributive justice, exemplified in work by Cohen and by Roemer, argue that justice requires equal distribution of goods for which people aren't responsible. Such views of justice haven't focused attention on responsibility itself. Meanwhile, responsibility has been illuminat‐ingly articulated in work including, and influenced by, Frankfurt's seminal essays. My book brings these separate lines of work, on justice and on responsibility, into contact, examining how the new articulation of responsibility constrains the roles responsibility can play in distributive justice. Part I focuses on responsibility and its inverse correlate, luck; Part II assesses responsibility‐based approaches to justice in light of preceding arguments about responsibility. (See JLK, 4–5 on responsibility, reactive attitudes, and accountability.)     

Nationality, Distributive Justice and the Use of Force

To whom do we owe obligations of distributive justice? In the last decade a number of distinguished political theorists — such as David Miller and Yael Tamir — have defended a nationalist account of our distributive obligations. This paper examines their account of distributive justice. In particular, it analyses their contention (a) that individuals owe special obligations to fellow-nationals, (b) that these obligations are obligations of distributive justice and (c) that these obligations are enforceable. Miller and Tamir's justifications, I argue, do not support these claims. Moreover, I argue, (a) and (c) should only be accepted in a greatly qualified form and (b) should be rejected altogether. The paper thus concludes that the nationalists' preferred account of distributive justice is untenable.     

The Legal and Ethical Fiction of “Pure” Confidentiality

In the newly emerging debates about genetics and justice three distinct principles have begun to emerge concerning what the distributive aim of genetic interventions should be. These principles are: genetic equality, a genetic decent minimum, and the genetic difference principle. In this paper, I examine the rationale of each of these principles and argue that genetic equality and a genetic decent minimum are ill-equipped to tackle what I call the currency problem and the problem of weight. The genetic difference principle is the most promising of the three principles and I develop this principle so that it takes seriously the concerns of just health care and distributive justice in general. Given the strains on public funds for other important social programmes, the costs of pursuing genetic interventions and the nature of genetic interventions, I conclude that a more lax interpretation of the genetic difference principle is appropriate. This interpretation stipulates that genetic inequalities should be arranged so that they are to the greatest reasonable benefit of the least advantaged. Such a proposal is consistent with prioritarianism and provides some practical guidance for non-ideal societies–that is, societies that do not have the endless amount of resources needed to satisfy every requirement of justice.     

The genetic difference principle

In the newly emerging debates about genetics and justice three distinct principles have begun to emerge concerning what the distributive aim of genetic interventions should be. These principles are: genetic equality, a genetic decent minimum, and the genetic difference principle. In this paper, I examine the rationale of each of these principles and argue that genetic equality and a genetic decent minimum are ill-equipped to tackle what I call the currency problem and the problem of weight. The genetic difference principle is the most promising of the three principles and I develop this principle so that it takes seriously the concerns of just health care and distributive justice in general. Given the strains on public funds for other important social programmes, the costs of pursuing genetic interventions and the nature of genetic interventions, I conclude that a more lax interpretation of the genetic difference principle is appropriate. This interpretation stipulates that genetic inequalities should be arranged so that they are to the greatest reasonable benefit of the least advantaged. Such a proposal is consistent with prioritarianism and provides some practical guidance for non-ideal societies--that is, societies that do not have the endless amount of resources needed to satisfy every requirement of justice.     

Rawlsian Justice and the Social Determinants of Health

In this article, we suggest that the evidence regarding the social determinants of health calls for a deep re‐thinking of our understanding of distributive justice. Focusing on John Rawls's theory of distributive justice in particular, we argue that a full reckoning with the social determinants of health requires a re‐working of Rawls's principles of justice. We argue first that the social bases of health – a Rawlsian conception of the social determinants of health – should be considered a social primary good. We argue second that including the social bases of health as a social primary good would lead the parties to the original position to choose an additional principle of justice and assign it lexical priority over Rawls's second principle. According to this principle, inequalities in people's share of the social bases of health are to be arranged so as to improve the health status of those least advantaged on the social health gradient.     

Realizing Honneth: redistribution,recognition, and global justice

The purpose of this article is to explore the potential contribution of Axel Honneth's critical theory of recognition to empirical and normative debates on global justice. I first present, very briefly, an overview of recent theories of global distributive justice. I argue that theorists of distributive justice do not pay enough attention to sources of self-respect and conditions for identity formation, and that they are blind toward the danger of harming people's sense of self even by well-intentioned redistributive policies. Honneth's theory suffers from complementary shortcomings; it is anti-technocratic but largely oblivious to the global nature of many contemporary justice claims. Given this situation, I seek to broaden the theory's scope by outlining transnational extensions of the recognition principles of love, rights and solidarity identified by Honneth. In conclusion, I show how utilizing a broadened conceptualization of the struggle for recognition allows us to better understand the changing logic of justice-oriented foreign policies.     

A Theory of Providence for Distributive Justice

Distributive justice assumes a morally critical judgment of nature, which typically contradicts providential conceptions. Hence, simple conceptions of divine Providence cannot support distributive justice. This essay analyzes and develops a complex strand of theorizing about Providence within Jewish philosophy that is compatible with distributive justice. According to this conception, the actions of divine Providence express different and mutually exclusive considerations of justice. Therefore, the moral value of outcomes is intransitive between the situations of different people. And while each providential action is justified from an ethical perspective, the total outcome is distinct from God's ultimate desire. Human ethics responds to this disparity by redistribution. This conception of Providence also contributes to the additional issue of intergenerational justice through the concomitant idea of life missions. The classical rendering of missions creates problems, however, for distributive justice. I conclude by formulating a conception of life missions that is compatible with both distributive and intergenerational justice.     

Distributive Justice and Clinical Trials in the Third World

One of the arguments against conducting human subject trials inthe Third World adopts a distributive justice principle found ina commentary of the CIOM'S Eighth Guideline for internationalresearch on human subjects. Critics argue that non-participantmembers of the community in which the trials are conducted areexploited because sponsoring agencies do not ensure that theproducts developed have been made reasonably available to theseindividuals.I argue that the distributive principle's wording is too vagueand ambiguous to be used to criticize any trial. Furthermore,the mere fact that an experiment does not fulfill this particulardistributive justice principle does not entail that it isunethical.     

Justice,Health, and Healthcare

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."     

Natural Duties of Justice in a World of States

The agency objection to applying distributive justice globally is that principles of distributive justice need to apply to the behaviour of a special kind of institutional agent of distributive justice because of the special powers of that agent. No such agent exists capable of configuring cooperative arrangements between all persons globally, and so distributive justice does not apply globally. One response to institutional views of this kind is that they do not rule out Natural Duties of Justice that fall on all of us to bring about institutional agencies capable of global distributive justice. In this article I argue that this move presupposes a particular, teleological, conception of justice whilst institutional accounts most plausibly rest on a non‐teleological one. I provide an argument for favouring the non‐teleological conception. I also show why alternative ways of arguing for global Natural Duties of Justice do not get around this controversy. The debate is at the level of presuppositions about justice, and relying on a partisan conception is question begging.     

Smilansky, Arneson, and the asymmetry of desert

Desert plays an important role in most contemporary theories of retributive justice, but an unimportant role in most contemporary theories of distributive justice. Saul Smilansky has recently put forward a defense of this asymmetry. In this study, I argue that it fails. Then, drawing on an argument of Richard Arneson’s, I suggest an alternative consequentialist rationale for the asymmetry. But while this shows that desert cannot be expected to play the same role in distributive justice that it can play in retributive justice, it does not fully vindicate the asymmetry, since desert can still play an important role in the former.     

The Significance of the Concept of Disease for Justice in Health Care

In this paper, I want to scrutinise the value of utilising the concept of disease for a theory of distributive justice in health care. Although many people believe that the presence of a disease-related condition is a prerequisite of a justified claim on health care resources, the impact of the philosophical debate on the concept of disease is still relatively minor. This is surprising, because how we conceive of disease determines the amount of justified claims on health care resources. Therefore, the severity of scarcity depends on our interpretation of the concept of disease. I want to defend a specific combination of a theory of disease with a theory of distributive justice. A naturalist account of disease, together with sufficientarianism, is able to perform a gate-keeping function regarding entitlements to medical treatment. Although this combination cannot solve all problems of justice in health care, it may inform rationing decisions as well.