关注健康公平,保障健康权益

在卫生改革与发展的过程中,健康公平与健康权益的问题不断引出争论,而且,出现的许多新问题也都与健康公平相关.获得基本医疗服务对于全体居民来说,并不仅仅具有提高劳动力素质的意义,而且还是人们充分发挥自身潜力的一个前提,是人们参与社会经济政治决策过程的一个前提,有着超出个人投资回报的社会效益.因此,在卫生改革过程中应该关注健康公平,合理保护居民的健康权益.     

Moral Uncertainty and Distributive Sufficiency

According to the sufficiency principle, distributive justice requires that everyone have some sufficient level of resources or well-being, but inequalities above this threshold have no moral significance. This paper defends a version of the sufficiency principle as the appropriate response to moral uncertainty about distributive justice. Assuming that the appropriate response to moral uncertainty is to maximize expected choiceworthiness, and given a reasonable distribution of credence in some familiar views about distributive justice (including libertarianism, sufficientarianism, and egalitarianism), a version of the sufficiency principle strikes the optimal balance between the competing moral risks posed by implementing these views. In particular, it avoids the moral risk posed by views like Nozick’s libertarianism, which forbid redistributive taxation even for the sake of helping to provide for people’s basic needs: failing to do the latter, if it turns out that justice does require it, would be very morally wrong. This “uncertainty argument” has the advantage of minimizing reliance on controversial intuitions about distributive justice, helps to specifying a non-arbitrary threshold for sufficiency, and shows that the substantive moral implications of moral uncertainty are not limited to high-stakes applied ethics issues such as abortion and vegetarianism but instead extend to an issue at the heart of political philosophy.

     

The Leverage Approach for Sufficiency?

Sufficiency principles generally state that it is especially important for justice that people have enough of certain goods, but it can be hard to give a convincing answer as to what level of goods counts as enough. This paper examines a recent sufficiency view by George Sher (2014), who argues that the threshold level of resources and opportunities that the state should provide for each citizen is whatever level gives one enough leverage to obtain further resources and opportunities without inordinate difficulty or sacrifice. The argument relies on the idea that, with regard to resources and opportunities, the sufficient ability to live one’s life effectively requires only that one have enough of them as leverage. While Sher’s general account regarding “what counts as enough?” is promising in countering certain challenges typically raised against sufficiency principles, the approach to determine the threshold of resources and opportunities in terms of leverage is problematic.     

Reframing capabilities between welfarism and resourcism in the collaboration for the right to health

Since the Constitution of the World Health Organization (1946) and the Universal Declaration of Human Rights (1948) were drafted, two broad approaches to the human right to health have been prominent: the health-in-itself approach (WHO)—a kind of welfarism—and the standard-of-living approach (UDHR)—a kind of resourcism. More recently, the capabilities approach to human development has provided a viable third alternative. This article reframes the idea of human capabilities to health as a mediating baseline between welfarism and resourcism so that, first, the main strengths of both of these parent approaches are retained. Second, the emerging dialogical capabilities approach (DCA) opens up smoothly towards collaboration among faith-based approaches within human rights thought and law. While DCA allows a broad diversity of foundational understandings of the human right to health, it supports the need for a high-level practical consensus in terms of human rights. But if the capabilities approach is understood as sharply contrasted to either welfarism or resourcism, or if it is grounded in an exclusively secular manner, it risks becoming a peculiarly narrow agenda that could hardly serve as a conceptual baseline for the collaborative promotion of the human right to health.     

Just health care (II): Is equality too much?

In a previous essay I criticized Engelhardt's libertarian conception of justice, which grounds the view that society's obligation to assure access to adequate health care for all is a matter of beneficence [1]. Beneficence fails to capture the moral stringency associated with many claims for access to health care. In the present paper I argue that these claims are really matters of justice proper, where justice is conceived along moderate egalitarian lines, such as those suggested by Rawls and Daniels, rather than strong egalitarian lines. Further, given the empirical complexity associated with the distribution of contemporary health care, I argue that what we really need to address the relevant policy issues adequately is a theory of health care justice, as opposed to an all-purpose conception of justice. Daniels has made an important start toward that goal, though there are some large policy areas which I discuss that his account of health care justice does not really speak to. Finally, practical matters of health care justice really need to be addressed in a ‘non-ideal’ mode, a framework in which philosophers have done little.     

Is Social Justice Relative When It Comes to Oral Health? The Realities of a Complex Health Issue

For decades pastoral theology has emphasized care for the whole person and, more recently, this focus has been expanded to include caring for the physical health of parishioners. However, an overlooked area of general fitness has been the importance of oral health. Dental caries and periodontal disease are among the most common chronic diseases that disproportionately affect the most vulnerable populations. Despite significant progress in preventing and managing these oral diseases, there is a large segment of the population that have not experienced the same gains. This paper seeks to begin to fill this gap by identifying key epidemiological, professional and ethical issues related to social justice and oral health. Disparities of oral disease and access to oral health care in the United States will be addressed by examining questions and issues related to social justice. Critical problems are identified, including inadequate financial resources, a disjointed infrastructure of care, separation from the general medical care system, and poor understanding of important oral health determinants. Furthermore, if oral health is integral to one’s overall health and general well-being, then the concept of a basic human right should be entertained. Faith-based groups could provide a link for bridging this disparity gap in oral health among their parishioners through active listening, advocacy and targeted educational programs.     

Sufficiency and Satiable Values

This article identifies value‐satiability sufficientarianism as a distinctive version of the sufficiency view, which has been ignored in the literature on distributive justice. This is unfortunate because value‐satiability sufficientarianism is much better equipped than alternative sufficiency views to cope with the standard objections against sufficiency. Most often, sufficientarianism refers to satiability as a feature of moral principles and reasons. But value‐satiability sufficientarianism also invokes satiability in the space of value‐theory, as it determines the sufficiency threshold at the point where justice‐relevant values have been completely fulfilled. The article gives examples of how this view is widely apparent in the literature, and it provides some reasons in its favour. It then presents the two standard objections against sufficientarianism – the threshold objection and the indifference objection – and argues that these critiques do not apply to value‐satiability sufficientarianism. The general argument of the article therefore proves sufficientarianism more difficult to refute than is commonly credited.     

Raz on the Right to Autonomy

Abstract: In The Morality of Freedom, Joseph Raz argues against a right to autonomy. This argument helps to distinguish his theory from his competitors'. For, many liberal theories ground such a right. Some even defend entirely autonomy‐based accounts of rights. This paper suggests that Raz's argument against a right to autonomy raises an important dilemma for his larger theory. Unless his account of rights is limited in some way, Raz's argument applies against almost all (purported) rights, not just a right to autonomy. But, on the traditional way of limiting accounts like his, Raz's account actually supports the conclusion that people have a right to autonomy. So, unless there is another way of limiting his account that does not have this consequence, Raz's argument against a right to autonomy does not go through.     

The Human Right to Free Internet Access

In 2016, the United Nation's General Assembly adopted a non-binding resolution regarding ‘The Promotion, Protection and Enjoyment of Human Rights on the Internet’. At the heart of this resolution is the UN's concern that rights that people have offline must also be protected online. While the UN thus recognises the importance of the Internet, it problematically does so selectively by focusing on protecting existing offline rights online. I argue instead that Internet access is itself a moral human right that requires that everyone has unmonitored and uncensored access to this global medium, which should be publicly provided free of charge for those unable to afford it. Rather than being a mere luxury, Internet access should be considered a universal entitlement because it is necessary for people to be able to lead minimally decent lives. Accepting this claim transforms our conception of the Internet from a technology to that of a basic right.     

Gratuity,Embodiment, and Reciprocity

Protestant Christian ethicist Timothy Jackson and secular feminist philosopher Eva Feder Kittay each explore the relationship between love or care and justice through the lens of human dependency. Jackson sharply prioritizes agape over justice, whereas Kittay articulates a more complex and integrated understanding of the relationship of care and distributive justice. An account of Christian love and its relation to justice must account for the gratuity, mutuality, and reciprocity that pervade human existence. Such an account must integrate provision for another's basic needs, a feature of agape, with a distributive justice that fairly allocates the material prerequisites of care and the burden of caring labor. Kittay's treatment of care and justice is more adequate to the realities of human embodiment and the social organization of care than Jackson's, but neither offers a fully adequate ground for the moral personhood of all human beings, including deeply dependent persons.     

All Justice is Social but it’s not all Social Justice

I take social injustice to be injustice perpetrated on members of society by laws and public social practices. I take social justice to be the struggle to right social injustice. After explaining these ideas, I then address the question: why are so many people opposed to the very idea of social justice? I offer a number of explanations, among them, that to acknowledge that there is social injustice in one’s society often requires considerable change on one’s part.     

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。     

Fair equality of opportunity and decent minimums: a reply to Buchanan

Responding to criticism by Allen Buchanan in a Winter 1984 Philosophy and Public Affairs article on "The right to a decent minimum of health care," Daniels defends his thesis that if justice requires protecting equality of opportunity, then health care institutions should be governed by the principle of fair equality of opportunity because impairments of normal functioning, seen as impediments to opportunity, are obviated by good health care. He defines his concept of normal opportunity range, which is relative to certain social considerations, and shows that health care services affect the distribution of opportunity, but not the normal opportunity range, among individuals. He agrees with the criticism that his argument does not guarantee minimum health care or solve problems of resource allocation.     

Dignity,Capability, and Profound Disability

Martha Nussbaum has sought to establish the significance of disability for liberal theories of justice. She proposes that human dignity can serve as the basis of an entitlement to a set of capabilities that all human beings either possess or have the potential to develop. This article considers whether the concept of human dignity will serve as the justification for basic human capabilities in accounting for the demands of justice for people with profound learning difficulties and disabilities. It examines the relationship between dignity and capabilities, suggesting that Nussbaum fails to distinguish between several conceptions of human dignity, whilst also identifying one of these conceptions as coming close to meeting several of her demands. It is difficult enough, however, to show how dignity is related to just one of our basic entitlements, and even that requires more than the resources available in Nussbaum's approach.     

Progress in Reconciliation: Evidence from the Right and the Left

For a number of years now I have argued for a reconciliation of contemporary conceptions of justice. I have argued that a libertarian conception of justice with its ideal of liberty, a welfare liberal conception of justice with its ideal of fairness, a socialist conception of justice with its ideal of equality, a communitarian conception of justice with its ideal of the common good, and a feminist conception of justice with its ideal of androgyny can all be seen to support the same practical requirements, specifically the practical requirements that are usually associated with a welfare liberal conception of justice, namely, a right to welfare and a right to equal opportunity. Since most people endorse one or another of these conceptions of justice, to reach agreement in practice it should suffice to show them that all these conceptions support the same practical requirements of a right to welfare and a right to equal opportunity.     

From Contracts to Capabilities and Back Again

It has been common for researchers and commentators within the discipline of Social and Public Policy to evoke Rawlsian theories of justice. Yet some now argue that the contractualist tradition cannot adequately incorporate, or account for, relations of care, respect and interdependency. Though contractualism has its flaws this article proposes that we should not reject it. Through a critique of one of its most esteemed critics, Martha Nussbaum, it proposes that contractualism can be defended against the capabilities approach she prefers. The article concludes by suggesting how and why the moral philosophy of Thomas Scanlon offers a basis for reconciling the strengths of a contractualist, egalitarian liberalism with those of Nussbaum’s capabilities approach.

The place of human rights and the common good in global health policy

This article offers an integrated account of two strands of global health justice: health-related human rights and health-related common goods. After sketching a general understanding of the nature of human rights, it proceeds to explain both how individual human rights are to be individuated and the content of their associated obligations specified. With respect to both issues, the human right to health is taken as the primary illustration. It is argued that (1) the individuation of the right to health is fixed by reference to the subject matter of its corresponding obligations, and not by the interests it serves, and (2) the specification of the content of that right must be properly responsive to thresholds of possibility and burden. The article concludes by insisting that human rights cannot constitute the whole of global health justice and that, in addition, other considerations—including the promotion of health-related global public goods—should also shape such policy. Moreover, the relationship between human rights and common goods should not be conceived as mutually exclusive. On the contrary, there sometimes exists an individual right to some aspect of a common good, including a right to benefit from health-related common goods such as programmes for securing herd immunity from diphtheria.     

Evangelical Civil War on the College Campus,White Evangelical Right Framing Resistance to Racial Justice in 2020s America

This paper examines a civil war brewing among evangelicals on the college campus over racial justice—calls for greater racial equality, equity, and inclusion—in the era of Black Lives Matter (BLM). It examines how the white evangelical right are framing their resistance to racial justice and redrawing the color line in the contemporary college evangelical landscape not with distant “social justice warriors” in broader secular society, but with those right inside their evangelical community who, at varying levels, are coming out in support for racial justice in 2020s America. To do this, I first examine the varied campus evangelicals that support racial justice and how they express and frame their support as proper religious practice. I then explicate how the white evangelical right utilize a strategy of colorblind-othering to fight against these co-evangelicals that support racial justice. Data for the study come from the Landscape Study of Chaplaincy and Campus Ministry (2019–22).     

Is Health (Really) Special? Health Policy between Rawlsian and Luck Egalitarian Justice

In recent work, Norman Daniels extends the application of Rawls's principle of ‘fair equality of opportunity’ from health care to health proper. Crucial to that account is the view that health care, and now also health, is special. Daniels also claims that a rival theory of distributive justice, namely luck egalitarianism (or ‘equal opportunity for welfare’), cannot provide an adequate account of justice in health and health care. He argues that the application of that theory to health policy would result in an account that is, in a sense, too narrow, for it denies treatment to imprudent patients (e.g. lung cancer patients who smoked). In a different sense, Daniels argues, luck egalitarian health policy would be too wide: it arguably tells us to treat individuals for such brute‐luck conditions as shyness, stupidity, ugliness, and having the ‘wrong’ skin colour. I seek to advance three claims in response to Daniels's revised theory, and in defence of a luck egalitarian view of health policy. First, I question Daniels's assertion regarding the specialness of health. While he is right to abandon his insistence on the specialness of health care, it is doubtful that health proper can be depicted as special. Second, I try and meet Daniels's objections to luck egalitarianism. Luck egalitarian health policy escapes being too narrow for it does not in fact require denying basic care to imprudent patients. As for it being allegedly too wide, I try to show that it is not, after all, counterintuitive to rid individuals of unfortunate and disadvantageous biological traits (say, a disadvantageous skin colour). And third, I question whether Daniels's own Rawlsian account is in fact wide enough. I argue that fair equality of opportunity fails to justify some standard medical procedures that many health systems do already practice.     

A right to health care? Participatory politics,progressive policy,and the price of loose language

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 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.