“正义论”蕴含医疗公正吗?

本文试图以罗尔斯的正义论为例,从博格对于罗尔斯"机会的公平平等原则"之重建以及丹尼尔斯对于"健康需求之特殊道德重要性"的阐释出发,分析并揭示一般性的社会正义理论框架如何能够蕴含一种合理的医疗公正理论。这一尝试的目的在于表明,医疗(或健康)公正理论的完善,不仅限于医疗保健资源合理分配理论的确立,这是因为健康需求的道德特殊性决定了所要建构的医疗公正理论不可避免地要与其背后深层次的"健康之社会性决定因子"缠绕在一起。医疗公正理论的建构并不因其与一般性社会正义理论的兼容性而丧失其独立性,医疗公正作为实践伦理研究课题的特性,决定了我们必须不断弥合理论与实际问题的鸿沟,而这正是建立一种整全的医疗公正观的目标所在。     

受试者权利保护中的程序公正——对"黄金大米"事件的反思

"黄金大米"的儿童试验被曝程序违规,引起公众广泛的质疑和思考.此次试验的程序规范缺失,致使儿童受试者不但没有受到特殊保护,反而其正当权利被忽视与侵犯.儿童受试者权利被忽视是实质不公正,恰好暴露出我国的人体试验程序公正存在问题,法规条文并没有得到严格执行,伦理审查制度存在缺陷,致使受试者的权利没有得到有效保护.受试者权利保护是实质公正的价值追求.程序公正是实质公正的前提和保证,完善、正当的程序才能确保受试者权利得到最大限度的保护.因此追求程序公正,以达到最大限度的保护受试者权利,尤为重要.     

道德权利与公民道德建设

道德权利是公民道德的内在要求,它在公民社会中既是法律权利的基础,又是法律权利的扩展和深化,较之于法律权利,道德权利具有作用范围大、救济手段软、与义务对等等特性。但我们不能因此忽视道德权利的存在,相反,道德权利在公民社会中表现为道德行为选择的自由权、道德主体的被尊重权、道德行为公正评价权、请求报答权等,这些都是公民道德建设的基本内容。     

追求公正与党的执政能力建设

公正的本质含义是均衡与合理,即在处理人与人之间各种关系时,遵循不偏不倚的原则,给有关的每个社会成员以均衡的条件、平等的机会、适当的利益,从而实现权利与义务的最佳统一。追求公正与我党的根本宗旨是完全一致的,新形势下的中国共产党要更好地领导社会主义建设事业,提高长期执政的能力和水平,就必须树立公正的执政理念,贯彻公正的基本原则,追求公正的发展目标。     

国民公正观的结构

对429名被调查者的研究发现,最为公众赞同的公正观依次为:(1)公正体现在法律面前人人平等;(2)公正体现为人们在求学、就业、投资、参政等方面的机会平等;(3)公正体现在程序公平合理。因素分析表明,国民的公正观是多元的,可分为6个维度,分别为权利、衡平、救济、报应、平等、平均。聚类分析的结果表明,公正内隐观的6个维度最终可聚为"均等"和"对等"2类。     

试析伊斯兰女性主义对《古兰经》和圣训的重新解读北大核心CSSCISSCI

伊斯兰女性主义是20世纪90年代兴起的一个思潮,是在伊斯兰框架内的女性主义理论与实践,致力于对《古兰经》和圣训重新解释,争取性别平等权利和社会公正。伊斯兰女性主义将女性经验和视角带入《古兰经》和圣训解释,指出《古兰经》的基本原则是社会公正、平等和互相尊敬,男女平等体现了《古兰经》的原则。本文认为伊斯兰女性主义对《古兰经》和圣训的重新解读对于穆斯林和非穆斯林理解伊斯兰的公正、性别平等和争取妇女权利具有特别重要的意义。首先,赋权妇女,使妇女掌握话语权,在一定程度上消解对经训的男权式解释。其次,加强了在伊斯兰框架下提高穆斯林妇女地位、维护穆斯林妇女权利、追求性别平等的可能性和可行性。再次,有助于非穆斯林认识到伊斯兰教是保护妇女权利和主张男女平等的宗教。     

医疗保健是权利还是特权

分析了医疗保健是权利还是特权的问题,美国和中国的医疗保健供给体制在医疗保健的概念上被界定为医疗市场的一种商品。虽然作为商品的医疗保健的性质已被讨论,但更具社会责任感的论证应是强调医疗保健是一种权利。社会表示对其成员健康的关不的主要方式主要是通过国家健康保险而体现的,从这个角度出发回顾了美国和中国的医疗保健情况。     

斯宾塞论社会公正:对市场经济的一种道德辩护

斯宾塞的“理性功利主义”是一种主张公正优先的道德哲学。在他看来 ,只有人们在其中享有平等的自由和权利的社会 ,即自由竞争的市场经济社会 ,才能实现“按应得原则分配利益”的公正。他反对现实社会中凭借强制力而获取的“权利”,认为“按现存的权利制度分配”和“按需分配”都是违背社会公正的。斯宾塞一百多年前提出的社会公正观 ,包括他反对旨在扶助弱者的任何社会调节措施的“社会达尔文主义”谬误 ,对我们完善社会主义市场经济条件下的公正原则 ,无疑具有借鉴意义。     

组织公正研究:回顾与展望

文章主要回顾了组织公正40多年来的研究成果与进展,包括组织公正的概念和理论发展。并从组织公正概念的整合、机会公正、第三方公正、群体公正、跨文化研究、方法论等几个方面提出了进一步研究的思考和展望。     

论公正

公正的基准是权利。权利在本质上是一种获得性的社会性资格。公正就是这样的原则 :以权利为本位而义务与权利相对等、对称和对应。公正作为美德就是尊重他人的权利和尊重公共规则。公正作为制度伦理首先就是以权利为本位 ,其次是普遍和平等 ,再次是公开、明确和有既定程序。     

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.     

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.     

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.     

Is Age Special? Justice,Complete Lives and the Prudential Lifespan Account

This article explores the problem of justice between age‐groups. Specifically, it presents a challenge to a leading theory in this field, Norman Daniels' Prudential Lifespan Account. The challenge relates to a key assumption that underlies this theory, namely the assumption that all individuals live complete lives of equal length. Having identified the roles that this assumption plays, the article argues that the justifications Daniels offers for it are unsatisfactory and that this threatens the foundation of his position, undermining his claim that ‘the fact that we all age’ makes age a special problem of distributive justice. This shows that the problem of justice between age‐groups is not special in the way Daniels proposes; rather it involves the same irreducibly interpersonal distributive decisions as other problems of justice. The consequences of this argument are several‐fold. Most importantly, it shows that the Rawlsian account of justice to which Daniels hopes to attach his theory to requires significantly greater benefits to be conferred on those in earlier age‐groups relative to those in later age‐group, not a distribution similar to simultaneous equality as Daniels proposes.     

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.     

Age rationing and the just distribution of health care: is there a duty to die?

The author analyzes the argument that a policy involving distributive justice in the allocation of scarce health care resources, based on the strategy of rational self interest maximation under a veil of ignorance (Rawls/Daniels), would result in an age rationing system of voluntary, socially encouraged, direct termination of the lives of the elderly rather than their medical abandonment. She maintains that such a policy would be a fair response only in a situation of substantial scarcity of resources that cannot be relieved without introducing greater injustices. Battin suggests that some of the current pressure on resources could be reduced by pruning waste and the expenses attributable to paternalistic imposition of treatment and to the practice of defensive medicine. She also advocates reconsideration of societal priorities assigned to various social goods.     

The Right to Health Care as a Right to Basic Human Functional Capabilities

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).     

Access to Assistive Technology,Systems Thinking,and Market Shaping: A Response to Durocher et al.

Fairness of access to assistive technology is important for its allocation on an equitable basis and for broader social justice and rights issues. Although the use of Daniels’s notion of “justice as fair opportunity” is helpful to the context of assistive technology, other aspects of Daniels’s broader conceptualisation of “just health” are not appropriate in this context. It is argued that fairness of access to assistive technology is crucial for the equitable attainment of the sustainable development goals; however, such access will be achieved only by the sector developing a much stronger systems thinking and market shaping perspective.     

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.     

Normal Functioning and the Treatment/Enhancement Distinction: An Opportunity Based Assessment

As genome mapping technology uncovers the roots of pathologic and physiologic human functioning, important questions are brought to the fore concerning our conceptualization of ideas such as disease, treatment, and enhancement. In 1985, Norman Daniels proposed a normal-functioning model that expands John Rawls’ theory of justice to obligate the provision of health care based on the constraints disease places on individual opportunity, but also limits the commitment of the medical establishment by focusing on states that represent deviations from normal human function. While some argue that the boundaries of medical institutions’ commitment to provide services within a normal-functioning model are arbitrary, the degree to which these concerns truly threaten the framework is often exaggerated in special cases put forward in the literature. Furthermore, the normal-functioning model provides a comprehensive basis for agreement in discussions of medicine’s commitment to the demands of social justice where resources are limited and avoids the dangerous overextension of the healthcare system and medicalization to which more expansive models are exposed.