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."     

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.     

Distributive justice and rural healthcare: a case for e-health

People living in rural areas make up 20 percent of the U.S. population, but only 9 percent of physicians practice there. This uneven distribution is significant because rural areas have higher percentages of people in poverty, elderly people, people lacking health insurance coverage, and people with chronic diseases. As a way of ameliorating these disparities, e-health initiatives are being implemented. But the rural e-health movement raises its own set of distributive justice concerns about the digital divide. Moreover, even if the digital divide is overcome, e-health services may be of an inferior quality compared to face-to-face medical encounters. In this paper, I argue that before we can fully understand the distributive justice implications of e-health, we must first understand what distributive justice means. I argue that five elements--fairness, quality, accessibility, availability, and efficiency--constitute a general conception of justice and that all of these elements must be considered when evaluating e-health for rural health profession shortage areas. In doing so, it may be necessary to make important tradeoffs among these elements. I then examine the development of e-health programs in light of Rawls's principle of equal opportunity and Daniel's notion of species-typical functioning. I conclude that in the context of e-health, Rawls's principle should be expanded to include geography as a prima facie morally relevant criterion for allocating healthcare benefits. I also conclude that Daniel's notion of species-typical functioning provides grounds for thinking of health and some healthcare services as special goods.     

Health,justice and happiness during childhood

Health is certainly a valuable asset in the life of every human being and of particular relevance for a flourishing childhood. As empirical research concerning the social determinants of health shows, its distribution can, at least to a certain extent, be influenced by the way a society is arranged. Many philosophers now acknowledge that a fair distribution of health has to be a central part of a just society and they discuss to what extent a right to health can be justified. However, they do not typically distinguish between physical and mental health and neglect the special problems arising from these distinct, though related, perspectives. In this paper, we argue in favour of such a distinction and ask whether a minimally just society ought to include mental health among the goods that are to be distributed in a fair way among its children. Furthermore, we investigate the relationship between mental health and happiness and ask whether making mental health a subject of justice implies that children are entitled not only to a healthy but also to a happy childhood. Despite the positive impact of happiness on the lives of children, we conclude that happiness cannot be incorporated into a functional theory of justice, since it does not fully meet the criteria of objectivity, measurability and influenceability.     

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.     

Compensation vs. Fair Equality of Opportunity

ABSTRACT In this paper I attempt to show that our commonly shared ideas of justice, which include principles of fair distribution and of compensation for past injustices, tend to come into conflict in practice, and generate serious dilemmas for persons in certain positions of authority, such as managers. I identify the source and nature of such dilemmas, and sketch a rough pattern for analysing and partially resolving conflicts between the duty not to discriminate unfairly and the duty to compensate for past unfair discrimination. After stating what I regard as widely shared ideas of justice, I emphasise their application to actual policy decisions of the small-scale sort, using general precepts for avoiding or minimising conflicts. The precepts include a commitment to the priority of compensatory justice. The paper includes theoretical portions, principally defences of my position against other views on the relationship between compensation and fair distribution. I end with an examination of the virtues and limitations of money as a tool for compensatory social policies.     

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.     

How Much of What Matters Can We Redistribute? Love,Justice, and Luck

By meeting needs for individualized love and relatedness, the care we receive deeply shapes our social and economic chances and therefore represents a form of luck. Hence, distributive justice requires a fair distribution of care in society. I look at different ways of ensuring this and argue that full redistribution of care is beyond our reach. I conclude that a strong individual morality informed by an ethics of care is a necessary complement of well‐designed institutions.     

Inequalities in Health and Intergenerational Equity

In the popular folklore three-score-years-and-ten is treated as a fair innings for people, and thereby serves as an informal reference point for judgements about distributive justice within a community. But length of life alone is an insufficient basis for such judgements - a person's health-related quality-of-life also needs to be taken into account. If one of the objectives of public policy is to reduce inequalities in lifetime health, it will be demonstrated that this is very likely to require systematic discrimination against the older members of a community. The notion of community solidatity will also be tested, because a decision will need to be made as to whether the same fair innings applies to all members of the community, or whether some are entitled to more than others. The strength of the fair innings principle is that it brings these issues to the fore in a systematic way which should ais their resolition in a practical context.     

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.     

Comparative Assessments of Justice, Political Feasibility, and Ideal Theory

What should our theorizing about social justice aim at? Many political philosophers think that a crucial goal is to identify a perfectly just society. Amartya Sen disagrees. In The Idea of Justice, he argues that the proper goal of an inquiry about justice is to undertake comparative assessments of feasible social scenarios in order to identify reforms that involve justice-enhancement, or injustice-reduction, even if the results fall short of perfect justice. Sen calls this the “comparative approach” to the theory of justice. He urges its adoption on the basis of a sustained critique of the former approach, which he calls “transcendental.” In this paper I pursue two tasks, one critical and the other constructive. First, I argue that Sen’s account of the contrast between the transcendental and the comparative approaches is not convincing, and second, I suggest what I take to be a broader and more plausible account of comparative assessments of justice. The core claim is that political philosophers should not shy away from the pursuit of ambitious theories of justice (including, for example, ideal theories of perfect justice), although they should engage in careful consideration of issues of political feasibility bearing on their practical implementation.     

Migration,Open Borders,Human Rights,and Democracy

Two important recent books on migration and justice argue for different approaches to how we should view borders. Alex Sager defends open borders, while Sarah Song argues for the rights of democratic communities to find their own balance between open and closed borders. While both authors present significant considerations in defence of their views, in this article I argue that a human-rights-oriented account of migration justice captures their strengths well while not sharing the weaknesses I identify with each. In addition, the approach I favour offers some progressive pathways for holding each other to account in reducing migration injustice in our actual world, in ways that are both feasible and normatively compelling.     

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。     

Marriage,Morality, and Institutional Value

This paper develops a Kantian account of the moral assessment of institutions. The problem I address is this: while a deontological theory may find that some legal institutions are required by justice, it is not obvious how such a theory can assess institutions not strictly required (or prohibited) by justice. As a starting-point, I consider intuitions that in some cases it is desirable to attribute non-consequentialist moral value to institutions not required by justice. I will argue that neither consequentialist nor virtue-ethical accounts account for these intuitions, suggesting that a distinctive deontological account is needed. The account I give is drawn from Kant’s Metaphysics of Morals; I distinguish it from Kantian views of institutions developed by Barbara Herman and Onora O’Neill. Throughout, I use marriage as an example.

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.     

Gender and mental health: An examination of procedural justice in a specialized court context

The procedural justice framework has been applied in the criminal justice contexts of policing, corrections, and courts. According to this perspective, fair treatment, respectful dialogue and being given a proper voice will contribute to citizens' positive views of authority figures. While this literature has grown immensely, several questions remain unanswered. Do males and females perceive similar levels of procedural justice? Does mental health status influence perceptions of fair treatment? Whether procedural justice is a general perspective that can be applied across social groupings has important implications for correctional treatment in that programs that truly “work” for all are more cost‐effective. Toward that end, the current study investigates the relationships among procedural justice perceptions, gender, and mental health status in specialized drug courts, a context that has received little empirical attention. We do so using secondary data originally collected between 2003 and 2009 for Rossman, Roman, Zweig, Rempel and Lindquist's Multisite Adult Drug Court Evaluation (MADCE). Results from a full‐sample analysis reveal that women report higher levels of procedural justice; that drug court participation significantly influences procedural justice perceptions; and that depressive symptomology is a significant predictor of procedural justice perceptions. In male‐ and female‐specific subsamples, drug court participation exerts similar effects for males and females, as does depressive symptomology. Implications for theory, research, and practice are discussed.     

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.     

Age rationing,the virtues,and wanting more life

The goal of this paper is to show that Callahan's reasons for withholding life extending care cannot be made out exclusively in terms of contemporary notions of distributive justice and fair allocation. I argue that by relying on a notion of justice which links the merit of the individual with the fairness of a social pattern of shares, Callahan imputes vice to the elderly as he denies them eligibility for life-prolonging care. Aristotle's doctrine of the mean is a useful tool for character evaluation. One can speak meaningfully of a proper disposition of a person of a certain type (an elderly person) with respect to the good of continued life. I claim that the mean of one's disposition with respect to the good of continued life would be relative to one's age group, and would be determined by that principle by which an elderly person of practical wisdom would determine it. This leads to very different conclusions than those drawn by Callahan.     

Be Fair,Your Employees Are Watching: A Relational Response Model of External Third‐Party Justice

There is growing theoretical recognition in the organizational justice literature that an organization's treatment of external parties (such as patients, community members, customers, and the general public) shapes its own employees’ attitudes and behavior toward it. However, the emerging third‐party justice literature has an inward focus, emphasizing perceptions of the treatment of other insiders (e.g., coworkers or team members). This inward focus overlooks meaningful “outward” employee concerns relating to how organizations treat external parties. We propose a relational response model to advance the third‐party justice literature asserting that the organization's fair treatment of external parties sends important relational signals to employees that shape their social exchange perceptions toward their employer. Supporting this proposition, in two multisource studies in separate healthcare organizations we found that patient‐directed justice had indirect effects on supervisory cooperative behavior ratings through organizational trust and organizational identification.     

Solidarity,justice, and recognition of the other

Solidarity has for a long time been referred to as the core value underpinning European health and welfare systems. But there has been debate in recent years about whether solidarity, with its alleged communitarian content, can be reconciled with the emphasis on individual freedom and personal autonomy. One may wonder whether there is still a place for solidarity, and whether the concept of justice should be embraced to analyse the moral issues regarding access to health care. In this article, I will answer this question by analysing the normative foundations of the concept of justice, followed by a deeper examination of the concept of solidarity in continental philosophy. More specifically, I will compare the philosophical traditions rooted in Kant (with emphasis on autonomy and individual rights) to approaches rooted in Hegel (with emphasis on individual relations of recognition). In addition, I will present the work of Avishai Margalit on the decent society to criticize a predominantly liberal approach to access to health care. The importance of solidarity lies particularly in its emphasis on relational aspects and the role of recognition in care practices, which are usually ignored in liberal approaches to justice. However, the article will argue that solidarity is not an alternative to a rights-based concept of justice, but must be considered as a necessary complement to it.