Abstract
The capability approach, originated by Amartya Sen is among the most comprehensive and influential accounts of justice that applies to issues of health and health care. However, although health is always presumed as an important capability in Sen’s works, he never manages to fully explain why health is distinctively valuable. This paper provides an explanation. It does this by firstly laying out the general capability-based argument for health justice. It then discusses two recent attempts to justify why health is distinctively valuable from within a capability framework – these are Sridhar Venkatapuram’s conception of health as the central human meta-capability and, respectively, Norman Daniels’ embrace of the capability metric in his use of Rawls’ principle of fair equality of opportunity. The paper argues that none of these accounts succeed in providing a plausible justification of the value of health. Finally, the paper suggests an alternative more complex justification, closely tied to different but central element of the capability view, that captures the core intuitions of both Venkatapuram and Daniels’ accounts but without being vulnerable to the objections raised against each of them. This, the paper concludes, provides a promising ground on which the capability view on health justice should be founded.
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Notes
These arguments against welfarism are informed by Dworkin’s well-known Louis and Jude cases (2000, p. 49–59).
Although non-naturalists rarely focus on organisms other than human beings, I use the term “organism” here in both definitions in order to make them more closely related. This is not inconsistent, since human beings are organisms.
Note that Nordenfelt would not consider such disadvantages instances of health-deficits (Nordenfelt 2000, p. 71–73). Venkatapuram, on the contrary, would, due to his commitment to the definition of health as the meta-capability to access Nussbaum’s central human functionings.
Since the topic of this paper is the value of health (not its meaning), I will not defend a specific theory of health. However, as is made clear by the discussion here, I believe we would do best by adopting a naturalist but non-statistical definition. As a personal note, I see much potential in Daniel Hausman’s recently suggested “functional efficiency account” (2012).
This merely implies that some level of health functioning is important for any human life. It does not imply the much stronger claim, that health necessarily entails the freedom to what we value about life. Thus, my argument here against Daniels’ view is compatible with my rejection of Venkatapuram’s meta-capability conception.
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Acknowledgments
I owe many thanks to two anonymous reviewers and the editors of Ethical Theory and Moral Practice for their time and very useful comments. A special thanks to Daniel Hausman, J. Paul Kelleher, Kasper Lippert-Rasmussen, and Stephen Latham for very insightful comments on earlier drafts. I am also grateful to the members of the Department of Medical History and Bioethics, University of Wisconsin-Madison; the Yale University Interdisciplinary Center for Bioethics; as well as members of the Political Theory section at Aarhus University.
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Nielsen, L. Why Health Matters to Justice: A Capability Theory Perspective. Ethic Theory Moral Prac 18, 403–415 (2015). https://doi.org/10.1007/s10677-014-9526-8
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DOI: https://doi.org/10.1007/s10677-014-9526-8