Abstract
In recent works, Shlomi Segall suggests and defends a luck egalitarian approach to justice in health. Concurring with G. A. Cohen’s mature position he defends the idea that people should be compensated for “brute luck”, i.e. the outcome of actions that it would be unreasonable to expect them to avoid. In his defense of the luck egalitarian approach he seeks to rebut the criticism raised by Norman Daniels that luck egalitarianism is in some way too narrow and in another too wide to uphold justice in health and health care distribution. He points out that a pluralistic outline of luck egalitarianism taking into account the moral requirement of meeting everyone’s basic needs can avoid this line of criticism. In this article I argue against the application of such pluralistic luck egalitarianism in matters of health distribution. First of all, Segall has not shown that luck egalitarianism handles well health distributions above a threshold of basic needs. Secondly, his way of avoiding Elizabeth Anderson’s abandonment objection is theoretically problematic. Finally, I argue that luck egalitarianism in general fails to acknowledge the moral foundation of health and health care as a basic human entitlement. Thus I conclude that luck egalitarianism fails to take health needs seriously and that it cannot therefore uphold justice in health.
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Notes
This means that there is a case for a luck egalitarian tiebreak if patients are perfectly equal in terms of their lack of basic needs but differs even to the smallest degree in responsibility, and if patients are almost equal in terms of their lack of basic needs but sufficiently different in terms of their degree of responsibility. To see this, consider two cases, A and B. In A, two patients are equally in lack of basic needs (−100; −100) but differ only slightly in terms of responsibility (100; 99). Due to the perfect equality of neediness, the slight difference in responsibility would be a tiebreaker. In B, two patients are almost equal in terms of their lack of basic needs (−100; −99) but differ to a significant degree with respect to responsibility (100; 0). The large difference in the degree of responsibility might possibly outweigh the small difference in neediness and could therefore be a tiebreaker. It seems as though both A and B could be cases for a luck egalitarian tiebreak.
Some might find this a rather strange outline of luck egalitarianism, since it seems to imply that we ought to fund treatment for disadvantages that everybody suffers due to reasons beyond their control. However, this seems to ignore the relative aspect that we do normally ascribe to luck egalitarianism. To avoid this ignorance, I choose to read “disadvantageous” interpersonally.
Some claim that since this is an inevitable trade-off between an innocent and a reckless patient, it is in fact not harsh at all. I take this to be a valid point but will set it aside for now, since Segall himself finds this to be too harsh (Segall 2010a, p. 71).
In fact, I am grateful to an anonymous reviewer for pointing out that if this was the case of my argument, it would be dogmatic.
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Acknowledgments
I am very grateful to Shlomi Segall, Nir Eyal, Zofia Stemplowska, Matthew Clayton, Robert van der Veen, Kasper Lippert-Rasmussen, Søren Flinch Midtgaard, David Vestergaard Axelsen, Rasmus Sommer Hansen, Per Mouritsen, Tore Vincent Olsen and Morten Brænder for their useful comments on earlier versions of this article.
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Nielsen, L. Taking health needs seriously: against a luck egalitarian approach to justice in health. Med Health Care and Philos 16, 407–416 (2013). https://doi.org/10.1007/s11019-012-9399-3
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DOI: https://doi.org/10.1007/s11019-012-9399-3