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Health Care Needs and Distributive Justice

  • Norman Daniels
Part of the The Hastings Center Series in Ethics book series (HCSE)

Abstract

A theory of health care needs should serve two central purposes. First, it should illuminate the sense in which we—at least many of us—think health care is “special” and that it should be treated differently from other social goods. Specifically, even in societies in which poeple tolerate (and glorify) significant and pervasive inequalities in the distribution of most social goods, many feel there are special reasons of justice for distributing health care more equally. Some societies even have institutions for doing so. To be sure, others argue it is perverse to single out health care in this way, or that if we have reasons for doing so, they are rooted in charity, not justice. In any case, a theory of health care needs should show their connection to other central notions in an acceptable theory of justice. It should help us see what kind of social good health care is by properly relating it to social goods whose importance is similar and for which we may have a clearer grasp of appropriate distributive principles.

Keywords

Distributive Justice Fair Share Health Care Institution Social Good Primary Good 
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References

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    I paraphrase Charles Fried, Right and Wrong (Cambridge, Mass.: Harvard University Press, 1978), pp. 126ff. See my comments on Frieds proposal in “Rights to Health Care: Programmatic Worries,” Journal of Medicine and Philosophy, IV (June, 1979), 174–91. I ignore here an issue of paternalism that Fried may have wanted to pursue but which is better raised when fair shares are clearly large enough to purchase a reasonable insurance package. Should the premium be compulsory?Google Scholar
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    For example, appeals to equality of opportunity have historically played a conservative, deceptive role, blinding people to the injustice of class and race inequalities in rewards. Historically, appeals to the ideal of equal opportunity have implicitly justified strongly competitive individual relations. More concretely, we often find institutions, like the U.S. educational system, praised as embodying (at least approximately) that ideal, whereas there is strong evidence that the system function primarily to replicate class inequalities. See my “IQ, Heritability and Human Nature” in Proceedings of the Philosophy of Science Association, 1974, ed. by R. S. Cohen (Dordrecht, Netherlands: Reidel, 1976), pp. 143–80; and (with J. Cronin, A. Krock, and R. Webber) “Race, Class and Intelligence: A Critical Look at the IQ Controversy,” International Journal of Mental Health, III, no. 4, 46–123; and S. Bowles and H. Gintin, Schooling and Capitalist America (New York: Basic Books, 1976).Google Scholar
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    It would be interesting to know whether this age-relativized opportunity range yields results similar to that achieved by the Rawlsian device of a veil. If people who do not know their age are asked to design a system of health care delivery for the society they will be in, they would presumably budget their resources in a fashion that takes the special features of each stage of the life cycle into account and gives each stage a reasonable claim on resources. Cf. my “Am I My Parents’ Keeper?” Midwest Studies in Philosophy, VII (1982), pp. 517–540.Google Scholar
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    I discuss these difficulties in “Conflicting Objectives and the Priorities Problem,” Income Support: Conceptual and Policy Issues ed. by Peter G. Brown, Conrad Johnson, and Paul Vernier (Totowa, N.J.: Rowman and Littlefield, 1981), pp. 147–64. My Justice and Health Care Delivery develops some applications in detail.Google Scholar
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    The strongest objections to such mixed systems is that the upper tier competes for resources with the lower tiers. See Claudine McCreadie, “Rawlsian Justice and the Financing of the National Health Service,” Journal of Social Policy, V, no. 2 (1976), 113–31.CrossRefGoogle Scholar
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    See Avedis Donabedian, Aspects of Medical Care Administration (Cambridge, Mass.: Harvard University Press, 1973).Google Scholar
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    I ignore the crudeness of such measures. For fuller discussion of these manpower distribution issues, see my “What Is the Obligation of the Medical Profession in the Distribution of Health Care?” Social Science and Medicine, Vol. 15F, no. 4 (December, 1981), pp. 129–133.Google Scholar
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Copyright information

© The Hastings Center 1983

Authors and Affiliations

  • Norman Daniels
    • 1
  1. 1.Department of PhilosophyTufts UniversityMedfordUSA

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