Abstract
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).
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Notes
Ram-Tiktin, E, Distributive justice in health care: Sufficiency of capabilities approach (in progress).
Of course, not every life plan and not every course of realization is considered legitimate in a free society.
There is some ambiguity in Nussbaum’s writing, since, on the one hand, she wishes to achieve equality of capabilities, but, on the other, refers to a good enough human life threshold. However, I will not address this problem here.
According to Ronald Dworkin, concrete rights “are political aims that are more precisely defined so as to express more definitely the weight they have against other political aims on particular occasions” (1977, p. 93).
Because of the two distinct aspects of health and illness, I presented four definitions as part of my theory: “health” and “illness” for the value-laden aspect, “intactness” and “malady” for value-free aspect. For a full discussion and definitions of those concepts, see Ram-Tiktin (2009), chap. 6; in progress (see note 2).
Nussbaum (2006) also addressed that question and firmly asserted that we should use only one threshold. She provided two arguments that align with my argument. The first is strategic: If we set a lower threshold, the medical institutions will make less effort to improve those individuals’ well-being. The second is normative: one threshold for everyone reminds us of the dignity owed to both the mentally and terminally ill. It obliges us to see them as equal members of the human community entitled to a good human life despite their impairments.
Yitzhak Benbaji (2006) presented a multilevel, non-absolutist, homogeneous version of the doctrine of sufficiency and listed three thresholds: personhood, pain, and luxury.
For simplicity, I am keeping the number of beneficiaries constant, thereby focusing on the more relevant criteria of the discussion.
Personal responsibility for one’s health could be relevant in micro-allocation (that is, in prioritizing among patients of the same group), but I will not discuss this aspect in the present article.
In cases of plastic surgery due to aesthetic considerations, if there is evidence that the patient is emotionally unsound and experiences considerable difficulty integrating socially due to his/her appearance, then he/she should be considered located beneath the threshold and thus having a claim-right to plastic surgery.
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Ram-Tiktin, E. The Right to Health Care as a Right to Basic Human Functional Capabilities. Ethic Theory Moral Prac 15, 337–351 (2012). https://doi.org/10.1007/s10677-011-9322-7
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DOI: https://doi.org/10.1007/s10677-011-9322-7