Mark D. White
I just came across a fascinating paper titled "Is Health (Really) Special? Health Policy Between Rawlsian and Luck Egalitarian Justice" by Shlomi Segall (Hebrew University of Jerusalem) in the Journal of Applied Philosophy. From the abstract:
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.
Segall takes issue with Daniels' analysis, but (with apologies to Segall) it is Daniels' basic thesis that interests me more. As regular readers of this blog may guess, even on utilitarian terms I would regard health (and by extension heath care) to be undeserving of any special moral status and, rather, just one component of a person's well-being which she can choose to pursue to whatever extent she wishes in conjunction with the other components (such as wealth, love, pleasure, etc.).
With respect to health care, Segall explains that
To say that health care is special was to say that it is morally significant in ways that justify distributing medical resources in isolation from the way in which other social goods, and wealth in particular, are distributed. The most obvious implication of the specialness account, understood this way, is that health care resources should not be treated as mere commodities... [they] should be distributed more equally than most other goods, and, in any case, independently of ability to pay. (p. 346)
He claims that this follows from commonly held beliefs regarding health care:
Such thinking about health care seems to correspond to a widely shared intuition: while many of us would not object to some people being wealthier than others, far fewer would condone a situation whereby greater wealth buys superior medical care. This intuition about health care as constituting a special and separate sphere is thus a well entrenched one. (Ibid.)
He then goes on to discuss (critically) Daniels' extension of this same status to health in general. I plan on reading the article carefully, and also Daniels' books in the area, Just Health Care and Just Health: Meeting Health Needs Fairly, both of which I ordered today.
I'm fascinated by this line of thinking, as well as the claim that this is a common intuition--and I agree that it very well may be--because I find it so profoundly wrong. Simply put, I fail to see why health or health care should be morally privileged when it is a matter of individual choice to what extent a person takes care of her own health, or seeks out health care in pursuit of it. (For more on this, see my earlier posts on health care here, here, and here.) Accordingly, I think there is more of a case (though not a good enough case to support it overall) for resource egaliarianism which provides more equal resources for individuals to use as they choose, whether on health (or health care) or not, without granting either one any special status. But I don't see why health or health care should be given more status than other goals individuals may pursue with their resources (however those resources may be earned or allocated).