Just Health Care

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Paperback | 30 September 1985

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260 Pages

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21.59 x 13.97 x 1.5

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How should medical services be distributed within society? Who should pay for them? Is it right that large amounts should be spent on sophisticated new technology and expensive operations, or would the resources be better employed in, for instance, less costly preventive measures? These and others are the questions addreses in this book. Norman Daniels examines some of the dilemmas thrown up by conflicting demands for medical attention, and goes on to advance a theory of justice in the distribution of health care. The central argument is that health care, both preventive and acute, has a crucial effect on equality of opportunity, and that a principle guaranteeing equality of opportunity must underly the distribution of health-care services. Access to care, preventive measures, treatment of the elderly, and the obligations of doctors and medical administrations are fully discussed, and the theory is shown to underwrite various practical policies in the area.

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Preface	p. ix
Acknowledgements	p. xii
Is health care special?	p. 1
Micro and macro	p. 1
Rights to health care	p. 4
General theories of justice	p. 9
Some public policy issues	p. 11
Is health care special?	p. 17
Health-care needs	p. 19
Why a theory of health-care needs?	p. 19
Can we avoid talk about needs?	p. 20
Not all preferences are created equal	p. 23
Needs and species-typical functioning	p. 26
Disease and health	p. 28
Disease and opportunity	p. 32
Toward a distributive theory	p. 36
Satisfaction and social hijacking	p. 36
The scope of justice	p. 37
Fair equality of opportunity	p. 39
Extending Rawls's theory to health care	p. 42
Some qualifications and clarifications	p. 48
Summary and applications	p. 56
Equity of access to health care	p. 59
Sources of disagreement about access	p. 59
When is access equal?	p. 60
Three accounts of equitable access	p. 63
Decent minimums and the requirements of justice	p. 74
Am I my parents' keeper?	p. 86
Opportunity, age-bias, and competition for resources	p. 86
When are acts, policies, or institutions age-biased?	p. 89
Does aging pose a distinct distribution problem?	p. 94
Prudence and aging	p. 98
Equal opportunity and health care for the elderly	p. 103
Equity, errors, and the stability of 'savings institutions'	p. 108
Some qualifications	p. 111
Doing justice to providers	p. 114
Four issues	p. 114
What are the obligations of providers to deliver just health care?	p. 115
Does just health care violate provider liberty?	p. 119
Does just health care deny physicians just economic rewards or incentives?	p. 124
Does just health care threaten traditional ethical obligations of physicians to their patients?	p. 135
Conclusion	p. 138
Doth OSHA protect too much?	p. 140
Fair equality of opportunity and preventive health care	p. 140
Prevention and OSHA regulation	p. 142
The OSHA 'feasibility' criterion: in search of a rationale	p. 144
The feasibility criterion: beyond market regulation	p. 148
The 'specialness' of health protection and the problem of consent	p. 150
More protection than I want: a libertarian lament	p. 153
Autonomy, paternalism, and risky life-style choices	p. 156
Information and competency	p. 159
Intrinsic and extrinsic rewards of risk-taking	p. 162
Coercion	p. 165
Voluntariness and justice	p. 171
Worries and conclusions	p. 176
Risk and opportunity	p. 180
Safe workplaces and safe workers	p. 180
Biological monitoring in the lead standard	p. 187
Individual variation in sensitivity and discrimination in employment	p. 199
Summary and conclusions	p. 218
Philosophy and public policy	p. 221
Does justice require funding heart transplants?	p. 221
Frameworks and contexts of compliance	p. 223
Works cited	p. 231
Index	p. 238
Table of Contents provided by Syndetics. All Rights Reserved.

Just Health Care

At a Glance

Paperback

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