Health, Luck, and Justice

Health, Luck, and Justice

Shlomi Segall
Copyright Date: 2010
Pages: 252
  • Cite this Item
  • Book Info
    Health, Luck, and Justice
    Book Description:

    "Luck egalitarianism"--the idea that justice requires correcting disadvantages resulting from brute luck--has gained ground in recent years and is now the main rival to John Rawls's theory of distributive justice. Health, Luck, and Justice is the first attempt to systematically apply luck egalitarianism to the just distribution of health and health care. Challenging Rawlsian approaches to health policy, Shlomi Segall develops an account of just health that is sensitive to considerations of luck and personal responsibility, arguing that people's health and the health care they receive are just only when society works to neutralize the effects of bad luck.

    Combining philosophical analysis with a discussion of real-life public health issues,Health, Luck, and Justiceaddresses key questions: What is owed to patients who are in some way responsible for their own medical conditions? Could inequalities in health and life expectancy be just even when they are solely determined by the "natural lottery" of genes and other such factors? And is it just to allow political borders to affect the quality of health care and the distribution of health? Is it right, on the one hand, to break up national health care systems in multicultural societies? And, on the other hand, should our obligation to curb disparities in health extend beyond the nation-state?

    By focusing on the ways health is affected by the moral arbitrariness of luck,Health, Luck, and Justiceprovides an important new perspective on the ethics of national and international health policy.

    eISBN: 978-1-4008-3171-5
    Subjects: Philosophy, Political Science, Health Sciences

Table of Contents

  1. Front Matter
    (pp. i-vi)
  2. Table of Contents
    (pp. vii-viii)
  3. Preface
    (pp. ix-xii)
  4. Introduction
    (pp. 1-8)

    What is the just distribution of health and health care? The answer this book seeks to offer is deceptively simple perhaps: Differences in health and health care are unjust if they reflect differences in brute luck.

    The invocation of luck in accounts of egalitarian justice has become increasingly salient in recent years. In fact, “luck egalitarianism” can be said to be the main rival to John Rawls’s dominant theory of justice. According to luck egalitarians, distributive justice requires correcting disadvantages for which individuals cannot be held responsible. In other words, the theory seeks to compensate individuals for the effects of...

  5. 1 Justice, Luck, and Equality
    (pp. 9-26)

    The purpose of this opening chapter is to provide the working understanding of luck egalitarianism as the theory of distributive justice that guides my account of justice in health care and health. I intend to do so by undertaking three tasks. The first, in section I, is to introduce luck egalitarianism as a conception of distributive justice to rival John Rawls’s dominant account of egalitarian distributive justice. Juxtaposing the two conceptions of egalitarian distributive justice—the Rawlsian and the luck egalitarian one—is important not only for our understanding of luck egalitarianism as such, but particularly for discussing health, the...

  6. Part I Health Care
    • 2 Responsibility-Insensitive Health Care
      (pp. 29-44)

      Luck egalitarians hold that inequalities are unjust when they are the outcome of individuals’ unchosen natural and social circumstances. Accordingly, they hold that justice only requires compensating individuals for disadvantages for which they cannot be held responsible. Arguably, it follows that luck egalitarians must deny our obligation to provide assistance to those who come to need it through some fault of their own, e.g., an emergency service to a reckless driver or a liver transplant to a persistent alcoholic. Many believe that these counterintuitive cases demonstrate that luck egalitarianism cannot provide a theory of justice in health care. This is...

    • 3 Ultra-Responsibility-Sensitive Health Care: “All-Luck Egalitarianism”
      (pp. 45-57)

      In the preceding chapter we reviewed two accounts of justice in health care. The first was premised on ensuring equal opportunity for individuals to pursue their life plans, whereas the second was based on guaranteeing to citizens the capabilities to participate as equals in a democratic society. Both theories, we saw, cope well with the dilemma of providing treatment to irresponsible patients. The former seeks an equal starting point in the pursuit of life plans, regardless of considerations of personal responsibility. The latter seeks to guarantee equal capability to participate as citizens, again, in disregard to the patient’s prior conduct....

    • 4 Tough Luck? Why Luck Egalitarians Need Not Abandon Reckless Patients
      (pp. 58-73)

      Let us take stock of what has been discussed so far. I started this first part of the book by presenting the abandonment dilemma, namely, how to sustain a responsibility-sensitive account of egalitarian justice that is yet able to justify universal and unconditional (i.e., one that does not deny it from imprudent patients) medical care. We saw that the fair opportunity account and the democratic equality account, although able to justify universal care, cannot, for different reasons, provide a truly egalitarian account. All-luck egalitarianism, for its part, proved unsatisfactory for the somewhat opposite reasons (e.g., it justifies pooling casino gambles)....

    • 5 Responsibility-Sensitive Universal Health Care
      (pp. 74-86)

      Luck egalitarians, we just saw, are not committed to the view that the imprudent ought to be abandoned. Egalitarian distributive justice is but a narrow slice of morality and thus allows for a plurality of other moral considerations to be coupled and traded off with it. As I said in the previous chapter, one such major concern that is particularly relevant for the matter at hand is that of meeting basic needs, including medical needs. Our positive account of health care thus supplements luck egalitarian distributive justice with a layer of sufficientarian concern for meeting everybody’s basic needs regardless of...

  7. Part II Health
    • 6 Why Justice in Health?
      (pp. 89-97)

      This part of the book shifts the focus of discussion from health care to health. In this chapter I outline the reasons for doing so, and consequently, for the need for a luck egalitarian theory of justice in health. In the three chapters to follow I shall attempt to fill in the details of such an account. Chapter 7 will attempt to justify a luck-sensitive distribution of health. Chapter 8 will further develop the account of justice in health by inquiring whether we ought to pursue equality or rather priority (to the worse off) in health. Chapter 9 will then...

    • 7 Luck Egalitarian Justice in Health
      (pp. 98-110)

      When, then, are inequalities in health unjust? An initial response may be—“always.” From an egalitarian perspective, it may be argued, it is always unacceptable that individuals do not enjoy the same level of health or that different social groups do not have the same healthy life expectancy. If so, it would follow that justice requires making everyone’s health as equal as possible.¹ Let us term this viewoutcome equalityin health.²

      Critics often observe the following two problems with outcome equality in health:³ First, some inequalities in health originate in individuals’ freely chosen lifestyle. The ideal of outcome equality...

    • 8 Equality or Priority in Health?
      (pp. 111-120)

      In this second part of the book I set out to defend a luck egalitarian account of justice in health proper. The previous chapter contrasted that luck egalitarian approach with a Rawlsian approach (fair equality of opportunity for health). I argued that the Rawlsian approach is vulnerable to two crucial objections and that this ought to lead us to dismiss it as an account of justice in health. But how does the luck egalitarian account cope with the objections that have led us to reject FEO for health? In particular, luck egalitarianism, I have already conceded, is as vulnerable to...

    • 9 Distributing Human Enhancements
      (pp. 121-136)

      As a result of the success of the human genome project and other recent advances in biomedicine, new opportunities for so-called human enhancement are becoming conceivable. Understandably, these opportunities are only now beginning to be fully assessed from an ethical perspective. To be sure, in recent years, there has been much inquiry into thepermissibilityof human enhancements (mostly through genetic means). Philosophers have discussed, for example, whether parents should be allowed to genetically improve their offspring, or whether athletes should be allowed to artificially enhance their performance.¹ Considerably less attention has been given by philosophers to fairness in the...

  8. Part III Health without Borders
    • 10 Devolution of Health Care Services
      (pp. 139-152)

      The first two parts of this book attempted to delineate a luck egalitarian account of justice in health care and then in health. In this last part of the book I intend to apply lessons from that account to the issue of political boundaries. In a world which, paradoxically, is increasingly both more globalized and more localized, political boundaries have important normative implications for almost any area of policy. Accordingly, this chapter deals with subnational boundaries, whereas the next and final chapter goes beyond national boundaries. In addition, mirroring the order of the first two parts of the book, the...

    • 11 Global Justice and National Responsibility for Health
      (pp. 153-170)

      The moral issues concerning intercommunal differences in health pale in comparison to those concerning international disparities. It hardly needs pointing out that the inequality in the health of nations is vast: for example, people living in Zambia have an average life expectancy of 40.5 years, whereas those living in Japan can enjoy more than double the life expectancy of 82.3 years.¹ This inequality is no doubt disturbing. But the important question for us is whether it is also unjust. I want to employ the luck egalitarian perspective and inquire when, if ever, it is unjust for a population of one...

  9. Conclusion
    (pp. 171-174)

    I began this book by saying that one of the merits of the luck egalitarian account of justice in health care and health is that it is quite simple and straightforward. Let us, then, try and summarize its recommendations and see if it lives up to that earlier depiction.

    First, according to the theory proposed here, the provision of health care is justified not through an attempt to equalize individuals’ opportunity to pursue their life plans or to equalize their political and civic capabilities. Rather, health care is justified by way of society’s obligation to reverse individuals’ disadvantaging biological conditions...

  10. Notes
    (pp. 175-220)
  11. Bibliography
    (pp. 221-234)
  12. Index
    (pp. 235-239)