Abstract

From the late 1970s through the mid-1980s, a number of philosophers carefully worked out theories of justice in health care. Most of those still working on these issues have turned to clinical applications of the philosophical frameworks developed earlier. Although theories have not received much recent attention in this debate, this paper will offer a new theoretical framework for approaching issues of justice in health care. There are two reasons for thinking that returning to theory would be worth- while. One concerns the fact that our society remains very far from realizing justice in health care. While there are several well-argued theories of just health care whose implementation would take us into the neighborhood of justice, it would also seem - in pluralistic spirit - that adding to the arsenal is helpful. The more good arguments there are for a given conclusion, the more likely it is to be correct and, ultimately, to persuade. It will be contended that a limited right to health care can be grounded in self-respect. The argument will exploit Rawls' key insight that self-respect is a primary social good and will depend on the assumption that, at least in moderately affluent nations, one has a right to the primary social goods. This assumption is not defended here. But it should be noted that a right to the primary social goods is not of interest only to Rawlsians and other liberal deontologists; an enlightened utilitarianism might also vindicate it. The second reason for advocating a return to theory is that self-respect is especially fruitful as a focal concept for addressing issues of justice in health care (and other issues).