Abstract

In extending the entitlement theory to health care, I will lay the groundwork for a scheme which takes into account historical entitlement, preserves patient and physician autonomy, and conceives health care on the maximum possible level. The entire health care delivery system will be governed by the crucial point for the entitlement theorist, that the appropriation of an unowned object not worsen the situation of others. The constraint is absolute. Any violation of the constraint calls for a halt to the permissible use of entitlement as a theory of justice in health care. Theories of Justice in Health Care is comprised of five chapters. The first is an examination of theories of justice in general and the health care systems that arise from the application of these theories. Norman Daniels' "fair equality of opportunity account" is closely scrutinized in order to evaluate whether his extension of John Rawls' theory of justice leads to a just health care system. Daniels' extension of Rawls is then contrasted with an extension of Robert Nozick's entitlement theory, in order to evaluate whether Nozick's theory of entitlement leads to a more just health care system than that achieved by Rawls' "fair equality of opportunity account." The practical question is whether a private health care system should co-exist with the publicly funded system. The second chapter is an analysis of theories of community. Through an understanding of community, we should broaden our conception to be international in scope. Conceiving health care as community-based, coupled with an international perspective, brings to human beings a new philosophy of healing. The remaining chapters apply the theories of justice and community as developed. Chapter three is a community-based approach to a crisis in an individual's health care and examines the resolution of the crisis through mediation rather than in the traditionally adversarial medical malpractice lawsuit. Chapter four applies theories of justice and community and considers a community-driven, internationally based perspective to alleviate the distinct problem of scarcity when there are insufficient resources independently of funding, specifically in the case of vital organ procurement, and in particular through a model of presumed consent. Chapter five applies the theories of justice and community once more and provides a framework within entitlement as a conception of justice to improve the health care system in Canada. A health care system which includes the integration of a public/private sphere is considered and then proposed, provided that there be a constraint that the position of others not be worsened. The implementation of this system would maximally respect the autonomy of physicians and patients, and in essence would produce greater resources in the public sector, since those who can pay would be able and allowed to do so, there would be more funding for technology, the strain on the public system would be alleviated, and the health care system would provide the additional incentive for physicians and patients to remain in Canada.