Abstract

Our society continues to debate the extent to which the government should guarantee a broad range of health care services for all of its citizens. With the demand for coverage of catastrophic illnesses being made in a time of budget deficits, the debate has become even more heated. Traditionally, such services have been justified by appealing to rights, to utilitarian considerations, or to the inhumanity of not providing such services. Others have argued from a particular theory of rights that society has no obligation to provide such services. But this controversy is not new. This is only one instance of a longstanding dispute amongst political theorists as to how the resources in a society ought to be distributed. In this project I consider the problems of recent theories of distributive justice offered by Dworkin, Rawls, Nozick and Gauthier. I develop and defend an alternative theory of justice, based upon a principle that requires a division of social goods such that every individual has the opportunity to achieve a satisfactory welfare level, consistent with an equal liberties requirement. I argue that the determination of what health care services are required by a just society depend not only upon this particular theory of justice but ultimately upon how one characterizes health and disease. I develop and defend a characterization of disease that follows Christopher Boorse's which claims that disease is functioning below what is typical of the appropriate reference class within the species. I argue for a dispositional reading of health, the ability of an organism to respond to its environment in a species-typical way that allows it to survive and meet its basic needs. Furthermore, I show that justice does not require access to treatment for all diseases. In fact, even though the health care distributional pattern required by justice guarantees access to a broad range of basic health care services, it does not justify access to a large number of other services that most now assume are required, e.g., some forms of lung cancer