Abstract
I chose the title of this essay in part because of the balanced alliteration between “injustice” and “inequality” on the one hand and “health” and “health care” on the other. But the parallelisms of sound in this case mirror analogies in the relations. In each pair, the first member is the more important and more general. Injustice is of obvious moral importance. Inequality is one source of injustice, though inequalities are not always unjust, and inequalities may have other ethically significant consequences. Similarly, health is much more important than health care, though health care obviously contributes to health and may have other morally significant effects on well-being and social solidarity.
This essay draws on other work of mine, especially Hausman (2007, 2011, 2012). I am grateful to Paul Kelleher for comments on an earlier draft of this paper and to discussion of the talk based on this paper at the conference in Leuven on Justice, Luck and Responsibility in Health Care in May of 2011.
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Notes
- 1.
This formulation assumes that humans are the only morally responsible agents.
- 2.
- 3.
- 4.
“[…] what makes us care about various inequalities is […] the hunger of the hungry, the need of the needy, the suffering of the ill, and so on. The fact that they are worse-off in the relevant respect than their neighbors is relevant. But it is relevant not as an independent evil of inequality. Its relevance is in showing that their hunger is greater, their need more pressing, their suffering more hurtful, and therefore our concern for the hungry, the needy, the suffering, and not our concern for equality makes us give them the priority” (Raz 1984, p. 240).
- 5.
For a related view, see O’Neill (2008).
- 6.
I am indebted to Matt Waldren for this reading of Temkin (which Temkin accepts). Segall explicitly rejects such a justification (2010, pp. 16–17), and argues that his concerns are completely independent of questions of desert. But he provides no alternative philosophical rationale for his qualified luck egalitarianism. The only consideration in its favor is its questionable ability to match our intuitions.
- 7.
See Kagan (1999). Serena Olsaretti (2002) disputes Kagan’s view that notions of desert completely displace egalitarian concerns. She argues that valuing equality makes a difference when considering starting points, where no one yet deserves anything, or when considering different patterns of desert.
- 8.
I first drew these distinctions in Hausman (2007). There is more to be said about them. It might be possible to mitigate the inequalities between Abby and Alan that are due to Alan’s irremediable bad health by providing Alan with additional non-health resources or by making Abby otherwise worse off. I count only the former as “compensation.” The fact that one might be able to make Alan and Abby equally well off by making Abby sufficiently miserable does not make Alan’s ill-health compensable.
- 9.
Lesley Jacobs makes a similar point, “Daniels could respond that from the perspective of equality of opportunity, the effects of some natural differences—those originating from differences in talents—are fair, but the effects of other natural differences—those originating from illness and disease—are unfair. The cogency of this response depends on the basis for this distinction” (1996, p. 337).
- 10.
Daniels adopts Christopher Boorse’s view (1977, 1997), according to which health is the absence of disease or pathology. According to Boorse, there is a pathology in some part of an organism when the level of functioning or capacity to function is in the lower tail of the distribution of efficiency of part function. Exactly where to draw the line between low normal and pathological functioning is in Boorse’s view arbitrary. There is nothing in theoretical medicine or biology that tells one whether the bottom 5% or 1% or .001% of liver function among some reference class divides the pathological from the non-pathological. For a critique of this view, see Schwartz (2007).
- 11.
One might question this claim on the grounds that improving the health of those who are worst off would lead to a population explosion which in the future would diminish total well-being. The tragic scenario suggested by this objection might come to pass. But the future is too uncertain to justify a certain present loss of well-being.
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Hausman, D.M. (2013). Injustice and Inequality in Health and Health Care. In: Denier, Y., Gastmans, C., Vandevelde, A. (eds) Justice, Luck & Responsibility in Health Care. Library of Ethics and Applied Philosophy, vol 30. Springer, Dordrecht. https://doi.org/10.1007/978-94-007-5335-8_2
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