Abstract
In this chapter I argue that health has special moral importance. I do so by suggesting that disadvantage ought to be the proper target of concern when examining justice. If we explore the nature of disadvantage suffered when one is in poor health or living with a disability, we can see that it negatively impacts one’s ability to secure other valuable states of being. I suggest that disadvantage differs not only in degree, but in kind, and as such, capabilities that result in corrosive disadvantage when insecure ought to be prioritized as a matter of justice.
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Notes
- 1.
While I recognize that there is an incredibly rich discussion of what constitutes health, in keeping with other aspects of this piece I will follow Daniel’s conception of health. I believe this to be compatible (although distinct) with Bickenbach’s use of the term health in the previous chapter. In Just Health: Meeting Health Needs Fairly (New York: Cambridge University Press, 2008), Daniels suggests a shift away from two misunderstandings of health (Daniels 2008). The first is that health is the absence of disease. This is because, of course, the notion of ‘disease’ is too narrow to capture all that we aim to capture when discussing health. Daniels also slightly pushes away from the World Health Organization (WHO) definition: “health is a state of complete physical, mental, and social well-being, and not merely the absence of disease or infirmity.” I think Daniels is correct when he states that the WHO conception risks turning all disadvantage into health. More recently, Venkatapuram’s conception of health advanced in his Health Justice: An Argument from the Capabilities Approach (Cambridge: Polity Press, 2011) seems to commit us to a somewhat vacuous conception of health, categorizing any deprivation of the central capabilities as being the result of poor health (Venkatapuram 2011). Instead of relying upon a subjective account of health like the WHO’s or Venkatapuram’s which seems incompatible with an objective theory of the good-life (e.g. the capabilities approach), Daniels relies upon an objective understanding. He suggests that health should be understood as the absence of pathology. Here we are to understand ‘pathology’ to refer to deviations from species typical functioning. While this conception may itself be too broad of a notion of health, I do want to leave such disagreement to the sideline for the time being.
- 2.
Norman Daniels, Just Health Care (New York: Cambridge University Press, 1985) (Daniels 1985); Norman Daniels, Justice and Justification: Reflective Equilibrium in Theory and Practice (New York: Cambridge University Press, 1999) (Daniels 1999); Norman Daniels, “Justice, Health, and Health Care,” American Journal of Bioethics 1, no. 2 (2001): 2–16 (Daniels 2001); Daniels, Just Health. (Daniels 2008)
- 3.
These questions put aside for the time being are undoubtedly incredibly important. Providing a justification for guaranteeing human rights without a feasible framework to secure them is concerning. That said, I take Daniels’s second and third questions to be better addressed after a conceptual framework is established.
- 4.
- 5.
Daniels, Just Health Care, 19. (Daniels 1985)
- 6.
Ibid. (Daniels 1985)
- 7.
Daniels’s notion of functioning differs, of course, from the functionings that are components of the capabilities approach.
- 8.
Daniels, Just Health, 19. (Daniels 2008)
- 9.
Ibid., 27. (Daniels 2008)
- 10.
Daniels, “Justice, Health, and Health Care,” 2. (Daniels 2001)
- 11.
Daniels, Just Health, 30. (Daniels 2008)
- 12.
Daniels, Just Health, 30 (Daniels 2008). Of course there may be other opportunity protectors that are important as a matter of justice, and we need not concern ourselves with a lexicographical ordering of these for the time being. As I argue below, I suspect that we can at least create two classifications of capabilities. I suggest that health resides in the category of capabilities that should be given special moral importance over the other class.
- 13.
- 14.
Ibid., 329. (Sen 1995)
- 15.
Ibid. (Sen 1995)
- 16.
Ibid. (Sen 1995)
- 17.
Martha Nussbaum, Women and Human Development (Cambridge: Cambridge University Press, 2000), 5. (Nussbaum 2000)
- 18.
Martha Nussbaum, Frontiers of Justice: Disability, Nationality and Species Membership (Cambridge: The Belknap Press of Harvard University Press, 2006), 155. (Nussbaum 2006)
- 19.
Martha Nussbaum, Creating Capabilities: The Human Development Approach (Cambridge: The Belknap Press of Harvard University Press, 2011), 18. (Nussbaum 2011)
- 20.
Jonathan Wolff and Avner De-Shalit, Disadvantage (Oxford: Oxford University Press, 2007), 24. (Wolff and De-Shalit 2007)
- 21.
Ibid., 65. (Wolff and De-Shalit 2007)
- 22.
Ibid., 75. (Wolff and De-Shalit 2007)
- 23.
In the next chapter we will see why such an emphasis is important for notions of autonomy.
- 24.
The most important of which I take to be: Jennifer Prah Ruger, Health and Social Justice (New York: Oxford University Press, 2009) (Ruger 2009); Jennifer Prah Ruger, “Toward a Theory of a Right to Health: Capability and Incompletely Theorized Agreements,” Yale Journal of Law and Humanities 17, no. 2 (2006): 273–326 (Ruger 2006); and Elizabeth S. Anderson, “What is the Point of Equality?,” Ethics 109, no. 2 (1999): 287–337. (Anderson 1999)
- 25.
Martha Nussbaum, “Aristotelian Social Democracy,” in Liberalism and the Good, ed. R. Bruce Douglas, Gerald M. Mara, and Henry S. Richardson (New York: Routledge, 1990), 219. (Nussbaum 1990)
- 26.
Ibid. (Nussbaum 1990)
- 27.
Ibid., 222. (Nussbaum 1990)
- 28.
Ibid. (Nussbaum 1990)
- 29.
Nussbaum, Frontiers of Justice, 74. (Nussbaum 2006)
- 30.
I acknowledge the perhaps troubling use of the word ‘dignity’ in greater detail in C. A. Riddle, “Natural Diversity and Justice for People with Disabilities,” in Disability and the Good Human Life, ed. Jerome Bickenbach, Franziska Felder, and Barbara Schmitz (Cambridge: Cambridge University Press, 2013), 271–299. (Riddle 2013d)
- 31.
Jennifer Prah Ruger, Health and Social Justice (New York: Oxford University Press, 2009), 3. (Ruger 2009)
- 32.
I advance this position in greater depth in C. A. Riddle, “Responsibility and Foundational Material Conditions,” The American Journal of Bioethics 11, no. 7 (2011): 53–55. (Riddle 2011)
- 33.
I first encountered the example of celibacy and monks in Richard Arneson, “‘Good enough’ is not good enough,” in Capabilities Equality: Basic Issues and Problems, ed. Alexander Kauffman (Routledge: New York, 2005). (Arneson 2005)
- 34.
Martha Nussbaum, Creating Capabilities, 33. (Nussbaum 2011)
- 35.
Martha Nussbaum, Frontiers of Justice, 77. (Nussbaum 2006)
- 36.
Amartya Sen, “Capability and Well-Being,” in The Quality of Life, ed. Martha Nussbaum and Amartya Sen (Oxford: Oxford University, 1993), 30–53. (Sen 1993)
- 37.
It is important to note that the claim being made is that health has special moral importance. This claim does not exclude the fact that other capabilities might also reside in the category of things with special moral importance. The capability of ‘bodily health’ is simply being used as an example of a capability that resides in a subset of capabilities that Nussbaum fails to acknowledge as requiring special attention. Certainly the corrosiveness of capabilities resides on a spectrum that is difficult to measure definitely. That said, I employ the two examples of health and celibacy to point to two obvious cases of disadvantage: one that prompts justice considerations, and another that does not. One could point to other capabilities that are more difficult to classify as residing in the subset of capabilities that result in corrosive disadvantage if not secured. Thus, further work is required on establishing what threshold is employed to classify capabilities. Nonetheless, I suspect the point that holds that there are some disadvantages that prompt justice considerations because of the corrosiveness of that disadvantage, and there are some forms of disadvantage that do not. Poor health results in disadvantage that warrants concern in the realm of justice, while celibacy does not. The point being made concerns the fact that we need to distinguish between classes of disadvantage that result from the absence of a functioning, and not a question about how we should go about parsing the capabilities.
- 38.
Nussbaum, Frontiers of Justice, 76. (Nussbaum 2006)
- 39.
Ibid., 77. (Nussbaum 2006)
- 40.
Ibid. (Nussbaum 2006)
- 41.
For two of the many research projects that affirm this, see: David Alan. Nibert et al., “Assaults against Residents of a Psychiatric Institution: Residents’ History of Abuse,” Journal of Interpersonal Violence 4, no. 3 (1989): 342–349 (Nibert et al. 1989); or Statistics Canada, Centre for Justice Statistics, “Wife Assault: The Findings of a National Survey,” Juristate: Service Bulletin 14, no. 9 (1994). (Statistics Canada, Centre for Justice Statistics 1994)
- 42.
Nussbaum, Frontiers of Justice, 77. (Nussbaum 2006)
- 43.
At this point one might be inclined to suggest that the importance of health might be exaggerated. Take for example Michel Petrucciani. Petrucciani was a famous jazz pianist who died at age 36 and suffered from a very substantial disability. One could reasonably conclude that he would not have traded his art for a longer or healthier life. Examples of people sacrificing bodily health for their art are abundant. Maybe we can view the Petrucciani example and other cases like it as evidence that health need not always trump other goods. I suspect this might be a reasonable claim. That said, if we continue to operate within the confines of the capabilities approach we can see that while this claim might be a distinct critique of capabilities, I do not feel it is a refutation of my intended point. I am operating within the parameters set by the capabilities approach. These parameters state, among other things, that the goal of justice should be to maximize the number of capabilities one has a minimally just level of access to. This implies that a capability that minimizes the amount of capabilities one has a minimally just level of access to is particularly important. It has special importance because without it other capabilities are more difficult to secure. If the goal of the capabilities approach is to maximize the number of capabilities one has minimal access to, then the argument being advanced in this work—that health resides in a class of capabilities that have special moral importance because of the corrosive disadvantage that results from a failure to secure a healthy life—seems to follow. The critique concerning the exaggeration of the importance of health seems to suggest that the antecedent of the previous claim—that the goal of justice is to maximize the number of capabilities one has minimal access to—is false. This is a distinct critique of the capabilities approach, and not a direct critique of the remarks being made here that assume the antecedent is true and offer critical remarks of the capabilities approach that grant its design is correct, while suggesting that its implementation is troubled.
- 44.
Christopher A. Riddle, “Measuring Capabilities: The Case of Disability,” in The Capability Approach on Social Order, edited by Niels Weidtmann, Yanti Martina Hölzchen, and Bilal Hawa (preface by Martha Nussbaum) (Munster: LIT Verlag, 2012), 51 (Riddle 2012); Christopher A. Riddle, “Indexing, Capabilities, and Disability,” The Journal of Social Philosophy 41, no. 4 (2010): 527–537. (Riddle 2010)
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Riddle, C.A. (2017). The Special Moral Importance of Health. In: Human Rights, Disability, and Capabilities. Palgrave Pivot, New York. https://doi.org/10.1057/978-1-137-59993-3_4
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