Social justice in health care: A critical appraisal
Engelhardt, H. Tristram, Jr.
Doctor of Philosophy
This work offers a philosophical appraisal of accounts of social justice in health care. By analyzing and comparing seven different accounts, it shows what is involved in advancing such an account and discloses what is involved in providing a moral justification, identifying a tripartite interplay among moral accounts, theories, and perspectives regarding the proper allocation of health care. Based on a distinction between substantive and procedural accounts of justice in health care allocation, it concludes that the prospect of agreement regarding substantive accounts of health care justice is unlikely. This study illustrates that it is moral perspectives, rather than moral theories, that are foundational to accounts of justice in health care. A moral perspective includes the complete content of a morality lived by a group of people, while a moral theory identifies general statements formulateable within a moral perspective, a moral account restructures in a systematic way a moral perspective regarding a domain of issues, such as that of justice in health care. Although a moral theory contributes to an account a general framework that arranges moral commitments into a discursive system, only a full-bodied moral perspective can provide a moral account the substance that it needs. Through closely looking at various moral perspectives embodied by different accounts of just health care, it becomes clear that disagreements in morality are extensive and deep. It is impossible to justify a particular substantive account of just health care without begging the question. Finally, a theoretical reconstruction of Singapore's Confucian moral perspective regarding health care justice is provided so as to offer a picture of a quite different theoretical foundation as well as a substantively different moral perspective from those that are often taken for granted in the West. It shows that moral perspectives are different from people to people, from community to community. A successful account of just health care will thus require more than what can be drawn from theories of justice.
Philosophy; Health sciences