Justice in the allocation of shared health care resources: Aiming for the elimination of preventable health shortfalls

Abstract

In this work, I argue against currently influential "broadly egalitarian" theories of distributive justice in health care as well as against health care models that take efficiency, or maximizing aggregate health benefits, as their sole aim. I offer a new account of what justice requires in the allocation of shared health care resources that can adequately respond to the objections raised against these competing alternatives. I argue that the proper aim of justice in health care is to alleviate those health disparities that constitute individuals' preventable failures to achieve their own maximal potentials for health, which could be overcome through the utilization of the health care means at our disposal within a given socio-historical context.

These avoidable underfulfillments of, or deviations from, individuals' own maximal potentials for health will be defined as "preventable health shortfalls". The "ideal" of justice that I propose is not a state of equal health outcomes among all persons, but rather a state in which each individual is provided with the health care means necessary to enable her to pursue her own opportunities for health, or to achieve her own full potential for health functioning – i.e., a state in which all preventable health shortfalls have been eliminated. This aim, I will argue, more fully accords with the moral requirement to treat persons as moral equals – with equal concern and respect – than any of its previously offered alternatives.

In contrast to Norman Daniels' account, I argue that health has intrinsic, rather than merely instrumental, value, and I contend that individuals' opportunities for health ought to be protected even when doing so would have no further impact on their fair equality of opportunity to pursue non-health opportunities. In contrast to Amartya Sen, I argue that the elimination of health shortfalls, rather than the achievement of "attainment equality", or equality of health outcomes between individuals, is what we ought to seek within just health care institutions. I argue that this aim is not only more consistent with Sen's "capabilities theory" of justice, but is also more in keeping with the considered judgments of our commonsense morality regarding health inequalities.