Considerations of autonomy and independence, properly understood, support strictly egalitarian provision of necessary medical treatment. If the financially better-off can purchase access to necessary medical treatments that the financially less well-off cannot purchase without help, then their discretionary power to give or to withhold monetary gifts indirectly gives them the power to make life-and-death or sickness-and-health decisions for others. To prevent private citizens from having this objectionable form of power, government must ensure that citizens’ finances do not affect their access (...) to medical treatments that significantly prolong life, relieve suffering, or cure or mitigate disabilities. Government should ensure this even if doing so involves leveling down and even if it is unclear whether egalitarian provision of necessary treatment would provide better care to the poor than a less egalitarian health care system would. (shrink)

This year marks the centenary of John Rawls's birth and the fiftieth anniversary of the publication of A Theory of Justice. The influence of Rawls's landmark book on the general fields of moral and political philosophy is undisputed and well-documented. It has also left a significant imprint on debates surrounding health policy, health care, and health inequalities. This article traces the changing ways in which Rawls's theory influenced debates about justice in health over the last five decades. Just as Rawls's (...) ideas have shaped debates about health, however, these debates can help us critically appraise the theory and its limitations. In that spirit, the article sketches three areas where a focus on health reveals challenges to the Rawlsian framework: the issue of priority setting among competing goods, the theory's egalitarian commitments, and its focus on the distribution of goods. (shrink)

Despite crowdfunding platforms’ growing involvement in financing welfare, related ethical issues have received little scholarly attention. To address this gap, we focus on GoFundMe, the leading welfare crowdfunding platform in the US, to examine whether it facilitates the establishment of a just society that democratizes access to funding. Informed by Rawls’s ethics, we conduct a comprehensive analysis, arguing that GoFundMe’s modus operandi merits criticism. We advance three interrelated arguments for why GoFundMe is morally problematic. First, it distributes information and primary (...) goods unfairly, perpetuating inequalities that disadvantage the most vulnerable. Second, it uses narratives that may distract public attention from systemic flaws in welfare provision, potentially reducing social pressure for institutional reform. Third, its emphasis on individual choice and responsibility may contribute to momentum for neoliberal policymaking. We show why scholars, policymakers, and platforms should engage in debate about regulating welfare crowdfunding activities to improve their ethicality. (shrink)