States are increasingly implementing policies aimed at changing people's dietary habits, such as fat taxes, food bans, and nudges. In this article, we ask whether healthy eating policies are consistent with public reason, the view that state laws and policies should be justified on the basis of reasons that all citizens can accept at some level of idealisation despite their different conceptions of the good. What we intend to explore is an ‘if…, then…’ line of thought: if one is committed (...) to public reason, then may one consistently endorse healthy eating policies? First, we illustrate multiple ways in which contemporary societies are characterised by a reasonable pluralism concerning conceptions of health and values attached to eating practices. Second, we critically assess the implications of three main conceptions of the structure of public reason, i.e. ‘shareability’, ‘intelligibility’ and ‘accessibility’, for the public justifiability of healthy eating policies. We conclude that healthy eating policies are only consistent with public reason under the ‘accessibility’ conception, i.e. if they are based on reasons grounded in shared epistemic and moral evaluative standards, as long as such reasons reflect a reasonable balance of political values and do not overly prioritise or neglect any of these values. (shrink)

In this stimulating work of political philosophy, acclaimed philosopher G. A. Cohen sets out to rescue the egalitarian thesis that in a society in which distributive justice prevails, peopleâes material prospects are roughly equal. Arguing against the Rawlsian version of a just society, Cohen demonstrates that distributive justice does not tolerate deep inequality. In the course of providing a deep and sophisticated critique of Rawlsâes theory of justice, Cohen demonstrates that questions of distributive justice arise not only for the state (...) but also for people in their daily lives. The right rules for the macro scale of public institutions and policies also apply, with suitable adjustments, to the micro level of individual decision-making. Cohen also charges Rawlsâes constructivism with systematically conflating the concept of justice with other concepts. Within the Rawlsian architectonic, justice is not distinguished either from other values or from optimal rules of social regulation. The elimination of those conflations brings justice closer to equality. (shrink)

Political philosophers have become increasingly interested in questions of justice as applied to health. Much of this literature works from a distributive understanding of justice. In the recent debate, however, ‘relational’ egalitarians have proposed a different way of conceptualising equality, which focuses on the quality of social relations among citizens and/or how social institutions ‘treat’ citizens. This paper explores some implications of a relational approach to health, with particular focus on health care, health inequalities and health policy. While the relational (...) account can add interesting perspectives to current debates on justice and health, we also highlight some tensions and difficulties relational egalitarians might encounter and some discontinuities between the implications of a relational account and current discourse on health equity. (shrink)

From the late 1970s through the mid-1980s, a number of philosophers carefully worked out theories of justice in health care. Most of those still working on these issues have turned to clinical applications of the philosophical frameworks developed earlier. Although theories have not received much recent attention in this debate, this paper will offer a new theoretical framework for approaching issues of justice in health care. There are two reasons for thinking that returning to theory would be worth- while. One (...) concerns the fact that our society remains very far from realizing justice in health care. While there are several well-argued theories of just health care whose implementation would take us into the neighborhood of justice, it would also seem - in pluralistic spirit - that adding to the arsenal is helpful. The more good arguments there are for a given conclusion, the more likely it is to be correct and, ultimately, to persuade. -/- It will be contended that a limited right to health care can be grounded in self-respect. The argument will exploit Rawls' key insight that self-respect is a primary social good and will depend on the assumption that, at least in moderately affluent nations, one has a right to the primary social goods. This assumption is not defended here. But it should be noted that a right to the primary social goods is not of interest only to Rawlsians and other liberal deontologists; an enlightened utilitarianism might also vindicate it. The second reason for advocating a return to theory is that self-respect is especially fruitful as a focal concept for addressing issues of justice in health care (and other issues). (shrink)

This paper considers whether Rawls' theory of justice as fairness may be used to justify a human right to health care. Though Rawls himself does not discuss health care, other writers have applied Rawls' theory to the provision of health care. Ronald Green argues that contractors in the original position would establish a basic right to health care. Green's proposal, however, requires considerable relaxation of the constraints Rawls places on the original position and thus jeopardizes Rawls' arguments for the two (...) principles of justice. Norman Daniels claims that health care is best understood as a means for helping to achieve Rawls' goal of equality of fair opportunity. Daniels acknowledges, however, that his interpretation cannot justify a basic right to health care; rather, it would at best require that certain kinds of care be made available to certain kinds of individuals. Finally, in place of the notion of health care is a human right, it is suggested that the provision of health care is a social ideal which may inspire the creation of specific legal rights. On this view, social provision of health care may properly vary significantly from culture to culture. Despite this variability, social systems may still be criticized on moral grounds. Keywords: justice, right to health care, equality, fair opportunity. (shrink)

Previous edition, 1st, published in 1971.

This paper examines the fairness of avoidable inequalities in health. It contrasts two approaches to this question, a direct approach and an indirect approach. Most of the discussion focuses on the indirect approach advocated by Daniels, Kennedy and Kawachi (2000). Their argument that avoidable inequalities in health are not unfair when their causes are otherwise fair is criticised on two counts. First, it encounters a surprising difficulty when one attends carefully to the point at which ethics intersects with epidemiology here. (...) Second, it fails to address the fundamental issue, which is whether any version of the direct approach is valid. (shrink)

Although discussions of John Rawls’ A Theory of Justice generally refer to Rawls’ two principles of justice, and although Rawls himself labels his principles “the two principles of justice”, Rawls actually sets forth three distinct principles in the following lexical order: the liberty principle, the fair equality of opportunity principle, and the difference principle. Rawls argues at some length for the priority of the liberty principle over the other two. On the other hand, Rawls offers hardly any argument at all (...) for the priority of the fair equality of opportunity principle over the difference principle. In this article I will argue that making the fair equality of opportunity principle separate from and lexically prior to the difference principle is both intuitively unattractive and inconsistent with Rawls’ method of deriving principles of justice from the choices of rational contractors in the original position. (shrink)

How should we think, from the point of view of distributive justice, about inequalities in health and longevity? Norman Daniels’s influential account derives a social duty to reduce health inequalities from Rawls’s principle of fair equality of opportunity. This paper criticises Daniels’s approach and offers an alternative. To the extent that the basic structure of society shapes people’s opportunities to be healthy, we ought to think of ‘the social bases of health’ directly as a Rawlsian primary social good. The paper (...) attempts to clarify the correct principle for its distribution, and its relationship to other goods that give rise to considerations of justice. (shrink)

One widely accepted way of justifying universal access to health care is to argue that access to health care is necessary to ensure health, which is necessary to provide equality of opportunity. But the evidence on the social determinants of health undermines this argument.

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Rawls' Difference Principle asserts that a basic economic structure is just if it makes the worst off people as well off as is feasible. How well off someone is is to be measured by an ‘index’ of ‘primary social goods’. It is this index that gives content to the principle, and Rawls gives no adequate directions for constructing it. In this essay a version of the difference principle is proposed that fits much of what Rawls says, but that makes use (...) of no index. Instead of invoking an index of primary social goods, the principle formulated here invokes a partial ordering of prospects for opportunities. (shrink)

In this first-ever history of contemporary liberal theory, Forrester shows how liberal egalitarianism--a set of ideas about justice, equality, obligation, and the state--became dominant, and traces its emergence from the political and ideological context of the postwar United States and Britain.d Britain.