In this article, I argue that Powers and Faden’s non-ideal, comprehensive theory of justice cannot keep in line with the proposed moderateness of their essentialist approach. My argument is as follows: Powers and Faden’s comprehensive theory of justice contravenes the thrust of moderate essentialism, in claiming that their theory values health for its own sake. Why do they define their conception of justice as valuing health for its own sake when it is likely to be incongruous with their essentialist approach? (...) To understand this, we should examine their sufficientarian proposal. There are two requirements for plausible sufficientarianism. The first requirement is to specify the threshold below which people are seriously deprived and must be urgently benefited in a non-arbitrary manner. The second requirement is that sufficientarianism should be sensitive to certain inequalities above the threshold. Powers and Faden’s approach convincingly meets the first requirement. However, the non-ideal aspect of their approach, which is key to meeting the second requirement, makes it explicit that at least one of the listed dimensions of well-being must be valued for their own sake. This is not reconcilable with their own characterization of moderate essentialism. For this reason, we should conclude that Powers and Faden fail to argue for moderate essentialism. (shrink)

The goal of this article is to explore how a social justice framework can help illuminate the role that consent should play in health and science policy. In the first section, we set the stage for our inquiry with the important case of Henrietta Lacks. Without her knowledge or consent, or that of her family, Mrs. Lacks’s cells gave rise to an enormous advance in biomedical science—the first immortal human cell line, or HeLa cells.

Powers and Faden argue that social justice ‘is concerned with securing and maintaining the social conditions necessary for a sufficient level of well-being in all of its essential dimensions for everyone’ (2006: 50). Moreover, social justice is concerned with the ‘achievement of well-being, not the freedom or capability to achieve well-being’ (p. 40). Although Powers and Faden note that an agent alone cannot achieve well-being without the necessary social conditions of life (e.g. equal civil liberties and basic material resources, such (...) as food and shelter), it seems that achievement requires that an agent actually pursue the six dimensions of well-being. In this article, I question the extent to which an individual has an obligation to achieve well-being, even if he or she would choose to do otherwise. For example, can an agent choose to forgo being healthy even if all the social conditions are met in her life, thereby choosing to not achieve well-being? It remains unclear how the dimension of self-determination coheres with the remaining five dimensions of well-being and the extent of society’s obligations toward an individual’s achievement of well-being, even in those instances when society’s actions may go against an individual’s right to self-determination. (shrink)

South Africa has the highest rate of foetal alcohol syndrome (FAS) in the world. The problem of alcohol abuse in pregnancy has very deep historical roots that are intertwined with the injustices of both apartheid and pre-apartheid colonialism. Much of the research that is being done in these communities is focused on identifying the epidemiological variables associated with these patterns of alcohol abuse. The underlying reasons as to why these patterns continue seem to remain largely obscured from view. In this (...) article, I apply the theory proposed by Powers and Faden of social justice as a ‘moral foundation for public health and health policy’ to the problem of FAS in South Africa. The objective of this application is two-fold: first, to critically explore the additional insights and alternative perspectives to the problem of FAS that this approach may provide and second, to assess the utility of the theory when applied directly to a specific public health problem. I conclude by noting that although this approach could result in the kind of ‘public health scope creep’ that has been criticized by various authors, it does provide fresh insights to the problem of FAS in South Africa. (shrink)

While Powers and Faden do not consider possible anti-paternalism objections to their view, there are two variants of this objection that a social justice perspective is susceptible to. It is worth exploring which responses to such objections may be less promising than others. It is argued that for most public health measures targeting the disadvantaged, theorists and practitioners taking a social justice perspective should bite the paternalist bullet. Insofar as the government has the ability to reduce mortality and morbidity within (...) the population in a way that is fair and in everyone’s interests, then the use of paternalistic means or resultant paternalistic effects should be thought to be the lesser evil. (shrink)

Social justice has strong historical roots in public health. This does not mean that we always understand what it entails when conducting an ethical analysis of a particular public health program. This article shows that Powers and Faden’s theory of social justice can provide important insights and nuance to such an analysis. The Ontario human papilloma virus vaccination program that is underway in Canada provides an important and timely case where we can surface ethical issues pertaining to social justice that (...) may otherwise remain unarticulated in the context of this program. This analysis focuses on the normative issues raised by the prioritization of a school-based program for girls only. It also examines the relevant domains of well-being identified in Powers and Faden’s theory to see whether the program is likely to enhance the well-being of those for whom it is most important. Finally, the role of vaccines in general in promoting well-being is discussed. (shrink)