Health and Social Justice

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  • Edition: Reprint
  • Format: Paperback
  • Copyright: 2012-05-23
  • Publisher: Oxford University Press

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Health and Social Justice provides a theoretical framework for health ethics, public policy and law in which Dr Ruger introduces the health capability paradigm, an innovative and unique approach which considers the capability of health as a moral imperative. This book is the culmination ofmore than a decade and a half of work to develop the health capability paradigm, with a vision of a world where all have the capability to be healthy. This vision is grounded in the Aristotelian view of human flourishing and also Amartya Sen's capability approach. In this new paradigm, not justhealth care, or even just health alone, but the capability for health itself is a moral imperative, as is ensuring the conditions that allow all individuals the means to achieve central health capabilities. Key tenets of health capability include health agency, shared health governance, where individuals, providers and institutions work together to create a social system enabling all to be healthy, and the use of theorized agreements and shared reasoning to guide social choice and shape health policyand decision-making. This book provides philosophical justification for the direct moral importance of health and the capability for health and follows a norms-based approach to health promotion. It employs a joint scientific and deliberative approach to guide health system development and reform,and the allocation of scarce health resources. The health capability paradigm integrates both proceduralist and consequentialist approaches to justice, and both moral and political legitimacy are critical.

Table of Contents

List of Figuresp. xxxviii
List of Tablesp. xxxix
List of Abbreviationsp. xxxx
Introductionp. 1
The Current Set of Ethical Frameworks
Approaches to Medical and Public Health Ethicsp. 19
Welfare economic and utilitarian approachesp. 19
Communitarianism and liberal communitarianismp. 25
Egalitarian theories: equal opportunity and equal welfarep. 26
Libertarian and market-based approachesp. 30
Deliberative democratic proceduresp. 33
Summary of problems with the current set of frameworksp. 36
An Alternative Account-The Health Capability Paradigm
Health and Human nourishingp. 45
Aristotle's theoryp. 45
Human flourishingp. 45
Appropriate ends of political activityp. 46
Enabling functioning as a measure of political arrangementsp. 47
Other ends for political actionp. 47
Defining flourishingp. 47
The capability approachp. 50
Capability setsp. 51
Heterogeneityp. 53
Measures of well-beingp. 54
Freedom: opportunity and processp. 54
Selection and valuationp. 55
Basic capabilitiesp. 57
An underspecified theoryp. 58
Capability and health policyp. 58
Pluralism, Incompletely Theorized Agreements, and Public Policyp. 65
Social choice theory, collective rationality, and Arrow's impossibility resultp. 66
Problems in social choicep. 66
Arrow's impossibility theoremp. 67
Incompletely theorized agreementsp. 69
Incompletely specified agreementsp. 71
Incompletely specified and generalized agreementsp. 73
Incompletely theorized agreements on particular outcomesp. 73
Incompletely theorized agreements and public policyp. 73
Pluralism, ambiguity, and incompletely theorized agreementsp. 74
Incompletely theorized agreements and health capabilityp. 75
Health capability set: central and non-central health capabilitiesp. 76
Justice, Capability, and Health Policyp. 79
Trans-positionality: a global view of healthp. 79
Health capabilities: health functionings, health needs, and health agencyp. 81
Health and diseasep. 83
Equality, sufficiency, and priorityp. 88
A hybrid account: measuring inequality in health policyp. 88
Attainment and shortfall equalityp. 89
Efficiency and health policyp. 95
Ethics of the social determinants of healthp. 98
Limitations and objectionsp. 103
Capability, not opportunity or utilityp. 103
Other critiques and objectionsp. 109
Principles of the health capability paradigmp. 111
Grounding the Right to Healthp. 118
Scope and content of a right to healthp. 122
Duties and obligations in domestic and international policy and law: ethical commitments and public moral normsp. 123
Positive and negative rights: a constitutional right to medical self-defencep. 124
Domestic Health Policy Applications
A Health Capability Account of Equal Accessp. 133
Rethinking equal access: agency, quality, and normsp. 133
Defining equal access and a right to health carep. 134
Equal opportunity and equal resourcesp. 136
Rethinking equal access: a health capability perspectivep. 140
Justification for high-quality carep. 143
Health agencyp. 146
Health normsp. 148
High-quality care and a two-tiered systemp. 150
Responsibility and health: voluntary risk compared with involuntary riskp. 153
Paternalism, libertarian paternalism, and free willp. 155
A Health Capability Account of Equitable and Efficient Health Financing and Insurancep. 159
Theory of demand for health insurancep. 161
Behavioural economics and prospect theoryp. 161
Medical ethics and equal access to health carep. 162
Welfare economics and the capability approachp. 162
Vulnerability and insecurityp. 163
Moral foundations of health insurancep. 163
Gains in well-being from risk pooling and health insurancep. 166
Empirical evidence on the equity of health financing modelsp. 167
Market failures, public goods, and the role of the public sectorp. 168
Allocating Resources: A Joint Scientific and Deliberative Approachp. 172
Reasoned consensus through scientific and deliberative processesp. 172
Frameworks for combining technical and ethical rationality for collective choicep. 175
Allocations within the broader social budgetp. 175
Allocating within the health policy budget: benefits package: types of goods and services guaranteedp. 177
An evidence-based approach: medical appropriateness and clinical practice guidelinesp. 178
Medical futility and setting limitsp. 183
Universal benefits packagep. 184
Hard cases: the æbottomless pit objection' and 'reasonable accommodation'p. 187
Joint clinical and economic solutions: incorporating efficiencyp. 192
Resource allocation and age: reaching the highest average life expectancyp. 199
Domestic Health Reform
Political and Moral Legitimacy: A Normative Theory of Health Policy Decision-Makingp. 205
Public moral norms and domestic health reformsp. 207
Norms and values in the public's assessment of policyp. 210
Alternative frameworks: political conceptions and political processesp. 212
Case study: the Clinton Administration and failed health reformp. 216
A model of American health care reform and incomplete theorizationp. 219
Agreement on universal health care coveragep. 219
Multiple high-level theories for universal coveragep. 220
Strategies for attaining universal coveragep. 222
A wedge theory of health care reformp. 225
Internalization and agreement on moral valuesp. 230
Conclusionp. 235
Bibliographyp. 237
Indexp. 271
Table of Contents provided by Ingram. All Rights Reserved.

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