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

机译：分配共享医疗资源时的正义：旨在消除可预防的医疗不足。

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摘要

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.
机译：在这项工作中，我反对当前在医疗保健领域具有影响力的分配正义的“广泛平均主义”理论，以及反对以效率或最大化整体健康利益为唯一目的的医疗保健模型。我重新解释了正义在分配共享医疗资源时需要什么，这些资源可以充分应对针对这些竞争性替代方案提出的反对意见。我认为，医疗保健正义的正确目标是减轻构成个人可预防的，无法实现自身最大健康潜力的健康差距，这可以通过在一定范围内利用我们掌握的医疗保健手段来克服社会历史背景。这些个体自身最大健康潜力的可避免的不足或偏离将被定义为“可预防的健康不足”。我提出的“理想”正义不是所有人之间享有平等健康结果的状态，而是向每个人提供必要的保健手段的状态，使她能够追求自己的健康机会或发挥自己的全部健康潜力-即消除所有可预防的健康不足的状态。我将争辩说，与以前提供的任何替代方案相比，该目标更完全符合道德要求，即平等地关注和尊重人，将人视为道德平等;与诺曼·丹尼尔斯的说法相反，我认为健康它具有内在的价值，而不仅仅是工具上的价值，我认为即使应该保护个人的健康机会，即使这样做也不会对其追求非健康机会的公平机会产生进一步的影响。与阿玛蒂亚·森相反，我认为消除健康不足，而不是实现“成就平等”或个人之间健康成果的平等，是我们应在医疗机构中追求的目标。我认为，这一目标不仅与森的正义“能力理论”更加一致，而且与我们对健康不平等的常识道德的深思熟虑的判断更加吻合。

著录项

  • 作者

    Esbensen, Kari L.;

  • 作者单位

    Georgetown University.;

  • 授予单位 Georgetown University.;
  • 学科 Philosophy.;Political Science General.;Health Sciences Public Health.
  • 学位 Ph.D.
  • 年度 2008
  • 页码 323 p.
  • 总页数 323
  • 原文格式 PDF
  • 正文语种 eng
  • 中图分类
  • 关键词

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