'Luck egalitarianism' - the idea that justice requires correcting disadvantages resulting from brute luck - has gained ground in recent years and is now the main rival to John Rawls' theory of distributive justice. "Health, Luck, and Justice" is the first attempt to systematically apply luck egalitarianism to the just distribution of health and health care. Challenging Rawlsian approaches to health policy, Shlomi Segall develops an account of just health that is sensitive to considerations of luck and personal responsibility, arguing that people's health and the health care they receive are just only when society works to neutralize the effects of bad luck. Combining philosophical analysis with a discussion of real-life public health issues, "Health, Luck, and Justice" addresses key questions: What is owed to patients who are in some way responsible for their own medical conditions? Could inequalities in health and life expectancy be just even when they are solely determined by the 'natural lottery' of genes and other such factors? And is it just to allow political borders to affect the quality of health care and the distribution of health?
Is it right, on the one hand, to break up national health care systems in multicultural societies? And, on the other hand, should our obligation to curb disparities in health extend beyond the nation-state? By focusing on the ways health is affected by the moral arbitrariness of luck, "Health, Luck, and Justice" provides an important new perspective on the ethics of national and international health policy.
Preface iv Introduction 1 Chapter 1: Justice, Luck, and Equality 9 I. Rawlsian vs. Luck Egalitarian Justice 10 II. Inequality vs. Equality 14 III. Reasonable Avoidability vs. Responsibility 19 Part I Health Care 27 Chapter 2: Responsibility- Insensitive Health Care 29 I. The Fair Opportunity Account 30 II. Opportunities and Life Plans 34 III. Th e Democratic Equality Account 37 Chapter 3: Ultra- Responsibility- Sensitive Health Care: "All- Luck Egalitarianism" 45 I. A Test Case: Justifying Medical Treatment for Smoking- Related Diseases 46 II. Some Preliminary Problems with All- Luck Egalitarianism 48 III. What's Wrong with Neutralizing Luck as Such? 51 IV. All- Luck Egalitarianism, Moral Luck, and Desert 54 Chapter 4: Tough Luck? Why Luck Egalitarians Need Not Abandon Reckless Patients 58 I. Luck Egalitarian Attempts to Defl ect the Abandonment Objection 59 II. Value Pluralism 64 III. Three Objections to Luck Egalitarian Value Pluralism 66 IV. A Potential Solution? 68 Chapter 5: Responsibility- Sensitive Universal Health Care 74 I. Meeting Basic Needs 75 II. Health Care as a Public Good 78 III. Some Counter- Objections and Clarifi cations 80 IV. In- Kind Health Care 83 Part II: Health 87 Chapter 6: Why Justice in Health? 89 I. Is Health Care (Still) Special? 89 II. Why a Separate Th eory of Justice in Health? 92 Chapter 7: Luck Egalitarian Justice in Health 98 I. Rawlsian vs. Luck Egalitarian Justice in Health 99 II. Two Problems with Fair Equality of Opportunity for Health 101 III. Health Inequalities between the Sexes Revisited 105 Chapter 8: Equality or Priority in Health? 111 I. The Value of Equality in Health 112 II. Some Potential Objections and Qualifi cations 115 III. Luck Prioritarian Justice in Health 118 Chapter 9: Distributing Human Enhancements 121 I. What Is Human Enhancement? 122 II. The Treatment vs. Enhancement Distinction 124 III. "Fair" Skin and Other Potential Objections 130 IV. Equality or Priority in Enhancement? 133 Part III: Health without Borders 137 Chapter 10: Devolution of Health Care Services 139 I. The Case for Devolution 141 II. How Devolution Upsets Distributive Justice 143 III. Ignoring Cultural Preferences in Health Care 144 IV. How Devolution Weakens Social Solidarity 148 V. Imposing a Uniform Pattern of Consumption 150 Chapter 11: Global Justice and National Responsibility for Health 153 I. Justice, Responsibility, and Double Standards 155 II. "The Health of Nations" and the Global Economic Order 158 III. Holding Nations Responsible for Th eir Health 160 IV. National Responsibility and Future Generations 162 V. Equality or Suffi ciency in Global Health? 165 VI. Intergalactic Egalitarianism 168 Conclusion 171 Notes 175 Bibliography 221 Index 235