Abstract
Many assume that theories of distributive justice must obviously take people’s lifetimes, and only their lifetimes, as the relevant period across which we distribute. Although the question of the temporal subject has risen in prominence, it is still relatively underdeveloped, particularly in the sphere of health and healthcare. This paper defends a particular view, “momentary sufficientarianism,” as being an important element of healthcare justice. At the heart of the argument is a commitment to pluralism about justice, where theorizing about just principles demands paying attention to the role particular goods play in our lives. This means that different approaches to the temporal subject—as well as other relevant issues—may be appropriate for different goods, including different goods within healthcare. In particular, the paper discusses two central goods targeted by healthcare: life-saving and pain relief. The view is offered as complementary to, rather than competitive with, lifetime approaches. As such, the paper finishes by considering how a pluralist approach, which engages both with people’s lives as a whole and with their states at particular moments, can reconcile the potentially competing claims in healthcare that emerge from these two perspectives.
Highlights
THREE QUESTIONS OF HEALTHCARE JUSTICEAccording to Dennis McKerlie (1989; 1992; 2001; 2013), discussions of egalitarian justice have mainly engaged with two central issues, at the expense of a third of equal importance
RÉSUMÉ : Plusieurs présument qu'il est clair que les théories de justice distributive doivent prendre la durée de vie des gens comme seule et unique période de distribution pertinente
My view is that different approaches to the pattern and temporal subject may be warranted depending on our choice of currency, and that there is no one currency that commands the undivided attention of justice
Summary
According to Dennis McKerlie (1989; 1992; 2001; 2013), discussions of egalitarian justice have mainly engaged with two central issues, at the expense of a third of equal importance. This means that the case for any particular answer to the questions of pattern and temporal subject demands attention to the nature of the good being distributed.1 This is true even within a single sphere of concern: while section 3 makes the case for adopting a momentary view with respect to some central aims of healthcare, healthcare has multiple aims, and they may suggest different answers to the temporal question. This is a second point of departure from McKerlie (2013), who rejects sufficientarianism with almost no discussion, instead advocating prioritarianism as a time-relative principle. I suggest that some ways of combining the two—lexical priority and a “tie-break” system—unreasonably relegate one principle to insignificance and argue that the best way to accommodate both kinds of claim is a macro approach to healthcare spending, rather than an attempt to micromanage individual patient claims
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