Abstract
Is health care “special”? That is, do we have moral reason to treat health care differently from how we treat other sorts of social goods? Intuitively, perhaps, we might think the proper response is “yes.” However, to date, philosophers have often struggled to justify this idea—known as the “specialness thesis about health care” or STHC. In this article, I offer a new justification of STHC, one I take to be immune from objections that have undercut other defenses. Notably, unlike previous utility- and opportunity-based theories, I argue that we can find normative justification for STHC in what I term our special duty to assist those unable to help themselves. It is this duty, I argue, that ultimately gives us reason to treat health care differently from other sorts of goods (even other goods meeting health needs) and to distribute it independently of individuals’ ability to pay.
Highlights
Abandoning a traditional formulation of specialness thesis about health care (STHC), Daniels claims that all those goods that meet health needs are special. This latter set is taken to include health care and any good or service that reduces the incidence of disease and disability; most notably, all those goods and services by which we might tackle the social determinants of health (Daniels, 2008, 29–30)
We might think that even if a platelet count at T1 falls within a normal range (e.g., 150,000–450,000 platelets per microliter of blood), insofar as we can determine that the platelet count is steadily dropping and will shortly fall below the lower limit of that range, or is steadily rising and will shortly climb above the higher limit of that range, we might conclude that these individuals are presently experiencing a harmful deviation from the norm. This would suggest that there are at least some actual health needs persons may experience by virtue of how their health is deviating from species-typical functioning despite the fact that, if we were to take their present health as a single time slice, nothing would indicate that their functioning has deviated to warrant classification as a pathology
We cannot be morally obliged to be dashing constantly this way and that, preventing anything bad from happening to anybody and rectifying bad situations wherever we find them? while the fact that others are experiencing, or are about to experience, something harmful would seem to present us with a reason to offer them our assistance, it seems clear that there is a host of further features of the moral situation that frequently speak against this requirement, features that disable those reasons to act in a wide range of cases and render the duty to assist less onerous across a wide range of cases
Summary
Why fund health care through public taxation? Why not have a system whereby everyone’s access to health care is dependent solely on their ability to pay? After all, this is the way we tend to treat other kinds of goods, even other kinds of social goods. While I spend some time establishing why the fact that individuals are unable to help themselves generates a special duty to assist, one thing I do not do here is defend the idea that, in general, we have a duty to assist those experiencing, or at risk of, harm (primarily for reasons of space) This is a significant limitation to the present argument—principally because it leaves it vulnerable to anyone who might deny we have any such duty in the first place. The further question of how we ought to fund health care, given those obligations—whether by public taxation, charitable donation, or some other mechanism—is something I leave to another time
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