Thomas Schramme

Any theory of health justice requires an account of what areas of social life are important enough to be of public concern. What are the goods that ought to be provided as a matter of justice? This is what I will call the metric problem. The capabilities approach puts forward a particular solution to this problem. In this article I will discuss some issues of such an approach in relation to Sridhar Venkatapuram's well-known theory. Another problem I examine is how to determine a threshold of provision within a theory of justice. What is enough in terms of health justice? I argue that we need such a threshold to avoid healthism, the expansion of the pursuit of health over and above the treatment and prevention of disease. This is an especially pertinent problem in public health, which is also the context of Venkatapuram's theory

The chapter focuses on cases of assisted suicide and voluntary euthanasia in relation to the rarely discussed notion of indirect paternalism. Indirect paternalism involves not just a paternalistic intervener and a person whose welfare is supposed to be protected, but also another party, whom I call “assistant.” Indirect paternalism interferes with an assistant in order to prevent harm to another person. I will introduce a strategy that paternalists can pursue to justify indirect paternalism. It specifically targets an element of assistance cases, namely the fact that people do not necessarily have a justified claim or entitlement to demand such assistance. To prevent people from providing assistance seems normatively different from preventing a person to do something to herself by her own means. I critically discuss arguments from the goals of medicine and from the conscientious objection. These aspects are not deemed decisive when considering the case of indirect paternalistic intervention. Finally, I argue against the rationale of indirect paternalism by showing that there are at least two situations where it does not succeed. One such situation that undermines the justification of indirect paternalism is present when the offered service is itself harmless, another pertinent situation consists of a person necessarily requiring assistance to be really free. At least in some cases, these very conditions are given when contemplating assistance to die.

In this paper, I will focus on the role that findings of the empirical sciences might play in justifying normative claims in political philosophy. In the first section, I will describe how political theory has become a discipline divorced from empirical sciences, against a strong current in post-war political philosophy. I then argue that Rawls’s idea of reflective equilibrium, rightly interpreted, leads to a perspective on the matter of justification that takes seriously empirical findings regarding currently held normative beliefs of people. I will finally outline some functions that empirical studies might have in political philosophy.

In this paper, I want to discuss the relation between ambivalence and the unity of the self. I will raise the question whether a person can be both ambivalent about his own will and nevertheless be wholehearted. Since Harry Frankfurt’s theory is my main point of reference, I briefly introduce his account of the will and the reasons for his opposition towards ambivalence in the first section. In the second section, I analyse different interpretations of ambivalence. In the third section, I provide a narrative account of a diachronic integration of the self that allows for the integration of volitional ambivalence. Finally, I scrutinise different meanings of the unity of the self, since disintegration, not ambivalence, seems to be bad for us. I conclude that persons can indeed be wholeheartedly ambivalent

According to Norman Daniels, the moral significance of health needs stem from their impact on the normal opportunity range: pathological conditions involve comparative disadvantage. In this paper I defend an alternative reading of the moral importance of healthcare, which focuses on non-comparative aspects of disease. In the first section I distinguish two contrasting perspectives on pathological conditions, viz a comparative versus a non-comparative. By using this distinction I introduce a related disparity regarding the moral importance of personal responsibility for disease. I claim that people are usually prepared to disregard individual responsibility for disease, if it involves non-comparative harm, but not if it entails mere disadvantage. Since disadvantage means to have less than equal opportunities, Daniels’ conception of opportunity is vital for his theory. It is therefore scrutinised more closely. I try to show that he wavers between two interpretations of the notion of opportunity, which are again linked to the distinction between a comparative and a non-comparative point of view. Finally, I criticise Daniels’ supposition that persons have an interest in the normal opportunity range

The predicate “natural” is often used in a normative fashion, especially in Bioethics. But that something is natural does not alone suffice to explain its value. In this essay, I want to fulfil mainly two tasks: Firstly, to differentiate between several usages of the concept of naturalness and scrutinize whether they may serve a function in ethics; secondly, to argue for the (eudaimonistic, not moral) value of naturalness in certain respects. The value of the natural lies firstly in its significance for human wellbeing: specific natural functions form necessary elements and conditions of the ability to lead a good life. Secondly, the very feature of the natural, its being purposeless, which implies that we cannot read our aims out of nature, serves as the basis of its eudaimonistic value.

The paper contrasts Lennart Nordenfelt’s normative theory of health with the naturalists’ point of view, especially in the version developed by Christopher Boorse. In the first part it defends Boorse’s analysis of disease against the charge that it falls short of its own standards by not being descriptive. The second part of the paper sets out to analyse the positive concept of health and introduces a distinction between a positive definition of health and a positive conception of health. An objection against Nordenfelt’s account is developed by making use of a specific example of an ambitious athlete. It is stated that Nordenfelt’s conceptualisation includes too many phenomena under the umbrella of ill health. An ideal conception of health like Nordenfelt’s is in danger of supporting medicalization. In conclusion, although Nordenfelt’s theory is not altogether rejected and even seen in congruence with Boorse’s account, it is claimed that the naturalistic framework should obtain conceptual priority.

This is the first wide-ranging, multi-authored handbook in the field of philosophy of medicine, covering the underlying conceptual issues of many important social, political and ethical issues in health care. It introduces and develops over 70 topics, concepts, and issues in the field. It is written by distinguished specialists from multiple disciplines, including philosophy, health sciences, nursing, sociology, political theory, and medicine. Many difficult social and ethical issues in health care are based on conceptual problems, most prominently on the definitions of health and disease, or on epistemological issues regarding causality or diagnosis. Philosophy is the discipline that deals with such conceptual, metaphysical, epistemological, methodological, and axiological matters. This handbook covers all the central concepts in medicine, such as ageing, death, disease, mental disorder, and well-being. It is an invaluable source for laypeople, academics with an interest in medicine, and health care specialists who want be informed and up to date with the relevant discussions. The text also advances these debates and will set the agenda for years to come.

In this paper I show that Rawls’s contract apparatus in A Theory of Justice depends on a particular presumption that is in conflict with the goal of conserving environmental resources. He presumes that parties in the original position want as many resources as possible. I challenge Rawls’s approach by introducing a rational alternative to maximising. The strategy of satisficing merely goes for what is good enough. However, it seems that under conditions of scarcity Rawls’s maximising strategy is the only rational alternative. I therefore scrutinise the common account of scarcity. I distinguish between absolute and relative scarcity in order to show that scarcity is influenced by our decisions. If we would not accept the claim to as much as possible without further legitimisation, like Rawls does, then scarcity might not be as severe a problem. Finally, I reject Rawls’s proposed solution for dealing with problems of sustainability, namely his idea of the just savings principle. I conclude that Rawlsian Justice as Fairness is bad for the environment.