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KMID : 1011120220160010107
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Bioethics Policy Studies
2022 Volume.16 No. 1 p.107 ~ p.132
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Egalitarianism and Justice in Health: From the Luck and Relational Perspective
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Kim Joo-Hyun
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Abstract
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The theory of justice in health is a theory of justice developed around the distribution of limited medical resources. The theory of justice in health was also strongly influenced by John Rawls’ theory of justice, which is considered the pillar of contemporary justice theories. Accordingly, several theories formed around the idea of the just healthcare system, among which was the egalitarian just healthcare theory. Egalitarian theory has evolved from strict egalitarianism into several theories, one of which is luck egalitarianism. Founded upon a moral intuition that individuals’ shares of the distribution should not be unfairly influenced by luck beyond their control, luck egalitarianism suggests a way to offset the differential effects of luck in distribution. In particular, luck egalitarians advocate for eliminating the effects of brute luck, not all luck. However, luck egalitarianism faces harsh objections by insisting on the responsibility of patients who have not adequately cared for their health. Critics regard the luck egalitarianism’s view on patients’ responsibility for their own illness as harsh and unjust. In defense of justice in healthcare according to luck egalitarianism, Segall proposes a new concept of brute luck as an outcome that would be unreasonable to expect the agent to avoid. This adjusts the scope of personal responsibility to allow for a more persuasive application of luck egalitarianism in the healthcare field.
Meanwhile, relational egalitarianism, a school of thought that explores equal relations among citizens, added to the discussions of justice in health and expanded its paradigm. Relational egalitarianism purports that the just health paradigm should shift from the equal distribution of medical resources to equal relations among citizens as equals. Relational egalitarianism focuses on the quality of social relations among citizens and the ways in which medical institutions treat citizens. Relational egalitarians call for eliminating unjust social relationships, such as domination, oppression, and discrimination, in health and healthcare. They regard members of society as citizens that can relate to others as equals, not only as entities distributed with equal amounts of medical resources. Relational egalitarianism pursues the ideal of equalizing relations between citizens in health and healthcare. Relational egalitarianism can manifest itself when these ideals are reflected in the healthcare system.
Egalitarian theories provide an opportunity to examine the problem of inequalities in health, a subject heretofore dominated by liberalism, through a new lens, and contribute to establishing a new egalitarian model of justice in health and healthcare.
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KEYWORD
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justice in health, egalitarianism, luck egalitarianism, relational egalitarianism, health inequali
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