“highest possible level of quality or strictly equal qual-ityany more than it requires equal amounts of care; ofcourse, adequacydoes require that everyone receivecare that meets standards ofsound medical practice.Any combination of arrangements forachievingadequacy will presumably include some health caredeliverysettings that mainly serve certain groups,such as the poor or thosecovered by public pro-grams. The fact that patients receive care indifferentsettings or from different providers does not itselfshowthat some are receiving inadequate care. TheCommission believesthat there is no moral objectionto such a system so long as allreceive care that is ade-quate in amount and quality and allpatients aretreated with concern and respect. . . .NOTES1. NormanDaniels, Health Care Needs and Distributive Jus-tice,10 Phil. &Pub. Aff. 146 (1981).2. Whether the issue of equity is framed interms of indi-vidual rights or societal obligation, it is importanttorecall that society’s moral imperative to achieve equi-tableaccess is not an unlimited commitment to pro-vide whatever care,regardless of cost, individualsneed or that would be of somebenefit to them.Instead, society’s obligation is to provideadequatecare for everyone. Consequently, if there is a moralrightthat corresponds to this obligation, it is limited,notopen-ended.the specific issues that should be consideredindetermining what constitutes adequate care. It isimportant, forexample, to gather accurate informa-tion about and compare thecosts and effects, bothfavorable and unfavorable, of varioustreatment ormanagement options. The options that better servethegoals that make health care of special impor-tance should beassigned a higher value. As alreadynoted, the assessment of costsmust take two factorsinto account: the cost of a proposed option inrela-tion to alternative forms of care that would achievethe samegoal of enhancing the welfare and oppor-tunities of the patient,and the cost of each proposedoption in terms of foregoneopportunities to applythe same resources to social goals other thanthat ofensuring equitable access.Furthermore, a reasonablespecification of ade-quate care must reflect an assessment of therelativeimportance of many different characteristics of agiven formof care for a particular condition. Some-times the problem is posedas: What amountsof careand what qualityof care? Such a formulationreducesa complex problem to only two dimensions, implyingthat allcare can readily be ranked as better or worse.Because twoalternative forms of care may vary alonga number of dimensions,there may be no consensusamong reasonable and informed individualsaboutwhich form is of higher overall quality. It is worthbearing inmind that adequacy does not mean the182Part Two / Allocation,Social Justice, and Health PolicyEQUAL OPPORTUNITY AND HEALTHCARENorman DanielsA natural place to seek principles of justice forreg-ulating health-care institutions is by examiningdif-ferent general theories of justice. Libertarian,utilitarian,and contractarian theories, for example,each support more generalprinciples governing thedistribution of rights, opportunities, andwealth,and these general principles may bear on the spe-cific issueof health care. But there is a difficultywith this strategy. Inorder to apply such generaltheories to health care, we need to knowwhat kindof a social good health care is. An analysis ofthisproblem is not provided by general theories of jus-tice. Oneway to see the problem is to ask whetherhealth-care services, saypersonal medical services,should be viewed as we view othercommodities inFrom Am I My Parent’s Keeper?by Norman Daniels,OxfordUniversity Press, 1988, pp. 68-73. Copyright © 1988NormanDaniels. Reprinted by permission of the author.Editors’note:Some text has been cut. Students who want toread the articlein its entirety should consult the original”
1.) What does the author mean by “normal opportunity range” fora given society? Staying within this line of reasoning, woulddisease and disability be fair or unfair? Why?
2.) What does the author conclude is the “moral function of thehealth-care system”?
3.) Does the author argue that “fair equality of opportunity”necessarily results in a right for persons to have all of theirhealth-care needs met? Why or why not?
4.) The author compares a lack of basic health-care coverage,relative to the normal opportunity range of a given society, toindividuals who have suffered from employment discrimination. Whatsimilarity exists between the two cases? Do you agree with hisview?
“The scope and limits of these rights—the entitle-ments theyactually carry with them—will be relativeto certain facts about agiven system. For example, ahealth-care system can protectopportunity onlywithin the limits imposed by resource scarcityandtechnological development for a given society. Wecannot make adirect inference from the fact that anindividual has a right tohealth care to the conclusionthat this person is entitled to somespecific health-care service, even if the service would meet ahealth-care need. Rather, the individual is entitled to aspecificservice only if it is or ought to be part of asystem thatappropriately protects fair equality ofopportunity. . ..REFERENCESBrandt, R. 1979. A Theory of the Good and theRight.Oxford:Oxford University Press.Daniels, N. 1985. “FamilyResponsibility Initiatives andJustice Between Age Groups.” Law,Medicine, and HealthCare13(4):153-159.Rawls, J. 1971. A Theory ofJustice. Cambridge, MA: HarvardUniversity Press.Scanlon, T. M.1975. “Preference and Urgency.” JournalofPhilosophy77(19):655-669.design of a system which, on the whole,protectsequal opportunity. If social obligations toprovideappropriate health care are not met, then individualsaredefinitely wronged. Injustice is done to them.Thus, even thoughdecisions have to be made abouthow best to protect opportunity,these obligationsnevertheless are not similar to imperfect dutiesofbeneficence. If I could benefit from your charity, butyou insteadgive charity to someone else, I am notwronged and you havefulfilled your duty of benef-icence. But if the just design of ahealth-care systemrequires providing a service from which I couldben-efit, then I am wronged if I do not get it.The case is similarto individuals who have injus-tice done to them because they arediscriminatedagainst in hiring or promotion practices on a job.Inboth cases, we can translate the specific sort of injus-ticedone, which involves acts or policies that impairor fail to protectopportunity, into a claim about indi-vidual rights. The principleof justice guaranteeingfair equality of opportunity shows thatindividualshave legitimate claims or rights when their opportu-nityis impaired in particular ways—against a back-ground ofinstitutions and practices which protectequal opportunity.Health-care rights in this vieware thus a species of rights toequal opportunity.Section 1 / Justice, Health, and HealthCare185GROWTH HORMONE THERAPY FOR THE DISABILITY OF SHORTSTATUREDavid B. AllenINTRODUCTION AND CONCEPTUAL GUIDELINESLimitedavailability of human growth hormone (GH)once provided a barrier toexpanding its usebeyondchildren who were unequivocally GH deficient(GHD).By necessity, strict arbitrary criteria wereestablished to identifyclassic GHD children entitledto GH. Today, increased availabilityof recombinantDNA-derived GH has allowed investigation ofitsgrowth-promoting effect in short children who donot fittraditional definitions of GHD. Increasedsupply has createdincreased demand: more thantwice as many children received GHtherapy in1989 and 1990 than in 1985 and 1986 at an averageannualcost per child of $10,000.Advantages conferred by increased heightinsocial, economic, professional, and political realmsof Westernsociety are well-documented. Stigmati-zation and discrimination areshared by allextremelyFrom Access to Treatment With Human GrowthHormone:Medical, Ethical, and Social Issues.Supplement toGrowth,Genetics, and Hormones8 (Suppl. 1, May 1992):70-73.Reprinted with permission of the author andpublisher.Editors’ note:All author’s notes have been cut.Studentswho want to follow up on sources should consult the o”
David Allen
1.) What are GHD and SS and what is the difference between thetwo? Do both qualify as diseases? Who does the author argue oughtto entitled to GH therapy? Why?
2.) Does the author recommend allowing those lacking both GHDand SS access to GH therapy?
3.) For those entitled to GH therapy, at what point does theauthor recommended treatment end?
4.) In general, do you believe that suffering from SS, eitherfor GHD or non-GHD reasons, infringes upon one’s equality ofopportunity?
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