Just Health by Norman Daniels - Essay Example

? Three Questions of Justice The Moral Imperative: Human Needs & Human Rights SCS - Political Philosophy 4/30 I. IntroductionIn “Just Health” by Norman Daniels, the author poses ‘Three Questions of Justice’ as a means of inquiry into the issue of whether or not society is obligated to protect and promote health in the community or whether the government should provide a safety-net for public healthcare assistance to individuals and families who cannot provide for these services themselves economically. (Daniels, 2008) These questions are intended to lead to a rational discussion through which social planning and public policy can be constructed or rejected through the determination of human need vs. social ability. Daniels' three questions ask the individual to consider the issues related to healthcare in the following manner: 1. "Is health, and therefore health care and other factors that affect health, of special moral importance?" 2. "When are health inequalities unjust? 3. “How can we meet health needs fairly under resource restraints?" (Daniels, 2008) This essay will evaluate the conceptualization of healthcare, global poverty, and world hunger on a common moral basis related to human need through an analysis of these ‘Three Questions of Justice’ in the works of Amartya Sen, Ronald Dworkin, John Rawls, and other modern scholars. In relating the issue of human needs to human rights through the lens of the moral imperative, the essay will seek to understand how societies and groups build political consensus and collectively address issues of human suffering through political organizations. This analysis includes an exploration of the theoretical and practical limits of humanitarian activity related to egalitarian economic rights frameworks and the goals of universal healthcare that are found in democracy, capitalism, and human rights. The moral awareness of the individual creates the categorical imperative to act, join into groups of free-association, build policies, and reform institutions to provide universal healthcare globally. This is based in human altruism fundamentally by definition. The issues of resource scarcity in society are only limited if the individual chooses to perceive them that way or they are controlled forcibly in a way that is inconsistent with the equality of human need defined through altruism. Similarly, they will only be enacted as policy or viewed as “universals” in society if enough people share these goals in group organizations collectively. Reform of institutions to implement economic rights or universal healthcare popularly is based in the shared moral awareness. The means of funding this process is limited only by resource restraints as individuals conceive them, and these are not inherent to society. Rather, the cost of universal healthcare is negligible compared to what society wastes on what can be considered non-essential goods and services or “socialism for the rich” as it operates under the hegemony of corporate democracy in modern America. Because the coercive aspects of wealth distribution are resisted politically, an ideal solution to Daniels’ “Three Questions of Justice” can only be implemented if people base their social decisions and policies on selfless, compassionate, and altruistic understanding of human needs and global development, highlighting the need for mind-change (metanoia) in the individual as the basis for the reform of institutions and policy. The shared fundamentals of both humanism and religion provide a basis for the realization of these goals in human society, yet education in moral values can be seen as the preferred method of achieving for lasting change in institutions and governance. II. Healthcare - Human Need Creates the Moral Imperative One way to interpret Daniels’ ‘Three Questions of Justice’ as they relate to the evolution of culture and civilization historically is to view healthcare issues related to global poverty, hunger, clean water, and sanitation of a special moral importance, because without them both the individual and society cannot progress to higher levels of development. (Huitt, 2007) Human needs are differentiated from “conspicuous consumption” or luxury goods, because of their essential relation to the standard of living and quality of life. Maslow states that issues related to hunger, thirst, and healthcare are fundamental and basic requirements that must be met by society through its structures of organization, for without this both the individual and the collective will struggle to realize higher stages of self-actualization and cultural development. (Huitt, 2007) This relates further to what Daniels has called a “systematic theory of distributive justice for health-related needs.” (Daniels, 2008) The current international system where advanced industrial and socialist countries in Western Europe and the world have instituted universal healthcare as an aspect of government policy illustrates the importance of individuals defining this issue personally and then accomplishing it politically through institutional organization. Where countries in the developing world have failed to do so, in contrast, can be seen as a failure of both capitalism and socialism through corruption in government, as well as a failure of the altruistic nature and compassion of individuals to come to the aid of the suffering that are in dire need globally. These are the same reasons that universal healthcare has not been enacted in America, despite the country’s status as the world’s leading economy, and they are conditions based psychologically in selfishness, ignorance, and greed primarily. In the free-market capitalist worldview of mainstream America, it is considered simply “too expensive” for businesses and society to provide universal healthcare, yet smaller nations such as Cuba, Canada, and many European nations strive towards this ideal in government policy. Therefore, it cannot be considered inherently “too expensive” to provide these services socially unless the question is evaluated only in the interests of a narrow ownership class that profits in medicine, pharmaceutical production, and healthcare. In this manner, it is the culturally relative way that individuals, groups, and societies define social justice, human rights, equality, and other issues that is determinant. To highlight the political or ideological issues involved with social justice and healthcare is not to discount the moral aspect, for it is from the moral awareness that the basic sense of justice is defined, but it is to deny any “universal” aspects to the moral questions other than shared subjectivity and common humanity. III. Healthcare - Human Rights, Capitalism, & Socialism The closest document civil society has internationally to a systematic theory of justice is the United Nations’ Universal Declaration of Human Rights. The UDHR is concerned with political rights such as life, liberty, and personal freedoms, as well as the economic rights related to healthcare and standard of living globally. In Articles 25, it states: “Everyone has the right to a standard of living adequate for the health and well-being of himself and of his family...” (UDHR, 1948) The Universal Declaration of Human Rights and similar agreements in international law provide a framework and foundation for a conceptualization of healthcare as a universal human right that every single being should have access to regardless of country of origin, socio-economic status, race, color, or creed. Unfortunately, the universal frameworks of human rights provide no funding or means of organization to implement the ideals of universal healthcare practically. This is one reason that Daniels is fundamentally skeptical of this approach. Yet, while he and many academics agree on the immensity of the issue and its vital importance to humanity, the biggest obstacle they see is in the budgetary allocation of collective social resources to meet the needs of humanity’s poorest people. In the capitalist analysis, the developing countries do not have enough public and private resource capital available to provide healthcare for their citizens in the same manner that late-capitalist and post-industrial nations have established as a basic standard of living. Western societies such as America, the world’s leading economy, claim that they are not able to “equally” provide health services to all sectors of their own domestic community, even when employing a combination of capitalist and socialist policies. The U.S. therefore rejects a fuller commitment to serving the needs of the global poor. The socialist argument is based on a fulfillment of economic rights fundamentally, and the capitalist will fight to extinguish this ideology in order to preserve a system of private profit and concentration of wealth. Yet it is essential to note that a concept of “universal” healthcare or human rights, or an ideal of “equality,” both require the individual to accept that these rights should be provided to everyone on the planet in a truly egalitarian manner, in every country, in every village or town globally, according to human need. This is the fundamental ideal or goal of equality that must be implemented for a “true” sense of justice to be established, based on a validation in altruistic moral consciousness. Outside of the developed economies, billions of human beings live without adequate access to food, clean drinking water, healthcare, and other basics regarded as fundamental human needs. In the capitalist interpretation, there simply is not adequate budgetary capital allocated for these communities by the domestic governments, local economies, and international aid organizations to address the problem through the construction and operation of facilities. Yet, when the cost of universal health care is compared to what the late-capitalist societies alone spend on items such as cosmetics, ice cream, perfumes, pet foods, entertainment, cigarettes, alcoholic drinks, and other “non-essentials,” it is thousands of times over the actual cost to “save the world” or at least provide universal social services such as healthcare, food, clean water, sanitation, and education to the developing world and poorest of society so that social injustice can be healed. (Shah, 2011) IV. Healthcare - Social Primary Goods Theory & Democratic Equality Most would agree that the moral obligation to help others in dire situations is critically imperative when local, but that in actuality on a global level the problem with healthcare, poverty, or hunger is too large to be addressed quickly by any agency, group, or individual. Yet, this only glosses a political debate that goes to the heart of the economic system itself and the historical conflicts between the developing nations and the global economic powers in the era of imperialism and colonialism. Harry Brighouse and Ingrid Robeyns identify two main schools of thought among contemporary theorists regarding the question of social justice and the distribution of resources: the ‘Social Primary Goods Approach’ as promoted by Rawls and others, and the ‘Capability Approach’ as advocated by Amartya Sen. In “Measuring Justice: Primary Goods and Capabilities,” the authors write: "Social primary goods are, according to Rawls, those goods that anyone would want regardless of whatever else they wanted. They are means, or resources (broadly conceived), and this approach says that we should compare holdings of such resources, without looking closely at what individuals, possessed of heterogeneous abilities and preferences, can do with them.” (Brighouse & Robeyns, 2010) “Democratic Equality” is preferable for Rawls as an ideal born in recognition of the shortcomings of the modern, liberal democratic system itself, balanced against the other choices of government historically. (Brighouse & Robeyns, 2010) Rawls’s theory of social primary goods shows the interrelation between the social, economic, and political values in practice, as well as how the psychological factors of human nature lead to the self-definition of a person’s own autonomy and freedom through the choice of activities, goals, beliefs, and associations. This is an optimistic and hopeful vision of human nature which realistically recognizes the need to re-organize society to address income and wealth misallocations that are based on socially-defined problems and issues on the basis of a shared morality. “Democratic Equality” also proceeds with an unbiased view fundamentally towards both capitalism and socialism, in that citizens are free to choose and change policies that best reflect the moral imperatives of human need in the community. V. Healthcare - The Capability Approach There may be both capitalist and socialist solutions that can be implemented to address the problems of universal healthcare, global poverty, and world hunger. What is problematic is if the collective conscience in economically advantaged countries does not extend to or recognize problems that are occurring in the “Third World” or the underclass of their own society, and are further unwilling to undertake the sacrifices required to solve them politically. The strength of Rawls’ theory is that it can be used to show the pressure points and breakdowns of the system, such as when social division leads to civil war in a society or minority interests concentrate resources and power unequally. The problem is that Rawls’ theory requires the altruistic basis of humanity to be triumphant, whereas politics and society are both typically conditioned by the human emotions of selfishness, greed, and ego. “The other approach, developed most prominently by Amartya Sen, and more recently also by Martha Nussbaum, is known as the capability approach. Instead of looking at people's holdings of, or prospects for holding, external goods, we look at what kind of functionings they are able to achieve..." (Sen, 1999, p.74) The ‘functionings’ of Sen’s philosophy can be seen as the forces integrating the individual psychologically and socially at each level of personal development. For example, when the human needs for food, water, and good health are met, the functioning of individual is stable and he/she may progress to higher levels of development, personal and collective. When the same fundamental needs of the individual are unmet, as in global hunger or access to education and healthcare in developing nations, both the system and the individual are considered to be functioning improperly and unhealthy. This is a very direct and medical way of analyzing social and individual needs on a common basis and applying policy solutions as healing. The greater level of functioning leads to both social and individual health in the integration of society on multiple levels. In searching for the basis of social justice in Sen, he reaches the same inescapable conclusion as the other theorists, which is that the moral awareness is based in the individual consciousness and society is organized through groups and institutions on a shared moral basis. Therefore, following this it is important to educate and also be active in society based upon one’s own authentic moral voice. This is the basis of society and the manner through which the functionings are achieved. As it is impossible to proceed in a way that is truly just without a developing and growing sense of altruism, both society and the individual should cultivate this aspect of personal character in citizens to achieve greater functionings. This creates a self-reinforcing pattern of positive development, change, and progress in society that can ultimately lead to the establishment of universal ideals of healthcare. VI. Healthcare - The Equality of Welfare Dworkin deconstructs the practice of equality in democratic and undemocratic systems by discussing the different aspects of Daniels’ three questions in a series of essays. The equality of welfare, the equality of resources, and other moral questions of political and economic systems are engaged with a critical view that highlights the problems of practical application of progressive ideals. The most obvious problem is that natural resources within local environments and globally on earth are finite, and ownership is centralized and concentrated into the hands of a relative few in wealth. When these same economic minorities control political institutions, they may prevent progressive reform or recognition of the rights of minorities. When idealized, but limited to a minority interest in application, the principles of democracy are inconsistent with equality and justice. The same can be concluded from human religion, for charity and compassion have failed to provide for an equal society universally on earth where the needs of all were met and none suffered unjustly due to the position of their birth, but religion is no longer considered the providing force or means through which society is integrated ideally in secular societies. The goals of both humanism and religion in relation to morality can be defined as integral psychologically to the sense of altruism. For Dworkin, like Rawls and Sen, the moral conscience of the individual is the a priori of greatest importance, for it allows for the individual judgment and decision-making that precedes even the binding into groups of interest and political identity in humanity. Yet, the moral conscience is educated. “Democratic Equality” is akin to the statistical generalization or averaging of the moral conscience over vast social populations, and the education process builds cohesion in larger social movements of reform within the democratic process towards the goal of equality and social justice on a humanistic basis. Dworkin writes in Part One of “What is Equality”: “Equality is a popular but mysterious political ideal. People can become equal (or at least more equal) in one way with consequence that they become unequal (or more unequal) in others. If people have equal income, for example, they will almost certainly differ in the amount of satisfaction they find in their lives, and vice versa.” (Dworkin, 1981) For Dworkin, this process of averaging is the means through which “Democratic Equality” generates its value systems and it is inherently a subjective process. Dworkin shows the relative nature of human enjoyment of wealth as a moral aspect conditioning the re-distribution of resources socially, but he does not address the moral imperative in terms of the human need for food, water, healthcare, education, and other fundamentals as a basis of equality when contextualized globally. The main question, as posited at the beginning by Daniels in “Just Health,” is to determine what responsibility society should take for the poorest of the poor and those who cannot take care of themselves, both locally and globally. Yet, each individual must choose for his or herself how much they can tolerate the suffering of others while balancing it with a realistic recognition of the limits of their willingness to act and sacrifice for the ideals they believe in. People may turn to religion, humanism, altruism, charity, and other forms of organization to further social justice ideals, but it is very difficult to persuade people to renounce inherent selfishness, the benefits that accompany power, or the status and prestige that accrue from minority concentrations of wealth. Because of this, the definition of equality and social justice will inevitably depend on how the individual defines it for his or herself. VII. Healthcare - The Moral Imperative What joins Daniels, Dworkin, Rawls, Sen, and others on this issue is the shared belief in a priori moral judgments by individual consciousness which precedes idealistic or ideological integration socially, and this is based primarily in Kant’s reform of classical Enlightenment philosophy.“Kant's first formulation of the Categorical Imperative states that you are to ‘act only in accordance with that maxim through which you can at the same time will that it become a universal law.’” (Johnson, 2008) The moral imperative argument draws upon the methodology of Kant’s categorical imperative in order to build a foundation for activism as it relates to health care, global poverty, and human suffering that is based on inequity. The moral imperative states that once recognizing the urgency relating to human suffering, the individual should seek ever more perfect states of altruism as an ideal for behavior, rather than building ever more aspects of selfishness, greed, and ego-driven behavior in motivation. Altruism leads to a reform of both the individual and society on a common basis of human morality rather than ideology, and can be seen as a political motivation that can be the root of all policies in government. Furthermore, as altruistic ideals are implemented through affinity groups as reform or change in institutions, progress can be seen to be developing on a valid moral and idealistic basis, rather than one corrupted by selfish greed, profit or power. This avoids the negative aspects of both Marxism and Capitalism. The subjective nature of the individual experience is the basis for the moral awareness and shared subjectivity joins the variety of means of working towards equality and justice in politics, religion, charity, or other vehicles of organization from the principles of choice and free-association. The social distribution of basic resources and facilities such as food, clean water, adequate sanitation, healthcare, and education represent the most fundamental values of a culture in expression. It is from defining altruism that the ideal form of justice can be conceived in the mind of the individual. When, following Kant’s Categorical Imperative, the individual develops an altruistic moral basis for action, activism is born which leads to the further reform and change of institutions through the practice of “Democratic Equality” organized through affinity groups. This answers Daniels’ third question of justice, as to “How can we meet health needs fairly under resource restraints?" VIII. Conclusion Politics is a type of functionality as defined by Sen, but far from an altruistic application of human ideals. If the “Democratic Equality” of Rawls is to serve as the mediating and decision-making process through which law and truth are composed, it must be based on the altruistic instinct and the moral awareness which feels the suffering of others and takes action. When the system prevents the individual from taking action efficiently, the moral awareness and altruistic urge should provide the inspiration and means of addressing the problem through agencies outside of the State or engage in political organization in order to reform State policy and institutions. Daniels believes that ideological groups organizing on shared values and belief systems can reform democratic institutions in order to overcome the inequality of application of values culturally and the historical failure to provide for economic rights or universal healthcare previously. This essay has reviewed the validity of such a plan in contrast with the social forces that are against its progress historically, namely the concentration of wealth and power in minority interests which control democratic institutions in a manner contrary to social justice ideals of equality. The call to organization and reform of institutions and policies on issues of social justice such as global poverty, world hunger, universal healthcare, etc. is based in the moral imperative and can be further conceptualized around a framework of rhetoric of related to either human rights or human needs. The moral imperative is an a priori for democratic organization on principles of equality, as it is required to define what the person believes is actually equal and just socially. The limitations of society related to universal healthcare and other issues of social justice are therefore related to the psychology of human motivation. In answering Daniels’ “Three Questions of Justice,” healthcare is a fundamental issue of human need and therefore must be addressed by society on a manner consistent with the ideals of equality. It is a fundamental need because other forms of higher self development and cultural organization of the individual depend upon it. Health inequalities are unjust when there is an absence of access amongst vast classes in the population related to poverty, or one class of people receive a significantly reduced level of service quality in healthcare than another group. Daniels defines healthcare as relating to “modern medicine” and the facilities, pharmaceuticals, and surgical operations that are credited with prolonging the lifespan and quality of life in mainstream society in the West. (Daniels, 2008) Problems of inequality and access to healthcare treatment relates to the historical divisions between capitalism and socialism. After the 20th Century and innumerable wars over this question, neither system can be relied upon inherently to meet health needs fairly under resource restraints as Daniels poses his third question. In looking at the failure of both systems, the altruistic nature of the individual can be positioned as a central and determining factor, rather than ideology or system of government, in meeting health needs fairly under resource restraints in a society. For example, status, bias, hoarding, exceptionalism, and greed may exist equally in both capitalist and socialist systems but an altruistic individual will be able to keep true to ideals of social justice and moral importance ideally within each system. From this conclusion, the individual first must recognize the moral imperative of health care in society on a basis of shared humanity and human need, proceeding to organize in groups within political systems to reform institutions and implement social policy solutions that meet health needs fairly under existing global resource restraints. References Brighouse, Harry and Robeyns, Ingrid (2010), Measuring Justice: Primary Goods and Capabilities, Cambridge University Press, 2010. Brown, Alexander (2009), Ronald Dworkin's Theory of Equality - Domestic and Global Perspectives, Palgrave Macmillan, 2009. Daniels, Norman (1985), Just Health Care, Cambridge University Press, 1985. Daniels, Norman (2008), Just Health: Meeting Health Needs Fairly, Cambridge University Press, 2008. Daniels, Norman (2008), Justice and Access to Health Care, The Stanford Encyclopedia of Philosophy, 2008. Dworkin, Ronald (1981), What is Equality? 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