The development of a rationale for egalitarian access to health care as a prerequisite for justice has been the focus of philosophical reflection on health and justice. This posting will analyze and provide an explanation of the theory of egalitarian theory of justice.
John Rawls championed the cause of egalitarian theory (1971). There are two binding principles attached to Rawls theory, one is the equality of the amount of liberty that each individual must have in comparison with the rest of society, and two, once maximum liberties are assured for everyone, inequalities in social primary good such as wealth, rights, and opportunities are to be allowed as long as the opportunities are open to everybody (Beauchamp & Childress, 2009). Norman Daniels adapted Rawls’ theory of justice and applied it to healthcare. According to Daniels (2008), fair equality of opportunity also requires universal access to comprehensive healthcare. Daniels view diseases and disabilities limit an individual’s opportunities to access basic healthcare goals. Thus the allocation of resources is a construct of fair equality of opportunity (Beauchamp & Childress, 2009; Daniels, 2008).
As applied to healthcare, egalitarianism espouses equal distribution of certain goods such as medical care, yet it permits inequalities as long as it benefits the needy (Beauchamp and Childress, 2009). The principle of justice has both social and political implications (Pence, 2009). Socially, it means treating people regardless of social standing. Thus, a just physician will treat everyone no matter what insurance the patients carry. In this context, justice requires physicians to treat patients impartially, without bias with regard to sex, race, sexuality or wealth. Politically, it implies distributive justice which is allocation of scarce resources (Pence, 2009). Similarly, Beauchamp and Childress (2009) contend that the principle of justice is relegated to the distribution of and sometimes, the redistribution of goods and services including health care services.
Allocation of resources is rationing and rationing is based on people’s need (Redwood, 2000). Need in health care is a concept that lacks precision because most systems recognize need under conditions of emergency or when life is under threat. There is not a single healthcare system in the world that can have a limitless amount of resource and not everyone can gain access to the healthcare that they need (Beauchamp & Childress, 2009; Feldstein, 2006). In chronic diseases, need is admitted more grudgingly, yet in a situation falls short of being medically compelling, need may be disallowed. As rationing discriminates between patients, clinical need becomes subservient to financial constraint (Redwood, 2000).
In sum, Rawls inspired theory of egalitarian justice inspires national health policy debate as well. The development of a rationale for egalitarian access to health care as a prerequisite for justice has been the focus of recent philosophical debate on universal healthcare.