Social Justice: The Moral Foundations of Public Health and Health Policy

Social Justice: The Moral Foundations of Public Health and Health Policy

Social Justice: The Moral Foundations of Public Health and Health Policy

Social Justice: The Moral Foundations of Public Health and Health Policy

Synopsis

In bioethics, discussions of justice have tended to focus on questions of fairness in access to health care: is there a right to medical treatment, and how should priorities be set when medical resources are scarce. But health care is only one of many factors that determine the extent to which people live healthy lives, and fairness is not the only consideration in determining whether a health policy is just. In this pathbreaking book, senior bioethicists Powers and Faden confront foundational issues about health and justice. How much inequality in health can a just society tolerate. The audience for the book is scholars and students of bioethics and moral and political philosophy, as well as anyone interested in public health and health policy.

Excerpt

Issues of justice in public health and health policy have been animating concerns for us both, independently and as research collaborators, over many years. We first worked together on aids, Women and the Next Generation (Faden, Geller, and Powers 1991). in the late 1980s, HIV/AIDS was emerging as a growing public health problem among women and children. There was no way at that time to interrupt transmission of the virus from mother to baby, and no way even to verify which newborns had acquired the infection. It was possible, however, to improve outcomes for babies if at-risk infants were identified early. We found ourselves puzzling over whether or under what conditions pregnant women or newborns should be screened for hiv. One familiar tenet of traditional public health doctrine recommends that we should seek the greatest health benefit achievable from the limited public health resources available. in line with that tenet, many argued for a policy in which only pregnant women at highest risk of hiv would be screened, which turned out to be disproportionately poor women of color. We were troubled by this position, however. We framed the question as follows: “Whether only high-risk pregnant women, in contrast to all pregnant women or all individuals, may be the target of hiv antibody screening programs is a classic example of a justice-based problem” (Faden, Kass, and Powers 1991, 19).

Even if such a program were voluntary, and even if the public welfare would be enhanced, we worried that it might not be warranted because of the “disproportionate burden that would result from targeted screening” (Faden, Kass, and Powers 1991, 19). Our underlying assumption, perhaps better appreciated by us now than then, was that matters of justice are at stake beyond the usual questions of the proper distribution of scarce resources. Our conclusion was that a variety of aspects of well-being other than health were relevant to judging whether this public health policy was just.

That more than health was at stake in crafting a just public health program offered no easy path to resolution of the question we had set for . . .

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