What is the Point of Health Care? A Defense of Relational Approaches to Justice in Health Care

Abstract

In this dissertation, I explore a question in liberal political philosophy about what it takes to treat citizens with equal regard in health care using insights from public health practices and bioethical theory. Two views dominate this debate in the liberal egalitarian tradition. According to the distributive view, a government treats its citizens as equals when it ensures that they have equal holdings of justice-relevant goods. According to the relational view, a government treats its citizens as equals when it ensures that they stand in relations of equality by eliminating conditions like oppression, domination, and discrimination. Determining which view is preferable in health care requires attention to government interest in health, which is exemplified in public health practice. I focus on how public health interventions like vaccination programs are collective enterprises that aim to halt collective harms like community spread of disease and produce collective benefit like herd immunity. This group-based and social account of health challenges standard distributive approaches to justice in health care, which frame justice in terms of distributions to individuals. Given this challenge, I argue that the relational view is preferable in health care since it captures how treating citizens as equals requires attention to justice-relevant social and group-based dimensions of health that are not merely about individual holdings.