Abstract

This dissertation is a study of issues of justice that arise in the practice of health care and an examination of the potential contributions that John Rawls' theory can yield towards a resolution of those issues. The primary goal is to define and defend a perspective from which individual health care practitioners can address problems of justice in health care. The dissertation begins with a discussion of the concept of justice, including the circumstances under which questions of justice arise, and the scope and role that principles of justice are thought to have in schemes of social cooperation. An important distinction between comparative and non-comparative justice is used to evaluate the role that justice can play in resolving various problems in biomedical ethics. Following an exposition and evaluation of Rawls' theory of justice, various proposals for applying this theory to health care institutions are assessed. Norman Daniels' attempt to use fair equality of opportunity as a principle for regulating these institutions is described and defended, along with certain important modifications. The implementation of this principle is then illustrated by sketching a procedure for determining the obligations of persons who occupy offices within health care institutions. A procedure based on Rawls' original position is elucidated for resolving problems of comparative justice. In situations where a scarce good must be rationed among a group of identifiable individuals, a "relativized" original position may be constructed in which the parties, who represent the individuals holding claims on the good, are imagined to hold those beliefs about the situation which it is reasonable to expect of the relevant health care practitioner but to be ignorant about which specific individuals they represent. The primary goal of these parties is to protect and/or restore the basic capabilities of the affected individuals so as to ensure an adequate range of opportunity for their pursuit of subjective ends. So long as the good is distributed in accordance with such parties' rational preferences, the outcome of the procedure will be fair. Applications and limitations of this procedure are presented by looking at specific examples.