Norman Daniels argues a positive right to healthcare, in which others have a duty to help right-bearers obtain that right, on the basis of Rawls’ contractarian theory of justice. He claims that disease and disability limit one’s range of opportunities, and therefore, a right to health care ensures “normal functioning” so that physical or biological disadvantages are not barriers to fair equality of opportunity. However, he acknowledges that there must be constraints to such a right, especially since resources and technology are limited. He seems to suggest that when choosing where to invest medical resources, treatments that meet fundamental health care needs (as opposed to cosmetic surgery, for example) or proven effective treatments (as opposed to experimental treatments) may be prioritized.
From a distance, Daniels’ “fair equality of opportunity” argument is generally convincing; however, when narrowing in towards more specific healthcare scenarios, this theory alone may be insufficient in providing answers. For example, what does “fair equality of opportunity” support when it comes to issues of abortion? Abortion is not necessarily categorized as either a treatment for disease or disability (which are largely what Daniels refers to), and rather than being an issue of justice, it might be more helpful to weigh abortion through a lens of autonomy vs. nonmaleficence. Another scenario to consider may be whether it is worth investing such a large chunk of healthcare resources for the elderly, some of whom may never really achieve “normal functioning” again. In the proposed situation, various parts of Daniels’ argument appear to clash. In a perfect world, the general concept of a right to healthcare seems to warrant taking age out of the equation; in agreement of this, Daniels opposes purely utilitarian justifications and discrimination in the distribution of healthcare. However, in acknowledging resource scarcity, Daniels seems to value the allocation of resources to the most people rather than directing these resources to a few who are furthest away from “normal functioning,” which takes on a utilitarian stance despite his initial criticism of utilitarianism. These contradictions in Daniels’ reasoning make it difficult to speculate where he actually stands in some of the most controversial issues of healthcare.
That being said, I agree with the general notion of a right to healthcare; I simply derive my criticisms of Norman Daniels’ piece not out of disagreement but rather to suggest areas in which Daniels can strengthen his support for such a right.