Considerations for Daniels’ Right to Health Care

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.

2 thoughts on “Considerations for Daniels’ Right to Health Care

  1. Kaeli Thompson

    Katherine does a great job of explaining Daniels’ stance on the right to healthcare, highlighting his main point that the illnesses, sicknesses, and disabilities that people have limit their opportunities in life and therefore health care as a right ensures that people may achieve “normal functioning” so as to overcome obstacles in the way of equal opportunity. However, she proceeds to point out flaws with the utility of his theory in practice, presenting instances when “normal functioning” may be subjective, like when a woman seeks an abortion or healthcare overall for the elderly. Katherine continues to identify that Daniels’ is opposed to employing utilitarian measures when it comes to distribution of healthcare but then he concurrently cedes to the idea that sometimes cost-effective analyses and publicly accountable decision making processes may utilize such measures. I agree with Katherine that Daniels’ reasoning weakens his argument for such a right, because he seems to contradict himself at points in the passage and is unable to provide a true definition of what “normal functioning” is in all circumstances (likely because one cannot truly be delineated). For instance, Is it a part of “normal functioning” for elderly people to have heart attacks, dementia, and high blood pressure since they are growing old in age and our bodies gradually wean in health as we near the end of our life? If a publicly accountable decision making process were to decide it is and view that the best decision is to not allocate as much research into dementia treatments or save people over a certain age from heart attacks, those who obtain these health statuses will be at a disadvantage because of age. Thus while the goal of ensuring normal functioning for all through a right to healthcare is ideally appealing, in practice, the diversity among a population’s citizens presents many problems that Daniels fails to address.

  2. Iris Wickham

    Katherine’s analysis not only clearly and effectively lays out the fundamental elements of Daniel’s argument, but raises highly important questions pertaining to the application of this objective to specific medical cases. I value her insightful critique and agree with the faults she identifies in the thesis. Katherine begins by describing the argument’s overarching theme of encouraging a “normal functioning” population, which refers to the ability of the population to access opportunity without physical disadvantages, to justify the positive right of healthcare. This philosophy in theory is overall reasonable and allows for a balance of preventing the population from unhappily contributing more than they want to, while still providing for those who need care. This, in summation, satisfies Daniel’s goal of maintaining a population with equal access to opportunity. As Katherine highlights, there are plenty of real-world medical scenarios that this theory would have a difficult time justifying perfectly. Abortion, the quintissential controversial and underserviced subject, does not really fit in this “fair equal opportunity” concept. I appreciate her criticism, as examining how Daniel’s theory functions in society is crucial. Hence, would a woman’s unwanted pregnancy qualify for hindering her normal functioning?


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