Norman Daniels and the Normal Function Model

In discussing the candid distribution of healthcare in modern-day society, Norman Daniels focuses mainly on his philosophical theoretical concept of “normal functioning” to justify healthcare as a right. Daniels also argues that healthcare is a positive right (a right that requires someone, in this case, the state, to engage in certain policies). Therefore, the state must enact comprehensive healthcare laws to protect its citizens. Within this argument, Daniels also actively refutes the ideals of utilitarianism and argues that they have no logical place within the sphere of healthcare. The normal functioning model that Daniels argues is, in my opinion, a comprehensive, accurate, and well thought out healthcare policy. If the medical establishment is solely committed to keeping patients within their normal functioning range, it would allow for complete care for very sick patients whilst also preventing the dangerous over-extension of healthcare programs, therefore also accounting for resource-oriented concerns.

To accurately dissect and analyze this argument, we must first understand the core piece of Daniel’s theory: that of the “normal functioning range”. To simplify this analysis, I will use a color-oriented method. Daniels argues that every human properly functions within a range- consider this the “green zone”. Within this zone, a person is medically well enough to pursue and attain opportunities within the social, political, economic, and personal spheres of their lives. Consider a patient in this green zone who then contracts a debilitating condition such as breast cancer. Look at this as the “red zone”. Within this zone, the patient is unable to attain success in any of the previously identified fields because of his medical condition. It is in this case that Daniels believes that the patient should have equal access to healthcare- to nurture him/her back inside their normal functioning range. This system would place a higher priority on patients whose conditions obviously inhibited their ability to attain success in their lives. 

It is important to note the distinction between Daniel’s argument and the theory of utilitarianism (absolute healthcare equality for all conditions). Daniels refutes this theory for the following reasons: it would not likely be economically possible, the difficulties of justifying any unequal access that would arise, and finally concerns about autonomy and paternalism (e.g could you refuse treatment in a universal healthcare society? What about changing or choosing which practitioner you saw?)

When analyzing this healthcare model, it is critical to consider the impacts this would have on medical practices that do not focus on bringing patients from the “red” to the “green” zone. This can be examined through Daniel’s “Treatment/Enhancement Distinction”. Daniels believes that healthcare should only be responsible for treating sicknesses and that a right to healthcare does not include treatment made to improve conditions that don’t’ take a person out of the “green zone” (e.g genome mapping technology, inherited trait modifications on fetuses). This would restrict healthcare to necessary practices, which Daniels believes is necessary to preserve moral integrity of healthcare.

I agree with Daniels in almost every facet of his argument. The only criticism I have is that of varying definitions of the normal function. Just as Goldman argued with his theory of value orderings, could different patients not have different intrinsic definitions of their own “successes” or opportunities in life? In this situation, Daniel’s model falls apart- when there is no one-model-fits-all that can be applied to the normal function.

1 thought on “Norman Daniels and the Normal Function Model

  1. Harrison Pire

    Jake points out the potential ambiguity in the concept of “normal functioning.” What should we consider “normal” for a given individual? Would “normal” be performance that meets an average threshold for a larger demographic or should it be performance that represents an average over the course of that individual’s life. If an ailment reduces a person’s capacity and that person was previously above average in performance, is she still functioning normally if she is now “just” average. We could also ask what “functioning” means. Does the idea of “functioning” require that we identify a person with her most recent occupation and gauge whether she is still able to undertake that occupation, or do we have a definition of “functioning” that simply requires that a person is physically mobile or living without significant pain?
    One way of potentially answering this question is to look at Daniels’ concept of “system relativity.” For Daniels, healthcare must be system relative; we determine what healthcare an individual should expect based in part on characteristics of her society: its wealth, size, technological capacity, etc.. These endogenous characteristics determine what sorts of treatment a person should expect in Daniels model. Individuals in Sweden should expect different healthcare rights from those in Zimbabwe, for example. System relativity might also help us identify what “normal functioning” should mean in a given society. Normal functioning might be defined by the social and cultural norms that predominate in that particular society. For example, Daniels argues that “there is room for different societies to ‘construct’ the concept of mental disorder somewhat differently, with resulting variation in decisions about insurance coverage” (768). In this case, “normal psychological functioning” would be determined by whatever standards of mental health exist in a given society. This same test might be extended to normal physical functioning. If this is the case, we probably wouldn’t define normal functioning in relation to an individual’s past capacity but instead according to some broader society-wide or demographic-wide threshold.

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