In his writing, Daniels breaks down different justice theories and finds their merits and shortcomings as a way to expose the true complexity of the issue of universal healthcare. One of the challenges he notes is that none of the moral philosophies directly mention the dilemma of healthcare–leaving uncertainty surrounding definitions and interpretations. His most engaging review was of the ideas of equal opportunity and moral contractarianism. In this, he looks at John Rawls’ theories and applies them to medicine. Rawls’ theories are based in a society structured by individuals from behind a “Veil of Ignorance”. From this Original Position, society’s governing principles will always resemble the Equal Liberty Principle and the Difference Principle. The Equal Liberty Principle states that everyone should have equal access to the largest set of liberties possible. Daniels argues that if this moral philosophy is followed, then every individual would not only have the right to equal healthcare but also to an equal baseline standard of physical and mental well-being. “For example, if through medical intervention we can ‘enhance’ the otherwise normal capabilities of those who are at a competitive disadvantage, then our commitment to equality of opportunity requires us to do so” (Daniels 766). In his view, if individuals were not all at the same starting point, then the Equal Liberty Principle would be violated since individuals would not truly be able to have access to the same opportunities.

Though Daniels’ argument lays a strong foundation for the merits of universal healthcare, his interpretations of contractarianism and the Equal Liberty Principle bring up important questions about the autonomy of individuals. Respect for autonomy is a cornerstone of an equal and just healthcare system and should be thoroughly evaluated before implementing further plans. Deciding on concrete expressions of normalcy brings up questions about the motives and justification behind deciding what traits are valued, and if that diminishes autonomy. For instance, in Deaf culture, there is backlash against defining deafness as a “disability”, and even resistance to using medical interventions to restore hearing (Byrd, Serena et al. 2011). The Deaf community, as well as many other individuals with disabilities, embrace their “differences” and use them adaptively to enrich their lives. It would be a detriment to the autonomy of individuals if these differences were eliminated solely for the purpose of strict adherence to the Equal Liberty Principle. 

A definition of normalcy that draws a hard line regardless of individual circumstances would be in direct contradiction with Aristotelian views of human flourishing and opportunity. An individual can only directly experience their life, and Aristotle would argue that through this experience, a person becomes moral and experiences personal worth or happiness. Deciding to make decisions about individual worth and happiness on a population-level is a serious drawback of Daniels’ framework. Understandably, some concessions have to be made when modeling a system for a large group of people, however, the violation of autonomy is something that needs to be considered very closely.

Byrd, Serena et al. “The right not to hear: the ethics of parental refusal of hearing rehabilitation.” The Laryngoscope vol. 121,8 (2011): 1800-4. doi:10.1002/lary.21886