Social Justice: The Moral Foundations of Public Health and Health Policy

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In bioethics, discussions of justice have tended to focus on questions of fairness in access to health care: is there a right to medical treatment, and how should priorities be set when medical resources are scarce. But health care is only one of many factors that determine the extent to which people live healthy lives, and fairness is not the only consideration in determining whether a health policy is just. In this pathbreaking book, senior bioethicists Powers and Faden confront foundational issues about health and justice.

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Editorial Reviews

From the Publisher
"Powers and Faden have given us a powerful and lucid theory that gives us the tools to unify our work in such disparate areas as bioethics, public health, global justice, and human rights. All of us who work in this area are in their debt.—John D. Arras, Porterfield Professor of Biomedical Ethics, University of Virginia

"Most moral theorists think about what principles of justice would govern an ideal world. Such ideal theories do not necessarily guide us well in our non-ideal world. Powers and Faden make a powerful case for moving from ideal to non-ideal theory, and ably show how to do it in the field of justice in health care. This book makes an important advance in making moral theory more empirically responsible."—Elizabeth Anderson, John Rawls Collegiate Professor of Philosophy and Women's Studies, University of Michigan, Ann Arbor

"Faden and Powers have produced a compelling and important argument regarding what social justice requires of states and the various social institutions they facilitate. One can only hope that their articulation of this very good constitutional idea—that as a very fundamental, constitutional matter states ought to promote social justice and that what that means is that states must provide for human well-being along those six crucial dimensions—will receive a wide readership, not only by public health professionals or the lay public, but also by constitutional lawyers and theorists."—Robin L. West, DePaul Journal of Health Care Law, Frederick J. Haas Chair in Law and Philosophy, Georgetown Law Center

"Social Justice is one of the most important books to come out in bioethics, and health policy ethics, in the last decade. It challenges us to think more broadly about what bioethics brings to the table when we evaluate health policies and public health practices. Its combination of rigor and clarity is uncommon."—Peter A. Ubel, M.D., Director, Center for Behavioral and Decision Sciences in Medicine, Ann Arbor

"Powers and Faden articulate a distinct theory of social justice emphasizing a threshold of sufficiency in six different dimensions of well-being. Their original, robust, well defended theory, combined with their subsequent application of the theory to a sensibly chosen set of health policy issues, make Social unmistakably prominent book in the field."—Paul T. Menzel, Professor of Philosophy, Pacific Lutheran University

"In this excellent book, Madison Powers and Ruth Faden set out to define the essential dimensions of well-being that should guide a theory of justice, and then to show how such a theory can be applied to important issues in public health and health policy."—Hastings Center Report

"With Social Justice: The Moral Foundations of Public Health and Health Policy, the multidisciplinary writers' team of Madison Powers and Ruth Faden have delivered an interesting and compelling answer to the questions of how much inequality in health a just society can tolerate and which inequalities matter most."

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Product Details

  • ISBN-13: 9780195375138
  • Publisher: Oxford University Press, USA
  • Publication date: 9/25/2008
  • Series: Issues in Biomedical Ethics Series
  • Edition description: New Edition
  • Pages: 248
  • Sales rank: 1,386,332
  • Product dimensions: 6.10 (w) x 9.10 (h) x 0.70 (d)

Meet the Author

Madison Powers is Professor of Philosophy and Senior Research Scholar, Kennedy Institute of Ethics, Georgetown University.

Ruth Faden is Wagley Professor of Biomedical Ethics, and Director, Berman Bioethics Institute, Johns Hopkins University.

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Table of Contents

Chapter 1: The Job of Justice
1.1 Which Inequalities Matter Most
1.2 Justice and Well-Being
1.3 Justice, Sufficiency, and Systematic Disadvantage
1.4 Foundations of Public Health
1.5 Medical Care and Insurance Markets
1.6 Setting Priorities
1.7 Justice, Democracy, and Social Values
Chapter 2
2.1 Introduction
2.2 Essential Dimensions of Well-Being
2.3 A Moderate Essentialism
2.4 Well-Being and Nonideal Theory
2.5 The Main Alternatives
2.6 Capabilities, Functioning, and Well-Being
2.7 Relativism, Moral Imperialism, and Political Neutrality
2.8 Justice and Basic Human Rights
Chapter 3: Justice, Sufficiency, and Systematic Disadvantage
3.1 Varieties of Egalitarianism
3.2 The Leveling-Down Objection
3.3 The Strict Egalitarian's Pluralist Defense
3.4 Is the Appeal to Equality Unavoidable
3.5 A Sufficiency of Well-Being Approach
3.6 Toward a Unified Theory of Social Determinants and Well-Being
3.7 Densely Woven, Systematic Patterns of Disadvantage
3.8 Conclusion
Chapter 4: Social Justice and Public Health
4.1 Introduction
4.2 Moral Justification for Public Health
4.3 Public Health, the Negative Point of Justice, and Systematic Disadvantage
4.4 Public Health, the Positive Point of Justice, and Health Inequalities
Chapter 5: Medical Care and Insurance Markets
5.1 The Moral Foundations of Markets
5.2 Sources of Market Failure
5.3 Responses to Market Failure: Some Examples from the U.S. Experience
5.4 Making Matters Worse: Employer-Based Insurance in the United States
5.5 Private Markets and Public Safety Nets
Chapter 6: Setting Priorities
6.1 Introduction
6.2 Mimicking Markets
6.3 Cost-Effectiveness and Cost-Utility Alternatives
6.4 Systematic Disadvantage
6.5 The Relevance of Childhood, Old Age, and Human Development
6.6 Beyond Separate Spheres of Justice
6.7 Trade-Offs within Health
6.8 Conclusion
Chapter 7: Justice, Democracy, and Social Values
7.1 Lost on the Oregon Trail
7.2 From Substantive Justice
7.3 Mimicking Majorities: Moralizing Preferences and Empiricizing Equity
7.4 Theory, After All?
7.5 DALYs, Deliberation, and Empirical Ethics
Chapter 8: Facts and Theory
Author Index
Subject Index

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