Health, Luck, and Justice

Preface iv Introduction 1 Chapter 1: Justice, Luck, and Equality 9 I. Rawlsian vs. Luck Egalitarian Justice 10 II. Inequality vs. Equality 14 III. Reasonable Avoidability vs. Responsibility 19 Part I Health Care 27 Chapter 2: Responsibility- Insensitive Health Care 29 I. The Fair Opportunity Account 30 II. Opportunities and Life Plans 34 III. Th e Democratic Equality Account 37 Chapter 3: Ultra- Responsibility- Sensitive Health Care: "All- Luck Egalitarianism" 45 I. A Test Case: Justifying Medical Treatment for Smoking- Related Diseases 46 II. Some Preliminary Problems with All- Luck Egalitarianism 48 III. What's Wrong with Neutralizing Luck as Such? 51 IV. All- Luck Egalitarianism, Moral Luck, and Desert 54 Chapter 4: Tough Luck? Why Luck Egalitarians Need Not Abandon Reckless Patients 58 I. Luck Egalitarian Attempts to Defl ect the Abandonment Objection 59 II. Value Pluralism 64 III. Three Objections to Luck Egalitarian Value Pluralism 66 IV. A Potential Solution? 68 Chapter 5: Responsibility- Sensitive Universal Health Care 74 I. Meeting Basic Needs 75 II. Health Care as a Public Good 78 III. Some Counter- Objections and Clarifi cations 80 IV. In- Kind Health Care 83 Part II: Health 87 Chapter 6: Why Justice in Health? 89 I. Is Health Care (Still) Special? 89 II. Why a Separate Th eory of Justice in Health? 92 Chapter 7: Luck Egalitarian Justice in Health 98 I. Rawlsian vs. Luck Egalitarian Justice in Health 99 II. Two Problems with Fair Equality of Opportunity for Health 101 III. Health Inequalities between the Sexes Revisited 105 Chapter 8: Equality or Priority in Health? 111 I. The Value of Equality in Health 112 II. Some Potential Objections and Qualifi cations 115 III. Luck Prioritarian Justice in Health 118 Chapter 9: Distributing Human Enhancements 121 I. What Is Human Enhancement? 122 II. The Treatment vs. Enhancement Distinction 124 III. "Fair" Skin and Other Potential Objections 130 IV. Equality or Priority in Enhancement? 133

Shlomi Segall is lecturer in the Department of Political Science and the Integrative Program of Philosophy, Economics, and Political Science (PEP) at the Hebrew University of Jerusalem.

"Segall ably defends why she thinks luck egalitarian theory, with important modifications to prevent the total abandonment of patients, provides a better solution for problems in health care allocation than other theories of justice do. This important, thought-provoking book is distinctive in defending the claim that so-called enhancement technologies should be made available to some as a matter of justice."--Choice "This is a thought-provoking volume deserving of a wide readership among academics and health professionals and health policy analysts who must struggle with the challenges of trying to create a more just health care system that gives due regard to issues of personal responsibility for one's own health status and costs that might be imposed on social budgets."--Leonard M. Fleck, Notre Dame Philosophical Review "Although I approached the book with a broadly similar ... stance to Segall?s, I found the arguments took many unexpected turns, though never in a way so as to leave me lost. Any political philosopher or bioethicist will come away from the book knowing much more about both luck egalitarianism and philosophical approaches to health and healthcare."--Carl Knight, Iyyun "[A]mbitious, rich, and challenging... It is bound to provoke much more extensive discussion."--Daniel M. Hausman, Economics and Philosophy "Segall's book is an important contribution to the discussion of justice in health care which shows how far theories of justice, especially a luck egalitarian approach can deal with the normative problems we face in this context. But it is also important in showing the limits of theories of justice when we think about the value of health in our overall scheme of good lives and human flourishing."--Michael Quante, Medicine Health Care and Philosophy "Segall raises the standard for the burgeoning philosophical discussions on health and social justice and gives us much novel material for further consideration. Graduate students and academics