Tag Archives: Health Care

Questa è probabilmente la notizia più importante del giorno

… e per una volta, non è una brutta notizia:

U.S. Congress Approves Bill to Extend Health Care to Millions

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Rescuing Justice as Fairness from Norman Daniels

Daniels’ extension of FEO seems unacceptable, for it seems to collapse two issues that ought to remain distinct in any “social structural” account of equality of opportunity, such as the one Justice as Fairness provides.

As I see things, Daniels starts from a good point, but then spoils it. The good point is that you can extend FEO in a plausible way to deal with certain cases where equality in the access to health care is at issue. He spoils it because he wants to extend it to an altogether different type of cases.

Consider:
Case 1. Here we have two individuals with roughly similar “natural endowments” (similar biological constitution) from different sectors of society (e.g. different socio-economic classes): P and R. Suppose that P is born in a poor family, which cannot afford health insurance, and as a result gets sick three times as often as R, who is born in a rich family. Because P gets sick so often, he fails to express and develop his talents to the same degree as R.

Daniels can appeal to our intuition about such cases to claim, quite plausibly,  that FEO extends to access to health care. After all it seems wholly correct to say that, just like unequal access to education, inequality in the access to health care affects opportunities between P and R, so that they end up with different social positions even if the two even if they are equally motivated and endowed .

Consider the second scencario (case 2). Here we have two individuals who are born with different “natural endowments” from the same sector of society: U and L. More precisely, U has a congenitally higher disposition to get sick than  L, and since none of them has access to high quality health care, U actually gets sick twice as often as L. Because of more days free of pain, U has a more successful education and gains access to a more rewarding professional career.

Ought case two figure as a violation of FEO? I think the answer is clearly: no! The case does not differ substantially from that of people born with different talents, for which equal access to opportunity according to Democratic Equality is not an issue. From the point of view of Democratic Equality, inequalities in income and wealth between U and L should satisfy the difference principle.

Daniels disagrees: he wants to extend FEO according to an intepretation that treats case 1 and case 2 as instances of the same scenario, while avoiding the “luck egalitarian” implication of his way of dealing with case 2 by placing a (seemingly arbitrary) constrain: only departures from normal functioning determine a violation of FEO.

I fail to see what could motivate Daniels’ solution, except wanting to respond to Sen’ and Arrows’ criticism of Rawls.

Health, Selection and Sex (Some thoughts on Boorse’s “a rebuttal on health” /4)

As in the previous post, here I am concerned with aspects of the “normativity” of Boorse’s account that cannot be considered objections against Boorse’s project, but which still count as objections once Boorsian health is made to play normative work in a political theory. It would be simplistic to assume that, if Boorse can show that his account is naturalistic, in its own terms, then its incorporation in normative theory is unproblematic. The problem discussed here shows why.

When discussing Hare’s “head hear argument”, at p. 71, Boorse writes that

On the other hand, head hair but not leg hair may have a function, in which case the BST predicts Hare’s two disease verdicts. […] Many other possibilities exist, such as that the graying of men’s hair, by indicating age, serves as a fitness indicator in sexual selection. […] Both the above sexual selection hypothesis and Hare himself open a can of worms I wold have liked to avoid: the reproductive effect of appearance. Yet another point about baldness is that many women find bald man unappealing, while few men demand woman with hairy legs. This fact too offers the BST a route to Hare’s two disease judgment, if only baldness impedes reproduction. Yet one cannot let the BST turn ugliness into a disease, especially not moderate or marginal ugliness, since it isn’t one. But baldness, if ugly, is not simple ugliness; it is the absence of a normal body part, a discrete structural anormality. One can see how a structural deviation from species design, coupled with damage to reproduction, might induce a BST-inspired physicial to call a trait pathological. Perhaps, then, this line of thought is one reason major deformities are seen as pathological. Structural defects much worse than baldness can be so hideous as to make reproduction almost impossible, though major structural defects (harelip, cleft palate) tend to involve dysfunction as well as deformity. Still, it seems odd to call attracting the opposite sex a biological (let alone a physiological) function of the mouth, face, scalp, fingers, spine and so on. So perhaps the BST does not, after all, entail that awful structural abnormalities are pathological, despite their antireproductive effect. One should note that this inference could only apply in any case to deformities that block reproduction throughout our species. The BST cannot make any one time’s or culture’s standards of beauty into requirements of health. And no such link between appearance and reproduction offers much confort to normativism anyway, since a fact about what the human race finds intolerably ugly, though a fact about values, is a fact nonetheless.” (71-72)

I have quoted this long paragraph because it gives an indication of the extent to which Boorse’s account runs into trouble when one attempts to apply it thoroughly and across the board. I simply see no way to avoid the conclusion that if an abnormal trait is found to be ugly (by the female sex) thorough our species (i.e. in a statistically normal way), then it counts as a disability, because it is an obstacle to reproduction.

To deny this would be ad hoc, because it would create an unbridgeable gap between pathology in the human and in other species (as Boorse reminds us – p. 15 – BST’s ability to explain disease judgments about plants and animals counts as one of its most important strengths). For it is impossible to account for normal species functioning in the animal world if one disregards those structures and processes whose unique or main purpose is to attract the opposite sex. To take a familiar example, consider the peakock’s tail, whose ipermorphism is solely explained by its capacity to attract the opposite sex. A clause ruling out the “increase partner’s attractiveness function” would imply that a peakock’s born without tail has no disease. Therefore there is no prospect of the BST fitting considered veterinary usage if such clause is included.

Having ascertained that the BST must therefore treat as pathological abnormal structural deviations whose sole functional defects derive from their uglyness in the eyes of the opposite sex, let us turn to the problem whether this makes the account value-laden.

The answer may be no, if one asks whether it makes the account “value-laden” in itself, for the reason that Boorse clearly mentions at the end of the paragraph. But it clearly makes the account too value-laden for the usage Daniels’s wants to make of it. For if health care depends on Boorsian pathology, and Boorsian pathology depends (in a crucial case) on what human individuals find sexually attractive, then health care is tied up by subjective desires and tastes, a conclusion that seems incompatible with  the spirit of a Rawlsian approach (because of its rejection of desire-based utility in political assessments).