Customer Reviews

Social Justice: The Moral Foundations of Public Health and Health Policy (Issues in Biomedical Ethics)

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This book by Madison Powers of Georgetown University and Ruth Faden of Johns Hopkins should prove influential in theories of justice, particularly those applying to health and health care. Powers and Faden move beyond Rawls, and accept many but not all of the ideas espoused by Martha Nussbaum and Amartya Sen. They differ from those authors in focusing on six factors that need to be attained in sufficient measure to enable the pursuit of lives with a meaningful range of choices and opportunities. Some of these are capacities and others are met only by actual outcomes (particularly in the case of children). It is the job of justice to ensure that these six thresholds are exceeded, and this book lays out the theory to perform that work.

This theory is more easily applied to health because the parameters map to real-world interventions. The notion of human rights is embedded in several of the parameters, but the theory moves away from a pure rights framework and toward a "sufficiency" criterion of well-being. The final chapters apply the theory to specific problems, such as advantages and limitations of formal quantitative methods for assessing health benefit, and the problem of access to health care (via health care financing). The extra weight accorded to ensuring the six parameters of justice are satisfied for children is explained in a developmental theory, resting on the fact that once developmental windows close, the later adult cannot compensate. Unjust disadvantages from childhoold thus accumulate and reinforce one another irreversibly, limiting future choices and opportunities.

The theory is much more tractable for addressing health and health care than the twists and turns needed to accommodate Rawls. Powers and Faden take up many of the ideas of Sen about "development as freedom" and ensuring sufficiency of capabilities, but differ from him in focusing on actual outcomes rather than mere capacities for some parameters.

This is not beach reading, but it is important and extremely useful.

This is a crucial addition to the conversation about social justice. Having read Daniels, Nussbaum, Sen & Rawls, I found this text to be contributing to the larger conversation in interesting and new ways. Not light reading, but neither are the other important folks in this field.

In particular, Powers & Faden are putting forward a non-ideal theory, viewing theories of social justice as crucially concerned with remedying unjust situations.

I've assigned this in an undergraduate course and the students are challenged by it but don't find it inaccessible. They are interested and keeping up with the reading.

You should keep in mind that this book is based on a care ethics model that does not fit with all people. There are some good starting points to work off of but the conclusions drawn are not fully thought out. The arguments are circular and have little solid support outside of "it works because we say it will". Be careful in just taking everything written as truth and remember to always critically evaluate what you are being told.