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This dissertation asks what distributive justice requires when individual patients make different choices on health and healthcare. Such differences often lead to inequalities in individual outcomes, raising the question which choice-driven inequalities in health and healthcare warrant rectification at the bar of justice. Among the various egalitarian theories, luck egalitarianism finds choice-driven health and healthcare inequalities fair and just insofar as they come from the disadvantaged individuals’ voluntary choices. The first two chapters accept luck egalitarianism but criticize arguments raised previously by luck egalitarians in that area.
Specifically, the first chapter discusses whether and to what extent men who make more unhealthful choices than their female counterparts should be held responsible for these choices. In previous literature, luck egalitarians argued that such men should not be held responsible for their unhealthful choices, mainly based on the empirical finding that what leads these men to make relatively unhealthful choices is gendered social norms. This chapter criticizes their argument. It proposes that when unhealthful choices that are comparatively common among men are rationally defensible, these choices might be a result of the men’s deliberate decisions, even if they correlate with, or result from, gendered social norms.
The second chapter examines one element of Alexander Cappelen and Ole Norheim’s luck-egalitarian approach. Cappelen and Norheim suggest taxing risk-takers to the extent that assigns them responsibility for their future expectancy of elevated treatment costs without denying to them affordable access to medical treatments and other potentially catastrophic expenditures, should those become necessary. The rates of such taxes, according to Cappelen and Norheim, should be equal among all those who have made the same risk-taking choices. Cappelen and Norheim call this the principle of equalization. This chapter criticizes the principle of equalization by exposing several cases in which the principle does not hold. It argues that luck egalitarians need not always support equalizing the outcomes for risk takers of the same risky choices.
The third chapter’s topic is justice in healthcare. Even in liberal societies where individuals are entitled to make different choices in healthcare, it needs to be collectively decided what kind of healthcare utilization costs should be covered by shared funds, such as national health insurance. Collective healthcare decisions of this sort, so-called “healthcare priority setting,” often give rise to serious disputes but are inevitable given the scarcity of healthcare resources. This is sometimes decided through deliberation workshops. This chapter reviews the two public deliberation workshops held in South Korea and discusses how to enhance the fairness and legitimacy of healthcare priority setting in deliberative workshops, including in non-Western settings. In these two workshops, a small representative sample of the Korean public convened and deliberated on the policy questions so that the deliberation results could inform the decisional process. This chapter finds some aspects of how these two workshops were organized, conducted, and implemented within the South-Korean health policy context to have been inappropriate and misguided, and provides recommendations for improving the current public deliberation process.

http://dissertations.umi.com/gsnb.rutgers:12273

Ph.D.

Includes bibliographical references

doi:10.7282/t3-qp92-cr39

The author owns the copyright to this work.