John Rawls, social justice, and health-care delivery systems

John Rawls' theory of justice holds special appeal for those who wish to apply a deontological moral theory to issues in medical ethics. This study is undertaken to examine Rawls' theory (and two notable modifications of it) to see if it is, in fact, a worthwhile evaluative tool in judging the justice of social issues in medicine.

In the first three chapters, issues are clarified and Rawls' theory is analyzed. The conclusion is that an unmodified Rawlsian theory is not applicable to distributive issues in medicine like access to the health-care delivery system without significant modification. Two notable modifications of Rawls' theory are analyzed and found to be conceptually and methodologically inconsistent. The author's own modification is undertaken, arguing for health as a social primary good with health care as a right subsumed into the second principle of justice. As a result, criteria for evaluating the justice of social issues in medicine are developed and applied to the issue of access in four health-care delivery systems. The criteria are found to be workable evaluative tools. Thus, Rawls' theory, although a "minimalist" theory with reference to second principle social primary goods, is applicable for evaluating social issues in medicine.