Theories of justice in health
- Theory
Theories of justice give different answers to one question: what is owed to each person in health care, and who pays.
What it is
Distributive justice asks how to share scarce goods among people who need them. In health there are several answers. Utilitarianism seeks the greatest total benefit. Libertarianism protects liberty and property and leaves care to the market and to charity. Rawls's egalitarianism, applied to health by Norman Daniels, protects health because it preserves fair equality of opportunity. The capability approach (Sen, Nussbaum) looks at what each person is able to be and do. Prioritarianism gives more weight to those who are worse off, and sufficientarianism asks that no one fall below a threshold. This page expands the «Justice» page, which presents the principle briefly.
Core ideas
- Utilitarianism: a distribution is just if it produces the greatest aggregate well-being; it uses measures such as quality-adjusted life-years.
- Libertarianism: justice depends on how goods were acquired; taxing people to fund others' health care would burden liberty.
- Rawls: behind a «veil of ignorance», people who do not know what position they will hold choose principles that protect the least advantaged.
- Daniels: disease shrinks the range of life plans a person can pursue; health care and public health restore that range.
- Capabilities: what matters is real freedom to achieve valuable functionings (being healthy, nourished, informed), not resources alone.
- Luck egalitarianism: compensate disadvantages that do not result from the person's own choices.
- Prioritarianism and sufficientarianism: give special weight to the worst off or to a minimum threshold for all.
What each theory answers in health
| Theory | What counts | Typical consequence |
|---|---|---|
| Utilitarianism | Total benefit | Fund what produces the most health per unit of money |
| Libertarianism | Liberty and property | An insurance market; charity for the poor |
| Daniels (Rawls) | Fair equality of opportunity | Universal access to what protects normal functioning |
| Capabilities | What the person is able to be and do | Also address the social determinants |
| Prioritarianism | Extra weight for the worst off | Prefer interventions for the sickest or poorest |
In clinical practice
- A committee deciding which services to cover almost always mixes utilitarian criteria (cost-effectiveness) with prioritarian ones (severity).
- When an institution prioritises rural areas or groups with worse health, it applies a logic of equity and priority to the worst off.
- Knowing which theory lies behind an argument helps in discussing a case: «save more lives» and «treat the sickest first» come from different theories.
Criticisms and limits
- Utilitarianism can sacrifice minorities or people with disabilities if that yields more total benefit.
- Libertarianism leaves those who cannot pay without care and clashes with the right to health in the Constitution (art. 49).
- Daniels's approach explains basic care well but gives little guidance when choosing between equally legitimate needs.
- No theory is enough on its own, which is why fair and public decision procedures are added (see «Priority setting and rationing»).
Test yourself
Think of the answer, then tap the question to see it.
Which theory justifies access to care because health protects fair equality of opportunity?
Norman Daniels's, which applies John Rawls's theory of justice to health.
What does prioritarianism hold?
That the same benefit has greater moral value when it goes to a person who is worse off.
What is the main criticism of utilitarianism in allocating health resources?
That it can sacrifice small or vulnerable groups, such as people with disabilities, if that produces more total benefit.
What does the capability approach look at instead of resources?
Each person's real freedom to achieve valuable functionings, such as being healthy, nourished and informed.
Elsewhere in DurgiPedia
Connections
Educational content on ethics and health law; not legal advice. Laws and case law change: each page links the official text and says when it was last checked. For a real case, read the text in force and ask a lawyer or the medical ethics tribunal.
Sources: Distributive Justice (Stanford Encyclopedia of Philosophy, 2017); Justice and Access to Health Care (Stanford Encyclopedia of Philosophy, 2017); The Capability Approach (Stanford Encyclopedia of Philosophy, 2025); Making fair choices on the path to universal health coverage (World Health Organization, 2014).
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Representative model, for educational purposes only.