According to Norman Daniels, the moral significance of health needs stem from their impact on the normal opportunity range: pathological conditions involve comparative disadvantage. In this paper I defend an alternative reading of the moral importance of healthcare, which focuses on non-comparative aspects of disease. In the first section I distinguish two contrasting perspectives on pathological conditions, viz a comparative versus a non-comparative. By using this distinction I introduce a related disparity regarding the moral importance of personal responsibility for disease. I claim that people are usually prepared to disregard individual responsibility for disease, if it involves non-comparative harm, but not if it entails mere disadvantage. Since disadvantage means to have less than equal opportunities, Daniels’ conception of opportunity is vital for his theory. It is therefore scrutinised more closely. I try to show that he wavers between two interpretations of the notion of opportunity, which are again linked to the distinction between a comparative and a non-comparative point of view. Finally, I criticise Daniels’ supposition that persons have an interest in the normal opportunity range.
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Competing interests: None.
↵i The claim would only be prima facie, because we would need to consider shortage of resources, hence potential rationing (cf6).
↵ii The competitive aspect is more explicit in another book, which Daniels co-authored: “(…) by keeping people close to normal functioning, healthcare preserves for people the ability to participate in political, social and economic life. It sustains them as fully participating citizens, as ‘normal competitors’ in all spheres of social life.” (Buchanan et al 2000, p122)5
↵iii Daniels interprets his claim as “a finding in moral anthropology” (p46),1 so he would not, at this point, use the phrase “people should have an interest in maintaining a normal opportunity range.”
↵iv Note that the opportunities we value are different from what Daniels calls effective opportunities. The latter are opportunities we have in reality. But certainly we can cherish opportunities we don’t have and the other way round.
↵v The difference between a comparative and a non-comparative perspective is even noticeable in the two different versions of phrasing the (alleged) object of our fundamental interest: (a) an interest in a normal opportunity range. This implies an interest in a non-impaired chance to succeed in various competitive scenarios; (b) an interest in a normal range of opportunities. This suggests an interest in standard abilities.
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