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Is there a duty to die? This inflammatory question, often originally attributed to then-Governor of Colorado Richard Lamm, was being explored some years ago within the context of American health care, but lately has dropped out of sight. If the strongest argument for the existence of a duty to die, rooted in Norman Daniels' early Rawlsian reconstruction, is supplemented by Allen Buchanan's distinctive approach to issues of international justice, it is possible that a new, stronger duty to die might emerge from this conjunction. This “duty to die” is sneaking up on us as we explore multilateralist, cosmopolitan accounts of international relations. In some familiar senses, we already recognize a variety of “duties to die” — including obligations to allow oneself to die, to risk dying, to let oneself be killed, or kill oneself — in a wide range of traditional circumstances. This chapter examines the notion of the duty to die and global life expectancies and compares the views of Dan Callahan, Norman Daniels, and John Hardwig.

Equality of opportunity is at the heart of the dominant theory of justice to date, namely Norman Daniels’s Rawlsian account. This chapter argues against the Rawlsian account and in favour of the radical account of equality of opportunity in health. Radical EOp for health says that health inequalities are just only when they track choice. The chapter then defends this account from two prominent objections. The first says that EOp is suitable only for regulating competitive goods, which health is not. The second objection says that EOp for health relies, to be attractive, on neutralizing natural inequalities. This is problematic, some critics argue, because the concept of ‘natural inequalities’ is incoherent.

The enormous disparities in health across national boundaries strikes most people who are aware of them as grossly immoral. Why should a child born in one country be unlikely to live to 40, while a child born in another country should expect to live into her 80s? Yet it is not easy to explain why an egalitarian should be especially concerned about health inequalities. So-called “luck” egalitarianism, which holds that all inequalities for which individuals are not responsible are unjust, suffers from philosophical defects and has trouble describing a feasible and attractive notion of health equality. Relational egalitarianism, which insists on equality of respect and status rather than directly on equality in distribution provides no reason to single out the distribution of health as of special moral importance. Moreover, inequalities between different countries raise different questions from a relational egalitarian perspective than inequalities within a single country. Although there is an egalitarian case to be made against global health inequalities, it is complex and controversial, unlike the powerful and direct condemnation of these inequalities provided by simple benevolence.

Compared with resource egalitarians, who cannot incorporate utilitarianism into their distributive theories without some modifications, welfare egalitarians make compromises with utilitarianism in two ways. Some are ethical pluralists, who simultaneously abide by a number of different distributive principles, including welfare egalitarianism and utilitarianism. Other welfare egalitarians propose a kind of weighted welfarism known as prioritarianism; they argue that society should seek to increase the welfare of everyone, but should give more importance to the welfare of those who are worse off. This chapter explores prioritarianism, focusing on the views of Amartya Sen, G. A. Cohen, Norman Daniels, and Martha Nussbaum. It presents examples that highlight the conflict between utilitarianism and prioritarianism.

This chapter examines the views of Norman Daniels about the relation between health and equal opportunity. It focuses on Daniels' treatment of two questions: Is healthcare special? When are health inequalities unjust? Daniels argues that a Rawlsian theory of justice must include health, understood as normal species functioning, since health is a precondition for fair equality of opportunity, the first part of Rawls' second principle of justice.

This chapter contrasts two approaches to affirmative action in health, a Rawlsian (liberal) approach and the radical approach. The former prioritizes the medical needs of patients whose condition is owed to social injustice. The radical approach prioritizes the needs of patients who ex-ante suffer worse health prospects. It is shown that the liberal approach is implausible, whereas the radical approaches may ground a plausible and attractive health policy (such as medical research that prioritizes the medical needs of disadvantaged groups).

Suppose that Churchill had known in advance about the German Blitz plan for Coventry and decided to do nothing against it, in order to cut overall British war casualties by a little. Would that decision be wrong? Norman Daniels has recently argued that, other things being equal, abandoning individuals or groups to what he calls “concentrated risk”—higher risk than others face—is wrong. Any such decision is unfair toward those who face concentrated risk. A Danielsian might claim that fairness toward the inhabitants of Coventry would have made it wrong to abandon them to unfairly concentrated risk of death. This chapter argues against treating risk Daniels’s way—as a currency of distributive justice. As it shows, applying fairness considerations to risk distribution founders on either epistemic or nonepistemic interpretations of risk.

This chapter reviews the book From Chance to Choice: Genetics and Justice (2000), by Allen Buchanan, Dan W. Brock, Norman Daniels, and Daniel Wikler. The book argues that we should use our new genetic knowledge to treat impairments against a baseline of some core human functions and abilities, but not necessarily (in most cases) to offer enhancements of human abilities above that baseline; that we should zealously protect reproductive freedom and oppose most (though not all) attempts to persuade parents or to require parents to have a particular sort of child; that genetic counseling and certain types of genetic services should be offered in all health-insurance packages; that society must evolve toward greater respect for and inclusion of the disabled, but this concern should not make us shrink from treating serious genetic impairments to the extent that we can do so. The authors also launch an assault on the ideological function of genetic determinism and conclude that we can to some extent separate the idea of genetic improvement of people from the hideously flawed ideals of the old eugenics.