Theories of justice and an HIV/AIDS health care policy for South Africa : a comparative analysis

[摘要] ENGLISH ABSTRACT:On The io of May 1994 Nelson Mandela was inaugurated as the first democraticallyelected black president of South Africa. The occasion was regarded, both nationally andinternationally, as a triumph for humanity and perfused with a widespread optimism for thefuture of South Africa. Mandela proclaimed in his inaugural speech that Never, never andnever again shall it be that this beautiful land will experience oppression of one byanother .... The sun shall never set on so glorious an achievement. However, now, lessthan 10 years later the rapidly accelerating and devastating HIV/AIDS epidemic is again'obscuring the sun'. Those people affected so negatively by the racial, economic andgender injustices of the apartheid past, seem again to be suffering a possible injustice,because of a health and welfare system that is struggling to meet the needs of the HIVaffected population.The purpose of this dissertation is to examine the concept of distributive justice in SouthAfrica, within the context of this devastating epidemic. I begin by discussing the Bill ofRights in the South African Constitution. I argue that an acceptable framework for a theoryof justice for health care in South Africa, must be worked out against the background ofthis egalitarian Bill of Rights. I then consider the extent of the HIV epidemic, the effect it ishaving on the people of South Africa and the consequent implications for health careneeds.It is within this context that I examine and compare three theories of distributive justice,namely utilitarianism, John Rawls' theory of Justice as Fairness and a libertarian conceptof justice, as proposed by Robert Nozick. Utilitarianism is a consequentialist theory thatfocuses on producing the 'greatest happiness for the greatest number'. I argue that manyhealth policy decisions in South Africa are in fact guided by this principle. Howeverutilitarianism has both strengths and weaknesses which are critically examined. Within theframework of health care policy making, utilitarian justice dictates that rights are derivativeand that the welfare of the majority usually takes precedence over the pressing needs of aminority. This issue in particular is discussed. Rawls' theory of Justice as fairness is critically discussed next. This theory has beenadapted to health care by Norman Daniels, who argues that the Rawlsian principle of fairequality of opportunity is a suitable founding principle for health care institutions.Apartheid entrenched a system of 'inequality of opportunity'. Consequently, a theory thatfocuses on equality of opportunity, has many advantages within the South African context.I examine this theory in detail and provide justification for my assertion that it could beusefully adapted to South African healthcare and the HIV/AIDS epidemic.Finally, I discuss a Libertarian (Nozickian) theory of justice and examine both the strengthsand weaknesses of this theory. I attempt to demonstrate why a libertarian system, with itvigorous commitment to moral and economic individualism and belief that one is onlyentitled to that share of healthcare that can be paid for, would be unjust, if rigorouslyapplied within the post-apartheid South African context. I conclude my dissertation by reiteratingmy assertion that Justice as Fair Equality of Opportunity could be used as a justfoundation for a theory of justice for health care in current day, HIV/AIDS affected SouthAfrica.

[发布机构] Stellenbosch University