Thomas Schramme: Theories of health justice: just enough health
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Thomas Schramme: Theories of health justice: just enough health Rowman & Littlefield, London, 2019, 147 pp, ISBN: 978-1-78660-144-5 Margherita Daverio1
© Springer Nature B.V. 2020
The author of this book is a professor of philosophy at the University of Liverpool, who is widely published in the field of philosophy of medicine. Given this background, Thomas Schramme is able to engage on a philosophical level not only with issues of health and justice but also with health justice theories. To this effect, throughout his work Schramme discusses the main theories of health, disease, and justice in order to give proper context to the argument in favor of his own view of health justice: sufficientarianism—a theory that aims at “enough health for all” (p. viii). This approach is well-justified from the stance that “philosophy enhances public debate and political decision by explaining, clarifying and sorting out bad arguments. In doing so, it lays the intellectual foundation for citizens to achieve reasoned beliefs, which is more than simply having opinions” (p. viii). In this way, the book is dynamic but also rigorous in its philosophical reasoning. Moreover, Schramme comes from a global health justice perspective, moving beyond the level of international justice (which concerns the rights and duties of states) and following a cosmopolitan view: “Cosmopolitanism sees individual people as the most basic unit of normative concern and accordingly interprets rights of people from a universal point of view” (p. 88). After two interesting chapters about the concept of disease and the concept of health, respectively, Schramme walks through the main theories of social justice— drawing largely on John Rawls, Amartya Sen, and Michael Walzer, among others— as well as the main theories of health justice. This critical review is a fundamental step in the author’s argument for and discussion of a sufficientarian view of health justice. In the light of the Rawlsian theory of justice and its concept of reflective equilibrium—namely, “a method of reflection guided by the criterion of coherence” (p. 44)—Schramme defends a marriage between a naturalist theory of disease and * Margherita Daverio [email protected] 1
LUMSA University, Rome, Italy
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sufficientarianism, which advocates for the provision of goods necessary for the possibility of leading a decent life: “Health justice … means that everyone ought to be entitled to the treatment of noncomparatively harmful dysfunctions. If this is not possible for reasons of shortage of resources, then health-care resources should be rationed in relation to their significance for the well-being of patients and to their costs of treatment” (p. 124). One could object, first, that the concept of “enough” health could result in ambiguity and, second, that the threshold of sufficiency implies that a life below such a standard is not worth living. Regarding the first objection, according to Schramme’s approach, a decent life seems at least to require the ability
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