Equality of Opportunity versus Sufficiency of Capabilities in Healthcare

Abstract

This paper compares three accounts of distributive justice in health and, more specifically, healthcare. I discuss two accounts—Norman Daniels’ fair equality of opportunity for health and Shlomi Segall’s luck-prioritarian equity in health—and contrast them with a sufficientarian account based on sufficiency of capabilities. The discussion highlights some important theoretical differences and similarities among the three accounts. The focus, however, is on the practical implications of each account in three hypothetical cases: synthesized growth hormone for short children, forms of compensation for paraplegics, and reconstructive breast surgery versus cosmetic breast enhancement. My aim is to show that by replacing egalitarian concerns with sufficiency and by focusing on capabilities (rather than opportunities), it is possible to provide a more reasonable and justifiable account of justice in healthcare.