Principles of global distributive justice: Moving beyond Rawls and Buchanan
The principal aim of this article is to focus on the problem of the applicability of Rawls's ideas to the growing interest in developing what might now well be called a "global bioethics". The specific focus is the question whether Rawls's later work helps us to develop principles of distributive justice for such an alleged global bioethics, drawing on and critically evaluating Alan Buchanan's critical discussion of Rawls's The Law of Peoples. The main tenets of Rawls's theory of justice, particularly as it concerns health care as one of our "primary needs", are discussed, drawing on the work of Norman Daniels. Secondly, an argument for the necessity of a global approach to biomedical ethics in view of the need for a more equitable provision of health care between developed and developing worlds is developed. Thirdly, the main tenets of Rawls's The Law of Peoples, the book in which Rawls extrapolated the implications of his theory of justice to the sphere of just international law, are discussed. Allen Buchanan's criticisms of this Rawlsian enterprise are critically reviewed. On the basis of this discussion, two additional Principles of Global Distributive Justice (PGDJ) are formulated. The first principle is: "Justice in international relations requires that the burden of catastrophic events be distributed equitably between affected and unaffected peoples". The implications of this principle are discussed, and complemented with an extended definition of the concept of "catastrophe". Drawing on each component of that definition, the author then illustrates how the HIV/AIDS pandemic is the best current example of an international catastrophe, and how that calls for the implementation of the formulated principle. Then follows the formulation of the second principle for distributive justice for the law of peoples. This principle is: "Justice requires that efforts at an equitable distribution of burdens at the level of international relations be met with policies from the beneficiaries that, as far as possible, sustain the benefits attained from these efforts". The author ends by showing how this principle is being neglected by the denialism of, for example, the South African policy-makers' lack of a responsible response to the HIV/AIDS pandemic over the past decade, and by making suggestions how this denial and neglect might be rectified in the area of the provision of antiretroviral drugs to prevent mother-to-child transmission of HIV.