Browsing by Author "Horn, Lynette (Lynette Margaret)"

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    Theories of justice and an HIV/AIDS health care policy for South Africa : a comparative analysis
    (Stellenbosch : Stellenbosch University, 2003-03) Horn, Lynette (Lynette Margaret); Van Niekerk, Anton A.; Stellenbosch University. Faculty of Arts and Social Sciences. Dept. of Philosophy.
    ENGLISH ABSTRACT: On The io" of May 1994 Nelson Mandela was inaugurated as the first democratically elected black president of South Africa. The occasion was regarded, both nationally and internationally, as a triumph for humanity and perfused with a widespread optimism for the future of South Africa. Mandela proclaimed in his inaugural speech that "Never, never and never again shall it be that this beautiful land will experience oppression of one by another .... The sun shall never set on so glorious an achievement." However, now, less than 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 and gender 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 HIV affected population. The purpose of this dissertation is to examine the concept of distributive justice in South Africa, within the context of this devastating epidemic. I begin by discussing the Bill of Rights in the South African Constitution. I argue that an acceptable framework for a theory of justice for health care in South Africa, must be worked out against the background of this egalitarian Bill of Rights. I then consider the extent of the HIV epidemic, the effect it is having on the people of South Africa and the consequent implications for health care needs. 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 concept of justice, as proposed by Robert Nozick. Utilitarianism is a consequentialist theory that focuses on producing the 'greatest happiness for the greatest number'. I argue that many health policy decisions in South Africa are in fact guided by this principle. However utilitarianism has both strengths and weaknesses which are critically examined. Within the framework of health care policy making, utilitarian justice dictates that rights are derivative and that the welfare of the majority usually takes precedence over the pressing needs of a minority. This issue in particular is discussed. Rawls' theory of "Justice as fairness" is critically discussed next. This theory has been adapted to health care by Norman Daniels, who argues that the Rawlsian principle of "fair equality of opportunity" is a suitable founding principle for health care institutions. Apartheid entrenched a system of 'inequality of opportunity'. Consequently, a theory that focuses 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 be usefully adapted to South African healthcare and the HIV/AIDS epidemic. Finally, I discuss a Libertarian (Nozickian) theory of justice and examine both the strengths and weaknesses of this theory. I attempt to demonstrate why a libertarian system, with it vigorous commitment to moral and economic individualism and belief that one is only entitled to that share of healthcare that can be paid for, would be unjust, if rigorously applied within the post-apartheid South African context. I conclude my dissertation by reiterating my assertion that "Justice as Fair Equality of Opportunity" could be used as a just foundation for a theory of justice for health care in current day, HIV/AIDS affected South Africa.