Faden R R, Powers M
Johns Hopkins Berman Institute of Bioethics, 624 N. Broadway, Baltimore, MD 21205, USA.
Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz. 2008 Feb;51(2):151-7. doi: 10.1007/s00103-008-0443-7.
Recently we argued that social justice is concerned with human well-being, which is best understood as involving plural, irreducible dimensions, each of which represents something of independent moral significance. Health is one of these distinct dimensions of well-being, as is personal security, the development and exercise of cognitive capacities for reasoning, living under conditions of social respect, developing and sustaining deep personal attachments, and being able to lead self-determining lives. In this paper, we address why considerations of justice, and not utilitarian aims as applied narrowly to health outcomes, are most foundational to public health. In particular, we argue that the aspiration for improvement of the health of populations defines the positive aim of justice in public health, along with the negative aim of reducing or combating systematic disadvantage that affects adversely historically situated social groups and, more generally, children across the normal life span when their well-being is not assigned a special priority in the development of public health policies.
最近我们认为，社会正义关乎人类福祉，而人类福祉最好理解为包含多个不可简化的维度，每个维度都具有独立的道德意义。健康是福祉的这些不同维度之一，个人安全、认知推理能力的发展与运用、在社会尊重的条件下生活、发展并维系深厚的个人情感以及能够过上自主的生活也是如此。在本文中，我们探讨为何正义考量而非狭义应用于健康结果的功利主义目标，对公共卫生最为根本。特别是，我们认为改善人群健康的愿望界定了公共卫生中正义的积极目标，同时还有减少或对抗系统性不利因素的消极目标，这种不利因素对历史上处于特定社会地位的群体产生不利影响，更广泛地说，在公共卫生政策制定过程中，当儿童的福祉未被赋予特殊优先地位时，会对其整个正常生命周期产生不利影响。
