ABSTRACT
The purpose of this chapter is to explore the possibility of developing a model of justice in health care that is appropriate to the European welfare states, and thereby to challenge the predominance of liberal social contract models. Crucially, the paper will seek to challenge the assumption that patients are to be conceptualised as autonomous agents, freely entering into a relationship with health care providers. It will be suggested, rather, that (at least within the European context) the patient may be understood as always already embedded within a particular community, and further as always already a member of a system of state health care provision, with at best limited scope for a partial withdrawal from that service. The justice of any such state system will be suggested to rest, not in rules of fair resource allocation, but rather in public subscription to, and negotiation of, the moral conditions under which health care is to be pursued.1
