Thesis (MPhil)--University of Stellenbosch, 2003. / 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. / AFRIKAANSE OPSOMMING: Teorieë van geregtigheid en 'n gesondheidsbeleid vir die VIGS epidemie in Suid
Afrika: 'n vergelykende ontleding.
Op die 10de Mei 1994 is Nelson Mandela ingehuldig as die eerste demokraties verkose
swart president van Suid- Afrika. Die geleentheid is in beide Suid-Afrika en in die buiteland
beskou as 'n oorwinning vir humaniteit. Optimisme oor Suid-Afrika se toekoms was oral
tasbaar. Mandela het in sy inhuldigingstoespraak verkondig dat dit nooit weer sal gebeur
dat hierdie pragtige land sal lyonder die onderdrukking van een oor die ander nie. Hy het
gesê dat die son nooit salondergaan op so 'n wonderlike prestasie nie. Nou, minder as
tien jaar later, is die verwoestende VIGS epidemie besig om weer die 'son te laat
ondergaan'. Dieselffde mense wat alreeds onder apartheid se rasisme en ekonomiese en
geslagsongeregtighede gely het, blyk nou weer verontreg te word; hierde keer omdat die
gesondheids- en welsynsisteem sukkel om in die behoeftes van die VIGS-geaffekteerde
populasie te voorsien.
Die doel van hierdie verhandeling is om die konsep van distributiewe geregtigheid in die
konteks van die dreigende VIGS epidemie te bespreek. Ek begin met 'n bespreking van
die Verklaring van Regte soos vervat in die Suid-Afrikaanse Grondwet. Ek voer aan dat
enige aanvaarbare teorie oor geregtigheid in die Suid-Afrikaanse gesondheidsisteem
gegrond moet word op hierdie egalitêre Verklaring van Regte. Tweedens kyk ek na die
omvang van die VIGS epidemie, die effek wat dit op die HIV-positiewe populasie en hulle
familielede het, en die gevolglike implikasies vir gesondheidsbehoeftes.
Dit is binne hierdie konteks dat ek drie teorieë van distributiewe geregtigheid ondersoek en
vergelyk; naamlik utilitarisme, John Rawls se teorie van "Justice as Fairness", en 'n
libertynse konsep van geregtigheid soos voorgestel deur Robert Nozick. Utilitarisme is 'n
konsekwensialistise teorie wat beteken dat die regte daad die een is wat in enige situasie
die grootste geluk vir die meeste persone sal meebring. Ek voer aan dat baie van die
beleidsrigtings wat 'n gesondheidsorg in Suid-Afrika gevolg is, deur hierdie teorie
beïnvloed is. Utilitarisme het uiteraard sterk en swak punte en beide kante word krities
ondersoek. In 'n gesondheidsorg konteks beteken utilitarisme dat regte altyd afgelei is en
dat die welsyn van die meerderheid gewoonlik belangriker is as die van 'n minderheid,
selfs wanneer die probleme van die minderheid ernstig en dringend is. Rawls se teorie van geregtigheid word vervolgens krities bespreek. Hierdie teorie is deur
Norman Daniels aangepas vir gesondheidsorg. Hy stel voor dat Rawls se beginsel van
'regverdige gelykheid van geleentheid' baie effektief aangepas kan word vir
gesondheidsorginstellings. Apartheid het 'n sisteem van ongelyke geleentheids verskans;
gevolglik hou 'n teorie wat gelykheid van geleentheid verseker baie voordele vir die Suid-
Afrikanse situasie in. Ek bespreek hierdie teorie in detail en poog om my standpunt dat die
teorie besonder geskik is vir Suid-Afrikaanse gesondheidsisteem - veral in die konteks
van die VIGS epidemie - te regverdig.
Laastens bespreek ek die libertynse teorie van geregtigheid soos voorgestel deur Robert
Nozick. Ek probeer aantoon waarom hierdie teorie, wat gebaseer is op morele en
ekonomiese individualisme en gevolglik aanvoer dat mense geregtig is op gesondheidsorg
alleenlik as hulle daarvoor kan betaal, onregverdig is in die Suid-Afrikaanse post-apartheid
konteks. Ek sluit hierdie. verhandeling af deur weer te argumenteerdat Rawls se teorie en
die beginsel van 'geregtigheid as gelyke geleentheide' uiters geskik is as 'n grondslag vir
gesondheidsorg in Suid-Afrika vandag.
| Identifer | oai:union.ndltd.org:netd.ac.za/oai:union.ndltd.org:sun/oai:scholar.sun.ac.za:10019.1/53662 |
| Date | 03 1900 |
| Creators | Horn, Lynette (Lynette Margaret) |
| Contributors | Van Niekerk, A. A., Stellenbosch University. Faculty of Arts and Social Sciences. Dept. of Philosophy. |
| Publisher | Stellenbosch : Stellenbosch University |
| Source Sets | South African National ETD Portal |
| Language | en_ZA |
| Detected Language | English |
| Type | Thesis |
| Format | 99 p. |
| Rights | Stellenbosch University |
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