How does the operation of PHARMAC's 'Community Exceptional ...

difference principle, which I will include in my exploration of the work of John
Rawls later in this chapter. I include feminist principles of justice because
Lamont included them in his lexicography; however I note their existence but do
not critique them.
Strict egalitarianism is based on the Aristotelian principle of substantive
equality, that all people should have the same level of goods and services. This
is justified on the grounds that people are owed equal respect and the equality
of goods and services gives effect to this respect (Lamont, 2007). However, the
principle of strict equality raises the problem of an ‘index’ of equality. How do
we know which level of goods and services should be equally distributed? This
question is the basis of the ‘categorical imperative’ of Immanuel Kant, a position
which he asserted, everyone in society could morally accept. Kant established
this theory on the justice principle that all people are to be treated not as a
means to an end, but as the ends in themselves (Russell, 1946).
Kant’s theory of utilitarianism relies on our pursuit of two opposing states–pain
and pleasure. He proposes maximising these two states for all in society.
Jeremy Bentham developed a quantity factor to the utilitarian principle that
utilitarianism should deliver the greatest happiness to the greatest number of
people 13 . The argument was advanced by John Stuart Mill who warned
however that the greatest happiness must not involve coercion which would
breach the harm principle, whether the coercion was in the best interests of the
person, or not.
Utilitarianism is a difficult area for health care and health workers. Health
professionals aim to benefit people in ways to do with caring for people;
however utilitarianism is not as simple as that (Campbell, Gillett, & Jones,
2006). As Bentham and Mill point out, the greater question (which might
particularly interest people who are excluded from access to health care) is
whose benefit is being advanced and at whose expense?
The primary moral criticism of utilitarian theory is that everyone cannot be better
off if a greater utility is to be provided to one person. This is because a
decrease in the utility of others creates inequality. Furthermore, providing an
13 Often restated as ‘the greatest good for the greatest number’.
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