• Formerly Goldthwaite Professor and Chair of the Philosphy Department at Tufts University and Professor of Medical Ethics at Tufts Medical School, 1969 - 2002
• Fellow of the Hastings Center
• Member of the Institute of Medicine
• Founding Member of the National Academy of Social Insurance
• Member of the International Society for Equity in Health
• Medicare Coverage Advisory Commission

Dr. Daniels's ongoing research falls into these main areas:

Moral Epistemolgy: The most recent statement of his views on
justification in ethics can be found in the Stanford Philosophy
Encyclopedia entry on reflective equilibrium. (Stanford Encyclopedia
of Philosophy, on-line edition, 2003.
http://plato.stanford.edu/info.html). A collection of his papers on
the topic can be found in his Justice and Justification (CUP, 1996).

Theory of Justice: Dr. Daniels has in recent years been interested in
the complex form of egalitarianism represented by Rawls's work and the
contrast between it and other recent work in egalitarian theory. For a
recent paper on just this issue, see his "Democratic Equality: Rawls's
Complex Egalitarianism" in Sam Freeman (ed) Cambridge Companion to
Rawls (2003). Dr. Daniels sees the work (described below) on a fair,
deliberative process for setting limits to health care (and for other
resource allocation or rationing efforts) as a needed legislative and
regulatory supplement to the kind of principled account of justice in
Rawls's work.

Justice and Health: Theory of justice for health - Dr. Daniels
recently completed Just Health: Meeting Health Needs Fairly (Cambridge
University Press, 2008), which is a sequel to his 1985 book Just
Health Care. To the original attempt to say why health care is of
special moral importance because of its connection to protecting
opportunities for individuals, he now adds a broader vision of the
socially controllable factors that affect population health and its
distribution. This permits an answer to the question, when are health
inequalities unjust? He argues that Rawls's principles of justice as
fairness capture the central social determinants of health: conforming
with them would flatten social gradients of health as much as we can
reasonably expect. Just Health integrates the account of fair
deliberative process, accountability for reasonableness, with the rest
of the theory as a way of answering the question, "How can we meet
needs fairly when we cannot meet them all." The book also has chapters
on justice between age groups, health system reform, social
experiments on populations, fair process in patient selection for AIDS
treatments, occupational health, professionalism, reducing health
disparities, human rights and priortiy setting, and international
health inequalities.

Setting Limits Fairly: Together with Jim Sabin, Dr. Daniels published
Setting Limits Fairly: Can We Learn to Share Medical Resources? (OUP,
2002). A second edition of that book is now out in paperback: Setting
Limits Fairly: Learning to Share Resources for Health (OUP, 2008).
They are also doing ongoing work on this topic with collaborators in
Canada, the United Kingdom, Norway, and elsewhere where fair process
has emerged as the key to priority and limit setting in universal
coverage systems. In the US, they continue to work on pharmacy
benefits (see our discussion of an "ethical template" in Health
Affairs, Jan-Feb 2002) and on independent review of insurance denials.
Daniels recently applied these ideas to patient selection in the WHO
program to deliver three million ARTs by 2005. He worked with the
Mexican Ministry of Health to develop a fair process for deciding on
additions to the catstrophic insurance plan included in Mexico's new
Segura Popular and is continuing work to extend that process for use
in other parts of the Mexican health system.

Ethics and Health Sector Reform (Benchmarks of Fairness):
Domestic: Dr. Daniels is interested in issues of access to the US
system, especially disparities that contribute to health disparities,
and participated on the subcommittee on social costs of the recent IOM
publication on uninsurance in the US. Recently he coauthored an
article on ethical issues in U.S. health reform with Marc Roberts that
will appeal in a "briefing book" on election issues being published by
the Hastings Center (in press).

Global: Together with collaborators in a dozen countries on three
continents, Dr. Daniels is working to demonstrate the utility of an
evidence-based policy tool for evaluating the fairness - the equity,
accountability, and efficiency - of health sector reforms in
developing countries and to improve capacity in those countries to
carry out research on the fairness of reform activities. Together with
collaborators from Cameroon, Thailand, and Guatemala, he presented
some recent results at the November 2003 APHA meeting in San
Francisco. The current work, reported on most recently in the Bulletin
of WHO in 2005, is an attempt to develop country-specific adaptations
of the generic benchmarks reported on in the Bulletin of WHO in June
2000. The application of that approach as a method of providing
ethical evaluation of health sector reforms, viewed as "social
experiments," is described in the American Journal of Public Health in
2006. Work on this approach is ongoing in the Philippines, Guatemala,
Brazil, and Colombia.

 

Ph.D., Philosophy, 1970, Harvard University
B.A.(M.A.),Philosophy and Psychology, 1966, Balliol College, Oxford
A.B., English, 1964, Wesleyan University

Books:

Thomas Reid's`Inquiry': the Geometry of Visibles and the Case for Realism (1974; Stanford, 1989); Reading Rawls (1975; Stanford, 1989); Just Health Care (Cambridge, 1985); Am I My Parents' Keeper? An Essay on Justice Between the Young and the Old (Oxford, 1988); Seeking Fair Treatment: From the AIDS Epidemic to National Health Care Reform Oxford, 1995); Justice and Justification: Reflective Equilibrium in Theory and Practice (Cambridge University Press, 1996); (with Donald Light and Ronald Caplan) Benchmarks of Fairness for Health Care Reform (Oxford, 1996); (with Allen Buchanan, Dan Brock, and Dan Wikler) From Chance to Choice: Genetics and Justice (Cambridge, 2000); (with Bruce Kennedy and Ichiro Kawachi) Is Inequality Bad for Our Health? (Beacon Press, 2000); and (with James Sabin) Setting Limits Fairly: Can We Learn to Share Medical Resoruces? (2nd ed.,Oxford, 2002); Just Health: A Population View (Cambridge, 2008).

Recent Journals, Chapters, and Editorials:

Daniels, N. Justice, Health and Health Care. American Journal of Bioethics 2001 1:2:3-15.

Daniels, N., Kennedy, B., Kawachi, I. Justice, Health, and Health Policy. In Danis M, Clancy C, (eds.) Integrating Ethics and Health Policy. New York: Oxford University Press, 2002.

Daniels, N.,Teagarden, R., and Sabin, J., An Ethical Template for Pharmacy Benefits. Health Affairs, January/February 2003; 22:1:125-137.

Daniels, N. Chevron v Echazabal: Protection, Opportunity, and Paternalism. American Journal of Public Health, April 2003; 93:4:545-549.

Daniels, N. Democratic Equality: Rawls?s Complex Egalitarianism. In Freeman, S (ed.) Pp. 241-277 The Cambridge Companion to Rawls. Cambridge University Press, 2003.

Daniels, N. The Functions of Insurance and the Fairness of Genetic Underwriting. In Rothstein, M.A. (ed). Genetics and Life Insurance: Medical Underwriting and Social Policy. Cambrdige MA: MIT Press, 2004, pp. 119-145.

Daniels, N. Accountability for Reasonable Limits to Care. In Mechanic D, Rogut L, Colby D, and Knickman J. (eds). Policy Challenges in Modern Health Care. New Brunswick, NJ: Rutgers University Press, 2005: 228-248.

Kawachi, I., Daniels N, Robinson, D. Health Disparities by Race and Class: Why Both Matter. Health Affairs. 2005; Mar/April 343-42.

Daniels, N., Flores, W., Ndumbe, P., Pannarunothai, S., Bryant, J., Ngulube, T.J., Wang, Y. An Evidence-Based Approach to Benchmarking the Fairness of Health Sector Reform in Develping Countries. Bulletin of WHO;July 2005:83:7:534-39.

Daniels, N. Toward an Ethical Review of Health System Transformations. American Journal of Public Health. 2006; 96:3:447-51.

Daniels, N., and Rosenthal, M., Consumer Driven Health Plans: Toward Ethical Review of a Social Experiment and the Responsibilities of Employers. Journal of Health Politics, Policy, and Law. 2006; 31:3:671-85.

Daniels, N., Kennedy B., Kawachi, I. Social Determinants of Health Inequalities: Why Justice is Good for Our Health. In Anand S, Peter F, Sen AK. (eds.) Public Health, Ethics, and Equity, Oxford University Press.