Norman Daniels

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

• Formerly Goldthwaite Professor and Chair of the Philosophy 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
• Advisory Board of the CIHR-Institute of Population and Public Health (Fall 2009-    )
• Ethics Advisory Board of the CDC (Fall 2009 -     )
• Ethics Advisory Board, IPPH Canada (2009-    )

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, 2011. 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 priority setting, and international health inequalities. In more recent years, Dr. Daniels has written about individual and social responsibility for health, revisited his views on the prudential lifespan account of justice for adjacent age groups, addressed the problems of identified vs. statistical victims, and explained the relationship between his account of exercisable opportunities and Sen's views about capabilities.  Currently, Dr. Daniels is working on a project on global health and global justice.

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, specifically "accountability for reasonableness," 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 discussionof 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 catastrophic insurance plan included in Mexico's new Segura Popular (2006) and is continuing work to extend that process for use in other parts of the Mexican health system.  A case study on the Mexican work is available on request.  An application of accountability for reasonableness to human rights approach to health is described in Gruskin and Daniels, Justice and Human Rights: Priority Setting and Fair Deliberative Process, American Journal of Public Health, 2008; 98:9.  An application to theproblem of identified vs. statistical victims is in the Hastings Center Report, Sept-Oct 2011. This work is the focus of an EU sponsored project in Tanzania, Zambia, and Kenya.

Justice and Intergenerational Equity: Dr. Daniels has revisited some of the issues involved in his previous work on justice between age groups in Am I My Parents' Keeper?  An Essay on Justice Between the Young and the Old (New York: Oxford, 1988) in "Justice Between Adjacent Generations: Further Thoughts" Journal of Political Theory 2008; 16:4:475-94.

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,with Brendan Saloner and Adriane Gelpi, and on "affordable insurance" with Brendan Saloner.

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. Other projects were carried out in the Philipines and elsewhere. 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. 

Benchmarks of Fairness - The Benchmarks of Fairness project, a system for assessing the fairness of health sector reform in developing countries.

Norman Daniels' website - Norman Daniels' personal website

Books:

Thomas Reid's`Inquiry': the Geometry of Visibles and the Case for Realism (1974; Stamford, 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? (Oxford, 2002;2nd ed., 2008); Just Health: Meeting Health Needs Fairly (Cambridge, 2008).

If you have difficulty locating publications, please contact the author.

Journal Articles, 2001-Present:

Daniels, N. 2000. Accountability for reasonableness. BMJ 321 (7272):1300-1.

Daniels, N. 2001. It isn't just the sex. Am J Bioeth 1 (1):10-1.

Daniels, N. 2001. Justice, health, and healthcare. Am J Bioeth 1 (2):2-16.

Daniels, N. 2001. Social responsibility and global pharmaceutical companies. Dev World Bioeth 1 (1):38-41.

Sabin, J. E., and N. Daniels. 2001. Managed care: strengthening the consumer voice in managed care: I. Can the private sector meet the public-sector standard? Psychiatr Serv 52 (4):461-2; 464. 

Sabin, J. E., and N. Daniels. 2002. Managed care: strengthening the consumer voice in managed care: III. The Philadelphia Consumer Satisfaction Team. Psychiatr Serv 53 (1):23-4, 29.

Sabin, J. E., and N. Daniels. 2002. Managed care: strengthening the consumer voice in managed care: IV. The Leadership Academy Program. Psychiatr Serv 53 (4):405-6, 411.

Daniels, N. 2003. Chevron v Echazabal: protection, opportunity, and paternalism. Am J Public Health 93 (4):545-8.

Daniels, N., J. R. Teagarden, and J. E. Sabin. 2003. An Ethical Template for Pharmacy Benefits. Health Aff (Millwood) 22 (1):125-137.

Teagarden, J. R., N. Daniels, and J. E. Sabin. 2003. A proposed ethical framework for prescription drug benefit allocation policy. J Am Pharm Assoc (Wash) 43 (1):69-74.

Daniels, N. 2004. Comment on Carino, T, Sheingold, S, Tunis, S. Using clinical trials as a condition of coverage: lessons from the National Emphysema Treatment Trial. Clinical Trials 1:108-121.

Sabin, J. E., N. Daniels, and J. R. Teagarden. 2004. The Perfect Storm. Psychiatric Annals 34 (2):125-132.

Daniels, N. 2005. Fair process in patient selection for antiretroviral treatment in WHO's goal of 3 by 5. Lancet 366 (9480):169-71.

Daniels, N., W. Flores, S. Pannarunothai, P. N. Ndumbe, J. H. Bryant, T. J. Ngulube, and Y. Wang. 2005. An evidence-based approach to benchmarking the fairness of health-sector reform in developing countries. Bull World Health Organ 83 (7):534-40.

Kawachi, I., N. Daniels, and D. E. Robinson. 2005. Health disparities by race and class: why both matter. Health Aff (Millwood) 24 (2):343-52.

Daniels, N. 2006. Equity and population health: toward a broader bioethics agenda. Hastings Cent Rep 36 (4):22-35.

Daniels, N. 2006. Toward ethical review of health system transformations. Am J Public Health 96 (3):447-51.

Rosenthal, M., and N. Daniels. 2006. Beyond competition: the normative implications of consumer-driven health plans. J Health Polit Policy Law 31 (3):671-85.

Wharam, J. F., and N. Daniels. 2007. Toward evidence-based policy making and standardized assessment of health policy reform. JAMA 298 (6):676-9.

Daniels, N. 2008. Justice Between Adjacent Generations: Further Thoughts. Journal of Political Theory 16 (4):475-94.

Daniels, N., and J. E. Sabin. 2008. Accountability for reasonableness: an update. BMJ 337:a1850.

Gruskin, S., and N. Daniels. 2008. Process is the point: justice and human rights: priority setting and fair deliberative process. Am J Public Health 98 (9):1573-7.

Neumann, P. J., J. A. Palmer, N. Daniels, K. Quigley, M. R. Gold, and S. Chao. 2008. A strategic plan for integrating cost-effectiveness analysis into the US healthcare system. Am J Manag Care 14 (4):185-8. 

Daniels, N., B. Saloner, and A. H. Gelpi. 2009. Access, cost, and financing: achieving an ethical health reform. Health Aff (Millwood) 28 (5):w909-16.

Nord, E., N. Daniels, and M. Kamlet. 2009. QALYs: some challenges. Value Health 12 Suppl 1:S10-5.

Daniels, N., A. Valencia-Mendoza, A. Gelpi, M. H. Avila, and S. Bertozzi. 2010. The art of public health: pneumococcal vaccine coverage in Mexico. Lancet 375 (9709):114-5.

Ladin, K., N. Daniels, and I. Kawachi. 2010. Exploring the relationship between absolute and relative position and late-life depression: evidence from 10 European countries. Gerontologist 50 (1):48-59.

Daniels, N. 2003, 2011. Reflective Equilibrium. Stanford Encyclopedia of Philosophical Ethics.  http://plato.stanford.edu/entries/reflective-equilibrium/  (Accessed 21 Jan 2011).

Daniels, N. and Saloner, B. 2011. The Ethics of Health Insurance Affordability. Journal of Health Politics, Policy, and Law. 36 (5): 815-827.

Goldie, S. and Daniels, N. 2011. Model-Based Analyses to Compare Health and Economic Outcomes of Cancer Control: Inclusion of Disparities. Journal of the National Cancer Institute. 103 (18): 1373-1386.

Daniels, N. 2012. Reasonable Disagreement About Identified vs. Statistical Victims. Hastings Center Report 42 (1): 35-45.

Chapters, Editorials, 2001-Present

Daniels, N. 2001. Reflective Equilibrium. In Encyclopedia of ethics, edited by L. C. Becker and C. B. Becker. New York: Routledge.

Daniels, N. 2001. Reflective Equilibrium. In International encyclopedia of the social & behavioral sciences, edited by N. J. Smelser and P. B. Baltes. Amsterdam; New York: Elsevier, 12872-12877.

Daniels, N., and J. E. Sabin. 2001. What are fairness and consistency in a national pharmacy benefit? Med Care 39 (4):312-4.

Sabin, J. E., and N. Daniels. 2001. Managed care: strengthening the consumer voice in managed care: I. Can the private sector meet the public-sector standard? Psychiatr Serv 52 (4):461-2; 464.

Sabin, J. E., M. F. O'Brien, and N. Daniels. 2001. Managed care: Strengthening the consumer voice in managed care: II. Moving NCQA standards from rights to empowerment. Psychiatr Serv 52 (10):1303-5.

Daniels, N. 2002. Justice, Health, and Health Care. In Medicine and social justice: essays on the distribution of health care, edited by R. Rhodes, M. P. Battin and A. Silvers. Oxford; New York: Oxford University Press, 6-23.

Daniels, N. 2002. Managing disappointment in health care: three stories from the United States. In Hidden assets: values and decision-making in the NHS /c edited by Bill New and Julia Neuberger, edited by B. New and J. Neuberger. London: King's Fund, 141-156.

Daniels, N., B. Kennedy, and I. Kawachi. 2002. Justice, Health, and Health Policy. In Ethical dimensions of health policy, edited by M. Danis, C. M. Clancy and L. R. Churchill. New York: Oxford University Press, 19-51.

Sabin, J. E., and N. Daniels. 2002. Managed care: strengthening the consumer voice in managed care: III. The Philadelphia Consumer Satisfaction Team. Psychiatr Serv 53 (1):23-4, 29.

Sabin, J. E., and N. Daniels. 2002. Managed care: strengthening the consumer voice in managed care: IV. The Leadership Academy Program. Psychiatr Serv 53 (4):405-6, 411.

Sabin, J. E., and N. Daniels. 2002. Managed care: Strengthening the consumer voice in managed care: V. helping professionals listen. Psychiatr Serv 53 (7):805-6, 811.

Daniels, N. 2003. Das Argument der Alterscrationierung im Ansatz der klugen Lebensplanung. In Gesundheitsversorgung im Alter: zwischen ethischer Verpflichtung und èokonomischem Zwang, edited by G. Marckmann and Robert Bosch Stiftung. Kolloquium Gesundheitsèokonomie. Stuttgart New York: Schattauer.

Daniels, N. 2003. Democratic Equality: Rawls's Complex Egalitarianism. In The Cambridge companion to Rawls, edited by S. R. Freeman. Cambridge, U.K.; New York: Cambridge University Press, 241-277. 

Sabin, J. E., and N. Daniels. 2003. Ethics. In Managed behavioral health services: perspectives and practice, edited by S. Feldman. Springfield, Ill., U.S.A.: Charles C. Thomas, 190-218.

Sabin, J. E., and N. Daniels. 2003. Managed care: Strengthening the consumer voice in managed care: VII. The Georgia peer specialist program. Psychiatr Serv 54 (4):497-8.

Sabin, J. E., K. Granoff, and N. Daniels. 2003. Managed care: Strengthening the consumer voice in managed care: VI. Initial lessons from independent external review. Psychiatr Serv 54 (1):24-5.

Daniels, N. 2004. Accountability for Reasonable Limits to Care. In Policy challenges in modern health care, edited by D. Mechanic. New Brunswick, N.J.: Rutgers University Press, 228-248.

Daniels, N. 2004. The Functions of Insurance and the Fairness of Genetic Underwriting. In Genetics and life insurance: medical underwriting and social policy, edited by M. A. Rothstein. Cambridge, Mass.: MIT Press, 119-145. 

Daniels, N. 2004. How to Achieve Fair Distribution of ARTs in "3 by 5": Fair Process and Legitimacy in Patient Selection. Geneva: World Health Organization/UNAIDS. World Health Organization: Geneva, January 26-27.

Daniels, N., and W. Flores. 2004. An Evidence-Based Approach to Benchmarking Fairness in Health Sector Reform in Latin America. In Dialogo Y Cooperacion en Salud, Diez Anos De Bioetica en la OPS, edited by L. Stepke. Santiago, Chile: Organizacion Panamerica de Salud, 101-114 

Daniels, N., B. Kennedy, and I. Kawachi. 2004. Health and inequality, or, why justice is good for our health. In Public health, ethics, and equity, edited by S. Anand, F. Peter and A. Sen. Oxford; New York: Oxford University Press, 63-91.

Daniels, N., W. Flores, and J. Gomez-Jauregui. 2005. Benchmarking Fairness in Reproductive Health: Who Consultation Paper, December 1. Available at: http://www.who.int/reproductive-health/tcc/meeting_documents/daniels_et_al.pdf.

Daniels, N., R. Teagarden, and J. E. Sabin. 2005. Ethical Template for Pharmacy Benefits. In Ethics and the pharmaceutical industry, edited by M. A. Santoro and T. M. Gorrie. Cambridge; New York, NY: Cambridge University Press, 206-224.

Daniels, N. 2007. Another Voice: Rescuing Universal Health Care. Hastings Center Report 37 (2):3.

Daniels, N. 2008. International Health Inequalities and Global Justice. In International public health policy and ethics, edited by M. Boylan. New York: Springer, 109-130.

Daniels, N., and M. Roberts. 2008. Ethics and Healthcare Reform. In From Birth to Death and Bench to Clinic: The Hastings Center Bioethics Briefing Book for Jounalists, Policymakers, and Campaigns, edited by M. Crowley. Garrison, NY: The Hastings Center.

Daniels, N. 2009. Broken Promises: Business-Friendly Strategies that Frustrate Just Health Care. In Ethics and the business of biomedicine, edited by D. G. Arnold. Cambridge; New York: Cambridge University Press, 35-64.

Daniels, N. 2009. Can anyone really be talking about ethically modifying human nature? In Human Enchancement, edited by J. Sevalescu and N. Bostrom. Oxford: Oxford University Press, 25-42.

Daniels, N., S. Rose, and E.D. Zide. 2009. Disability, Adaptation, and Inclusion. In Disability and Disadvantage: Re-examining Topics in Moral and Political Philosophy, edited by K. Brownlee and A. S. Cureton. Oxford; New York: Oxford University Press, 54-85.

Daniels, N. 2010. Capabilities, Opportunity, and Health. In Measuring justice: primary goods and capabilities, edited by H. Brighouse and I. Robeyns. Cambridge [England]; New York: Cambridge University Press, 131-149.

Daniels, N. 2010. Justice Between Adjacent Generations: Further Thoughts. In Population and political theory, edited by J. S. Fishkin and R. E. Goodin. Chichester, U.K.; Malden, MA: Wiley-Blackwell, 135-55. 

Daniels, N. 2010. Reasonableness in Health Policy. Edited by D. A. Warrell, T. M. Cox and J. D. Firth. 5th ed. 3 vols. Vol. 1, Oxford Textbook of Medicine. Oxford; New York: Oxford University Press, 54-58.

Daniels, N. 2011. International Health Inequalities and Global Justice: Toward a Middle Ground. In Global health and global health ethics, edited by S. R. Benatar and G. Brock. Cambridge; New York: Cambridge University Press, 97-107.

Daniels, N. 2011. Social and Individual Responsibility for Health. In Responsibility and Distributive Justice, edited by C. Knight and Z. Stemplowska. Oxford; New York: Oxford University Press, 266-86.

Daniels, N. 2011. Equity and Population Health: Toward a Broader Bioethics Agenda. In Public Health Ethics: Key Concepts and Issues in Policy and Practice, edited by A. Dawson. Cambridge; New York: Cambridge University Press.

Daniels, N. 2011. International Inequalities. In Social Justic, Global Dynamics: Theoretical and Empirical Perspectives (Routledge Research in International Relations Theory)ualities, edited by A. Banai, M. Ronzoni and C. Schemmel. New York; London: Routledge, 133-150.

Clarke, L., and D. Petrova. 2011. Health Justice, Equality and Fairness: Perspectives from Health Policy and Human Rights Law, an Interview with Norman Daniels and Paul Hunt. The Equal Rights Review 6:127-138.

Daniels, N. 2011. Equity and Population Health: Toward a Broader Bioethics Agenda. Hastings Center Report. 2006, 26(4): 22-35. Reprinted in Health, Politics, and Policy (SAGE Library of Political Science), edited by S. Tolleson-Rinehart and M. A. Peterson. London: Sage Publications.

Daniels, N. 2011. Treatment and Prevention: What Do We Owe Each Other? In Prevention vs. Treatment: What's the Right Balance, edited by H. S. Faust and P. T. Menzel. New York: Oxford University Press, Chapter 8.

Forthcoming Publications:

Daniels, N. Forthcoming. Distribution of Health Care. In The International Encyclopedia of Ethics, edited by H. La Follette. London: Blackwell Publishing Ltd.

Daniels, N. Forthcoming Jan. 24 2012. Health. In Blackwell's Companion to Political Philosophy, edited by F. D'Agostino. New Jersey: Wiley-Blackwell. 

Kimmel, A.D., Daniels, N., Betancourt, T.S., Wood, R., and Prosser, L.A. Decision maker priorities for providing antiretroviral therapy in HIV-infected South Africans: a qualitative assessment. AIDS Care.

Daniels, N. and Sabin, J.E. Accountability for Priority Setting.