The welfare state: justice or theft?

INVITED COMMENTARY ON... TALKING LIBERTIES

Sameer P. Sarkar is a consultant in forensic psychiatry at Broadmoor Hospital (Crowthorne, Berkshire RG45 7EG, UK. Email: Sameer.sarkar{at}wlmht.nhs.uk) and a tutor for the Royal College of Psychiatrists. He has studied law at Northumbria University and Harvard Law School. In addition to law as applied to psychiatry, his other major interest is in the ethics of the profession.

John Rawls’s theory of justice has been embraced by both the political left and the right, albeit for different reasons. This commentary points out some caveats regarding Rawls’s theory as applied to healthcare in general and psychiatry in particular. An alternative political philosophy, the theory of ‘entitlement justice’ as advanced by Nozick, is presented and it is argued that this has more real-life relevance for healthcare ethics than the Rawlsian theory of distributive justice. The reader is invited to determine which theory, if either, is the best fit for psychiatry. The article concludes with some thoughts on the limits to autonomy that mental illness imposes and likens it to the concept of ‘interstitial autonomy’.