Abstract

The operating assumption in mostdiscussions of health policy is that governmenthas some responsibility for the health of itscitizens and that it may legitimately tax,subsidize, and regulate its citizens in theexercise of that responsibility. On thisassumption, public obligations to HIV/AIDSpatients are a function of their needs inrelationship to other health needs. This paperchallenges the operating assumption by arguingthat it cannot be grounded in the obligationsthat individuals have to each other.The paper rests on its own assumption: themoral theory of individualism. On this theory,individuals are ends in themselves who have theright to choose their own actions and uses oftheir resources; they do not have unchosenobligations to help others. In regard toHIV/AIDS patients, consequently, individualshave no duty to help, nor any other obligationbeyond that of respecting their rights; andthere is no valid basis for governmentregulations or subsidies on their behalf.The paper argues against the two approachescommonly used to defend a more expansive viewof individual obligations and the role ofgovernment. The first is the assumption ofwelfare rights to goods and services; thesecond is the assumption that distributivejustice requires some redistribution of healthcare resources