What are the public obligations to AIDS patients?

The operating assumption in most discussions of health policy is that government has some responsibility for the health of its citizens and that it may legitimately tax, subsidize, and regulate its citizens in the exercise of that responsibility. On this assumption, public obligations to HIV/AIDS patients are a function of their needs in relationship to other health needs. This paper challenges the operating assumption by arguing that it cannot be grounded in the obligations that individuals have to each other. The paper rests on its own assumption: the moral theory of individualism. On this theory, individuals are ends in themselves who have the right to choose their own actions and uses of their resources; they do not have unchosen obligations to help others. In regard to HIV/AIDS patients, consequently, individuals have no duty to help, nor any other obligation beyond that of respecting their rights; and there is no valid basis for government regulations or subsidies on their behalf. The paper argues against the two approaches commonly used to defend a more expansive view of individual obligations and the role of government. The first is the assumption of welfare rights to goods and services; the second is the assumption that distributive justice requires some redistribution of health care resources.