Date of Award

Summer 2025

Embargo Period

7-18-2025

Document Type

Dissertation

Degree Name

Doctor of Philosophy (PhD)

College/School/Department

Department of Philosophy

Program

Philosophy

First Advisor

Monika Piotrowska

Committee Members

Monika Piotrowska, Kristen Hessler, James Tabrey

Keywords

Bioethics, Pharmaceuticals, Medical Ethics, Philosophy

Subject Categories

Bioethics and Medical Ethics | Ethics and Political Philosophy | Philosophy

Abstract

Compared to the rest of the world, the United States has one of the worst-performing health care systems. While this is influenced by our hospital systems and clinical care in certain contexts, one of the biggest culprits for our poor ratings is the cost and availability of prescription medications. We pay more than any comparable country for the exact same medications and have a harder time actually accessing them. In this dissertation, I aim to analyze how individuals, companies, and governmental agencies have responded to various instances of high-cost or low-availability prescription medications. To begin, I examine pharmaceutical patenting practices as one potential culprit for the difference in cost suffered by United States citizens. Specifically, I discuss two types of arguments typically used to defend the current patent structure for pharmaceutical products and show that while they may work for patenting generally, they do not justify the current state of pharmaceutical patenting. Then, to demonstrate that the inordinate pricing by the pharmaceutical industry constitutes a moral problem, I turn to two theories of just allocation and apply them to health care goods. I argue that the works of John Rawls and Ronald Dworkin both include a societal obligation to protect the health of citizens, which extends to a right to reasonable access to pharmaceutical products. From there, I move to four examples of ways in which we have dealt with access issues with pharmaceutical goods and discuss whether or not they are justifiable. These include a discussion of whether individuals would be justified in attempting to make their own EpiPens given cost and availability concerns, the rise of online direct-to-consumer pharmaceutical companies, the allocation of unplanned extra doses of COVID-19 vaccines, and concerns with disproportionate difficulties faced by transgender individuals in receiving gender-affirming care.

License

This work is licensed under the University at Albany Standard Author Agreement.

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