Rawls develops his account of justice as fairness in A Theory of Justice with a widely recognized theoretical simpliication that abstracts from the variation among people caused by differences in health states and duration of life. By hypothesis, his contractors are fully functional over a normal lifespan; disease, disability, and death as we know them are not issues that such contractors must grapple with. Instead, these fully normal contractors are to select fair terms of cooperation for whatever society in which they emerge. He repeats this simpliication in Political Liberalism (20) when he states the fundamental ideas in his view. How the theory developed in TJ should be extended to address signiicant illness, disability, and premature death, is not an issue addressed in TJ itself.

Two Nobel economists challenged Rawls about this omission early on. In his review of TJ, Kenneth Arrow (1973, 251) complained that a theory that could not tell us who was worse off, a rich but sick person or a poor but well one, had a serious problem. A few years later, Sen (1980, 215–219) argued that a person with a signiicant disability could not convert a given amount of primary social goods into as many things that he can do or be as someone without such a disability, and so Rawls’s concern about distribution is focused on the wrong space. The target of justice should be capabilities, the things people can actually do or be, not primary social goods.