All too often, the medical community treats people with disabilities in insulting and demeaning ways. Medical staff express disrespectful attitudes about disabled people through the environments they create, the policies they maintain, and the manner in which they interact with disabled patients. The symbolic messages of an inaccessible waiting room, a practice of transporting partially clothed disabled patients through public areas, or a turned-up lip at requests for accommodations are often offensive to disabled people. We – people with disabilities – deserve to be treated justly and humanely in medical settings, but we also deserve to be respected and to be shown respect in those contexts as well.

Rawls took very seriously the views of W. D. Ross (1877–1971), as representing two of the main traditions in moral and political philosophy that he sought to unsettle.

Pluralistic intuitionism is the normative view that there is a plurality of basic and conflicting values or principles that have to be weighed against one another on the basis of intuition to determine how we ought to act – Ross, for example, proposes seven prima facie duties that pick out features of acts that count for or against them but he also claims that there are no further principles, only bare intuitions, to help us decide what our duty is all things considered. Rawls regarded this view as the default position in moral and political theory because it captures core features of commonsense moral reasoning without oversimplifying the moral facts, so we ought to admit “the possibility that there is no way to get beyond a plurality of principles” (TJ 36). Yet he thinks that pluralistic intuitionism is “but half a conception” because “assignment of weights is an essential and not a minor part” of a moral and political theory (TJ 37).

A person is self-interested, in the narrow sense of selish or egoistic, if her most fundamental ends are focused on herself, such as her own health, wealth, social position, influence, or prestige (TJ 111; LHPP 58; JF 62). Someone is self-interested in a broader sense if she regards her aims and aspirations, whether selfish or not, as “worthy of recognition” and “deserving satisfaction” (TJ 110). More specifically, Rawls proposes that the interests of a self, which are not necessarily interests in oneself, are not merely determined by her tastes and preferences or her pains and pleasures. Her interests are instead determined by her conception of the good, which is the consistent and coherent plan of life she would choose under favorable conditions, with full information after careful reflection (TJ 358).

Egoism is one conception of the good, but personal ties, affections, and concern for the interests of others are likely to figure in the rational life plans of most people. Indeed egoism, according to Rawls, is incompatible with friendship and mutual trust because these relationships presuppose caring about others for their own sake. Egoism is also inconsistent with resentment and guilt because these moral feelings presuppose acceptance of principles of right or justice, which are necessarily general and universal (TJ 427). Egoism in its various forms is not a moral doctrine either because it fails to satisfy these formal constraints of morality and justice.