  John Rawls’s A Theory of Justice has been enormously influential in advanced work on these problems in biomedical ethics. Rawls argues that a social arrangement forming a political state is a communal effort to advance the good of all in the society. His starting assumptions are layered with beneficent, egalitarian goals of making the unequal situation of the naturally disadvantaged members of society both better and more equal. His recognition of a positive societal obligation to eliminate or reduce barriers that prevent fair opportunity and that correct or compensate for various disadvantages has implications for discussions of both beneficence and justice in health care.