Pleonexia and Public/Private Health Systems

Abstract

‘Pleonexia’ is an ancient Greek term that means taking or wanting to take more than is one’s due, or avoiding or wanting to avoid contributing what one justly owes. It is often translated as ‘greed,’ though it is more complex than an idea of greed like uncontrolled appetites, gluttony, or avarice. It is also concerned with goods beyond those that are material in nature, and includes honour, respect, and other non-material goods. Importantly, pleonexia is connected to justice and not just to appetite. It demands to know, what are you rightly owed, or what do you rightly owe in turn? In this paper, I use the idea of pleonexia to interrogate the common practice in Australia whereby physicians and specialists trained in the public healthcare system exit the public system immediately upon completing their training, for an exclusively private healthcare practice. All doctors are trained in the public system, and learn from doctors who have chosen to have all or part of their practice in the public side. However, many doctors choose to exit the public system entirely once their training is completed, removing their skills from the system and closing off access to both other trainees and the patients who would benefit from their practice. I argue that this is a case of pleonexia but not simply in the positive side of wanting more money or status (though these may be involved). Here, I will focus on the other side of pleonexia involved in this case, of not contributing what one justly owes, and leaving the system worse off as a result.

Bio

Kathryn MacKay is a Senior Lecturer and Program Director of the Master of Bioethics at Sydney Health Ethics. She has a BA in philosophy from the University of Western Ontario (Canada), an MA in philosophy from McGill University (Canada), and a PhD in bioethics from the University of Birmingham (UK). Kathryn's research brings a feminist theoretical lens to the field of bioethics, and especially public health ethics. Her work involves examining issues of human flourishing at the intersection of moral theory, feminist theory, and political philosophy. Kate's main programme of research is focussed on examining the structures of society that shape people's lives, the processes of public decision-making about health, and the manner in which such decisions are expressed to the broader community. In 2024, Kate was a Visiting Fellow at the University of Oxford Uehiro Centre for Practical Ethics. She has recently published a book on institutional virtue for public health, entitled Public Health Virtue Ethics: Institutions, Structures, and Political Virtue for the Good Society (Routledge, 2025).