Is access to healthcare a human right?
Welcome to the third installment of The Question: "Is access to healthcare a human right?"
This time around, we kick things off with posts from Simone Childs-Walker ('12), Rachel Levit-Ades ('13), and a joint post by Professor Amna Khalid (history) and Professor Paul Petzschmann (European Studies).
We encourage you to join the discussion with comments or questions of your own. There are various events happening this term, and early next term, related to The Question, including Convocation on May 11th with Carleton Alum, and prominent bioethicist, Peter Ubel. Be sure to check out the EthIC calendar and consider "liking" us on Facebook in order to stay abreast of all EthIC events.
Simone Childs-Walker ('12)
To me, The Question immediately elicits another question: what is a human right? To answer The Question, we need a definition of “human right,” something that “access to healthcare” is or is not. Philosophers and political philosophers have given various definitions and some deny that there are such things as human rights at all. Unfortunately, I just don’t know what a human right is or whether “access to healthcare” is one.
From a practical, local, perspective, however, I am comfortable giving an answer. Should all members of, for example, the Northfield community (citizens, non-citizens, children, elderly, the unemployed) have access to medical resources to help them overcome illness and stay well in the first place? Absolutely. Were I in any other person’s shoes, I could not but hope and expect to have the same access to health care that I do now. To deny that every member of the Northfield community should have that access would contradict my recognition of myself as a member of that community.
Also, in the US, access to education is generally considered a “right” (whatever that actually means). As I understand things, health is prior to education. Without access to healthcare, access to education may be meaningless; you can’t go to school (or at least, you can’t learn very well) if you’re sick. If we, as a country, value education and make it available to everyone, we should value healthcare and make it available to everyone too.
Rachel Levit-Ades ('13)
When we talk about whether healthcare is a human right, it seems we’re asking whether people, just because they’re people, are entitled to receive healthcare. Rights are tricky because they deal with the idea of desert; it seems clear that if I save up and legally buy a car, I have the right to that car. “Human rights” are especially difficult to discuss because they attempt to define what we are owed just because we happen to exist.
We enter the world with bodies—in fact, this seems a big part of being “human.” It seems we have the right to our will/soul/mind, if we have the right to anything upon first entering the world. At the very least, bodies are the devices through which our will/soul/mind exists and we experience the world. In this way at least, bodies define a big part of what it is to be “human.” So if there are any rights that ought to conferred just because you are a “human,” rights that have to do with preserving your body, especially from circumstances outside of your control, fit the bill.
How this right ought to be considered on a political level is an entirely different issue. We may have certain rights, but those rights are restricted by the rights of others; any right I have to swing my arm, for instance, ends when my arm reaches your face. Because providing healthcare involves limited resources, we must assess whether there are therefore competing rights at play; if so, the question then becomes how my right to healthcare compares to someone else's right to her full income.
Furthermore, it can seem odd to say an institution ought to make judgments about the value of the bodies of individuals, and we can ask interesting questions about whether presumed rights can be "cashed out" (e.g. if I decline healthcare in a universal system, am I entitled to the monetary value of my potential care?).
Amna Khalid (History) and Paul Petzschmann (European Studies)
Article 25 or the Declaration of Human Rights states, "Everyone has the right to a standard of living adequate for the health and well-being of himself and of his family, including … medical care."
Having lived in Pakistan where the healthcare provided by the state is as good as not; in England where the National Health Service provides healthcare for all free at the point of access (from general taxation); in Germany where universal health care works in tandem with private insurance (a mixed model); and now in the US where the debate about universal healthcare is at the top of the political agenda (especially with the upcoming elections), provides a number of different perspectives on how states have chosen to take the obligations arising from the enshrining of health care as a human right.
So the question arises whether it is meaningful to speak of the universal right to healthcare outside the context individual states who are at differencing levels of economic development and have different spending priorities. For example is it reasonable to demand such an expensive public good in Pakistan which is faced with a myriad challenges to its integrity and viability as a state? Should individual states have the right to determine their own priorities? For instance if the US electorate decided that universal healthcare was not a priority for them then can we delegitimize that choice?
So the question is: Is it meaningful to talk of a universal human right to healthcare in the absence of any discussion of corresponding obligations to provide it?
Leave a comment below (less than 300 words please) to join the conversation (Carleton login required).^
Links of Interest
Internet Access Is Not a Human Right (New York Times)
Health care is not a human right (British Medical Journal)
Human Rights Missing from Health Care Debate (Huffington Post)
Comments
To me, asking if healthcare is a human right is akin to asking if those who have the power have a moral responsibility to care for another person who cannot necessarily care for themselves. I absolutely think this is still a relevant question even if definitions of a human right may vary because if we do not talk about it and dismiss healthcare as too tied to something abstract to have a meaningful conversation around, we inherently are letting people suffer who may not have to.
The wording “human right” is tricky and debatable, whereas “moral responsibility of the state” is more subjective and accurately defines my preliminary views.
[300 words, eh? A Draconian rule that could only have issued from the mind of Professor Groll.]
I agree with Simone and others that the place to start is to try to get clearer on what a human right is (as opposed to, say, a *legal* right). I don't have a simple, elegant, analysis of rights to give. This would make me less sad if I had a complex, inelegant one to give. I don't have one of them either. Maybe it will be enough to observe that:
My right to bodily integrity means that, other things being equal, no one (except perhaps me) is permitted to hurt my body. Sometimes other things aren't equal. I might have given you permission to give me a tattoo or have put my body where it shouldn't be---for instance, in a bank lobby with a revolver in hand, pointing it at a teller's head. Importantly, it's not enough to make things non-equal that you'd very much like to remove my arm, or that it would be very difficult (or impossible) for you to avoid removing my arm while you pursue some other project that you value.
So consider the following situation: One thousand of us are shipwrecked on an island, and many of us are wounded or sick. You are the only one among us with any medical training. Before we shipwrecked, you practiced medicine for a number of years. You had left the profession because you absolutely loathed being a doctor, and you had gone into carpentry instead. Now here you are among us on the island. If each of us on the island has a right to health care, then by the claim that I labeled 'RIGHT', it follows that, other things being equal, no one is morally permitted to deprive any of us of health care. Now, although most of us aren't giving each other health care on the island, we're not really depriving each other of health care, since most of us have no ability to provide health care. Except you. You have the ability. If you don't provide us health care, then, you are depriving us, and so violating our purported right to health care (especially since your main reason for depriving us of it would be that you hate being a doctor and want to pursue other projects---e.g., building furniture---and we already said above that that's not enough to make things "non-equal"). In order to avoid violating our right to health-care, it seems that you must devote your entire life to our health; for there are many of us with many medical needs. I find this conclusion absurd. It would be nice of you to devote your life to our health care, and it might even be true that you really ought to give us some health care, but that doesn't mean that we have a right to it. If you pursue your other projects, you haven't violated our rights; at most you've been callous or cruel. If we compel you, though force or threat, to provide us with health care, then we are violating your rights, not just seeing to it that you don't violate ours.
Health care only happens because some people decide to be doctors, nurses, etc., and to set up hospitals, clinics, pharmaceutical companies, etc. No one is morally obliged to be a doctor or set up a clinic or to make the pills that I need for my special medical condition. We have no human right that entails that anyone must forgo other projects to do such things for us. So we don't have a human right to health care. Of course, this doesn't answer the question of whether the US, or any other state, should mandate universal access to health care. It just means that it would be confused to couch the argument for doing so in the language of human rights.
My esteemed and non-compliant colleague makes a good case for the claim that even if it is true that everyone in the United States *should* have access to healthcare, it is neither true that they have a moral right to it nor helpful to frame the debate about access to healthcare in such terms. That may well be right, but I want to see if a case can't be made for the claim that other things being equal, those in the US who not do have access to (adequate) health care have a moral right to it.
Are there situations where simply in virtue of needing X one has a claim on it? Consider this: Micah has an excess of X, and the cost to him of dispensing with the amount of X Eleanor needs for some basic level of well-being is negligible. I imagine everyone will agree that Micah *ought* to give Eleanor the X she needs. But does Eleanor have a *right* to that amount of X, even if it is Micah's possession?
Leaving aside important, but complicating, questions like "Why is Eleanor in the situation that she needs X?" and "How did Micah get so much X?", I think it is not wholly implausible that -- other things being equal -- simply in virtue of Eleanor's great need for X and Micah's excess of X (and the ease with which he can provide it), Eleanor has a right to it.
The basic thought is this: severe inequality with respect to some resource in a context where greater equality can be secured without great burden to those that already have a lot of the resource in question can ground a right to the resource in those that are deprived of the resource.
The connection to The Question is clear, though the analogy is hardly perfect. IF (and it's a big "if") some group has access to health care in spades, and it wouldn't be especially burdensome for us (perhaps through taxation or some such) to provide health care to those that do not have it but need it, THEN I think there's a case to be made that those people have a right to health care.
I would suggest it would be useful to examine the question from a different perspective. Rather than claiming that access to health care is a human right (or claiming that anything is a human right), let us investigate the potential responsibility we (society or us individually) have to provide health care (for example) to everyone. If we have the ability to reduce illness and suffering, then we should be morally obligated to do so, notwithstanding any perceived "right" the recipient may be deemed to have. We must always strive to maximize our contribution towards achieving the greater good. Clearly, in this case, wellness must be preferred over illness. To simplify, the requirement is not for each human to receive health care. Rather, the requirement is for us to proactively provide health care to the best of our ability. The emphasis is on giving, not receiving. We must not wait for requirements, or rights, to be identified before we act. We must constantly be searching for ways we can allocate our resources to better serve our fellow humans. In an ideal world everyone would be so engaged. Ask not what you may need, but what you are able to give (be you an individual, business, or government entity). It is through this sort of synergy, that the overall well being of humanity may be advanced.
In thinking about rights and responsibilities, I believe James’s point is quite relevant. Why should we only feel morally obligated to do something or provide a good when somebody has a right to it? And similarly, why should we feel unequivocally entitled when we do have a right? The discussion of rights and responsibilities prompts an essentialist element in the provision of health care that I believe is misplaced and overall, harmful. By thinking in this way, it lends a moral authority to these rights that dominates all other ethical responsibilities we might think we have. In essence, the existence of rights eliminates the individual’s ethical agency and allows the state/UN/governing body to identify a singular moral code that should be followed rigidly. Some may argue that the American legal system (and many other legal systems) allows for the petition of rights to be added to this moral code. This logic guided much of the civil rights legislation and legal decisions. However, this demands a certain amount of capital and influence of the petitioner that they may not have, rendering this system flawed.
The rights-based approach carries a certain contractual element, as well. I have a right to health care as long as I… am a citizen? Am working? Have dependents? This allows a gray area when a breach of contract is committed that excludes those who cannot meet the responsibilities necessary to claim a right. I believe everyone SHOULD have health care and that those in positions to make that possible SHOULD do that to their best ability. However, a rights-based approach allows room for the exclusion of those who cannot meet responsibilities and often this excludes those with the fewest resources.
Though the rights-based system has its flaws, I’m not quite sure how to enforce an ethical standard otherwise. Would people act ethically on their own without the legal guidance of the state? Unclear. Is it fair to give out rights without any responsibilities? Also unclear. But by thinking creatively, there could be a better alternative.
For the vast majority of human history healthcare was barely better than no healthcare at all. Leeches, surgery without anesthesia and with dirty implements were what you had to look forward to if you became injured or ill. Average life expectancy at birth worldwide has exploded since the early 20th century from 31 years in the early 20th century to over 65 years today (http://en.wikipedia.org/wiki/Life_expectancy#Human_life_expectancy_patterns).
Is that to say that humans were deprived of their right to healthcare in the past? Is that to say that all humans have access to healthcare today? Of course not, it’s all relative and if you were a king in the middle-ages you had better healthcare than the peasants, just like if you live like a king in the 21st century you have better healthcare than a low income family. So if low income families are living over twice as long today as they were 150 years ago, clearly there have been some advances in health care, and access to health care, for the poor.
A sad but true reality is that healthcare is expensive. It’s not easy to develop the knowledge, equipment, and skills to treat cancer, perform surgery, and administer vaccines. Everyone should get a chance to live, and no one should be forced to deliver a baby at home or allow their children to grow up unvaccinated because they don’t have the money to pay for basic medicine. In an ideal and equitable society, everyone would have access to the best healthcare. But basic human rights deal with the not-ideal society, and in our present (not ideal) society, access to healthcare beyond the basics is not a human right. Don’t get me wrong: Everyone should have good advanced healthcare, everyone needs good advanced healthcare, but healthcare is not an inalienable right.
Looking at the The Question from another angle, consider the following premises:
1. Humans have a right to life.
2. Access to healthcare is necessary for staying alive.
3. Therefore, humans have a right to healthcare.
Very few will argue against the first premise that humans have a right to life. If you believe this, then the argument hinges on the second premise, that access to healthcare is necessary for staying alive. As Billy points out, before modern healthcare, life expectancy was dramatically lower. This suggests that healthcare is necessary for the average people to stay alive (longer). However, it is unclear if humans have a right to longer lives than our ancestors did, simply because longer life is now possible.
Even if humans have a right to healthcare, it is obvious that granting this right infringes on the rights of others (for example, the right to spend your money how you please, or the right of the doctor on the island to live how he pleases). What it comes down to is whether or not the right to healthcare outweighs competing rights. As Daniel suggests, it turns into a numbers game. If the cost of providing healthcare is negligible, we should absolutely provide it. However, if the cost is too high (perhaps in the case of the doctor on the island), it is not so clear that everyone should be granted the right to healthcare.
I cannot help but think that Health Care is essentially a service that we pay for, and it does not seem correct to think that one has a right to a product regardless of whether or not they paid for it. Imagine that you had to put $1000 into a machine every day in order to sustain your life. If one thinks it is true that humans have a right to Health Care in order to sustain thier lives, than this commits one to the position that one has a right to other people's money in order to sustain you life. Could I rob a bank in order to pay the machine? When we say that one has a right to Health Care, and since Health Care is not an overabundant resource as some have pointed out, then doesn't the almost inevitable inequality of treatment amount to theft? Even if everyone used their care equally, the current tax system requires some to pay in more. Essentially, having a right ot Health Care implies that one also has a right to something that belongs to someone else--and this must be a prerequisite to a Health Care system that is premised upon universal accessibility regardless of one's ability to pay.
Contrary to Groll's view, it is very implausible that one's excesses give another a right to somthing of hers. If John has 10 kids, and Steve has none but really wants of one John's and could even relieve some of the burden on John in doing so, does Steve have a right to one of John's kids? Cleary not. At the very least, the fact that the loss isn't burdensome is not sufficient.
With the question being, is access to healthcare a human right, I would like to present the answer yes. I think it is for several reasons. To start off, if one person (or a group, such as the upper class) has a right to healthcare, then surely everyone does too. For instance, I presume if someone has infinite amount of money, everyone would agree that they have a right to healthcare (because, among other reasons, they can pay for whatever services they need.) Just because one person, A, has more money than person another person, B, A is by no means “better” or more valuable than B. Therefore, in this case, the debate quickly turns to the right to live (or at least live healthily.) Everyone morally is on the same level, and monetary wealth should not determine if someone should die or not (though of course this is not the case in the real world, morally, this point is true.)
Another reason that everyone has the right to healthcare is by doing a thought experiment. Pretend we found a tribe of humans living in the middle of nowhere. We could prove that they were humans, (though they did not speak any language we understood) and in addition they were way behind first-world countries in the sense of development and technology. However far behind they may be, these “tribal people”
are still absolutely entitled to health care. (If they would receive it, is a whole different debate, but I am just covering if they have a human right to healthcare.) I feel comfortable making this claim because in the debate of, if eating meat should be permissible, some arguments want to put all animals (including humans) on the same level. If all animals are on the same level morally, then obviously all humans are, and share the same rights (no matter if they are from this newly discovered tribe, from the lowest economic class, or in the wealthiest.)
I realize that people might argue that just because all people are on the same moral level, it will not actually make everyone get healthcare. In response I would say that all I covered was the question as I interpreted it, is access to healthcare a human right. I did not try to tackle the question in which James Stiles and others have discussed/proposed, on how we as humans/society/individually can make this actually happen.
As others have noted, to answer this question requires first a definition: what do we mean when we say something is a 'human right'? The Universal Declaration of Human Rights was adopted by the UN general assembly on 10 Dec 1948. It contains 30 articles outlining the various rights that are, by definition, possessed by every human being on the planet, by virtue of being human alone. These rights cannot be *granted* - you simply have them, because you are human, or so this document asserts.
Among the rights outlined in this document are these: - The right to liberty - The right to marry and build a family - The right to due process (which is really many different things; the right to a fair trial, the right to equal protection under the law, and more) And so on. As I read through the list, it occurs to me that all of the articles contain a common element: they describe rights and privileges that cannot be granted (by government) - only taken away. A government cannot grant me freedom; it can only, through its action, take my freedom away (or through its inaction allow another to do so). A government cannot grant me the right to due process; it can only deprive me of same by refusing to honor that right in a criminal proceeding.
So perhaps we can say safely that a human right, by this definition, is something intrinsic to being human that cannot be denied except through the application of force; and so when we assert that all humans, everywhere, have these rights what we are in fact asserting is that no government has the authority to deprive any person of those rights. Health care does not meet this definition.
If we assert that health care is a human right, what we are in effect saying is that every government, everywhere, who honors the notion of human rights has an obligation to provide health care for every citizen under its jurisdiction. That is a very dangerous thing to assert. It opens a huge rat's nest of questions. What is health care? How much health care is a human right? Does it include preventative care, like regular examinations? Contraception? Prenatal care? Does it include care for people with high-risk lifestyles (professional athletes, skydivers, whatever)? Do people have to pay for it? Do some people pay more than others?
A human right is something that no government has the right to deny, by force, to the people under its control. It is not the same as something that a government should provide for its constituents, even though almost all governments are formed with the notion that they will provide something (like a military) to its citizens for the common good. Health care is not, and cannot, be a human right.
What it should be is the right of every citizen of a civilized and wealthy nation. In other words, it should be an American right, or a Canadian or French or German right - it should be the goal of government to provide health care for its citizens because public health is a public good; the entire society benefits from public health care. But a human right? No.
Is it true that regardless of the context someone is born in, and regardless of the decisions they make over the course of their lifetime, every person should have access to medicine? A lot of responders so far have distanced this question of "should" from the essence of what a human right is (something feasible, or some universal truth). The logic here is often that it is not feasible. Health care is expensive, everyone can't have it, and so we can't say that everyone should. In reality, we can do a ton better. Millions of people die preventable deaths every year. Millions of those millions could be feasibly prevented. If you think that the prevention of those deaths is morally necessitated, don't you also think health care is a human right?
Can we really say that human rights are ahistorical? Given that human rights are political, I think it is reasonable to say that what is a human right today is not the same as what was a human right a thousand years ago. Isn't a human right something that everyone deserves at a particular time? There seem to be various things that our time calls for us all to have-- health care, education, sanitation, to name a few. Just because naming them "human rights" is political, and just because they weren't always necessary, doesn't seem to indicate that everyone shouldn't have them.
People have a right to healthcare, except when they don't.
Two points*:
1. Rights-talk is not a constructive way to approach ethics.
2.While we discuss whether all Americans should be guaranteed comprehensive healthcare we shouldn’t lose sight of the fact that many people go without basic healthcare because of our unwillingness to make small sacrifices to provide it.
*I’ve been sort of beaten to the punch on both of these but I’ll present my spin on them at any rate
As Dave Flynn and others have observed, positive rights (rights to something) can often only be guaranteed at the expense of other peoples negative rights (rights to non-interference), but it's also the case that negative rights can't be guaranteed either. Sometimes a trivial (or even non-trivial) violation of some peoples negative rights is necessary to prevent a non-trivial (or worse)violation of other people’s negative rights. Once it’s conceded that all rights are theoretically violable one is reduced to weighing the relative strengths of peoples rights in any given scenario. At that point, why not just weigh to consequences?
But maybe the language of rights can still be useful if it’s remembered that rights derive from the good and not the other way around. Perhaps we can come up with a more useful definition of a right:
Professor Decker offers a definition in which positive rights are framed in the language of negative ones, but his comments after his shipwreck situation essentially do away with the existence of moral obligations to provide to provide goods or services to others which I think is a little too convenient. I’m also puzzled by what the ‘other things being equal’ clause in his actual definition means in this context. Does it mean ‘assuming no other morally relevant considerations’? That would suggest that rights are only relevant when you are not confronted with an ethical decision.
I’m going to define rights (because I can) as: rules of thumb from which deviations must be justified. I’ll call rights of this type ‘soft-rights’.
Under my definition:
I think basic healthcare is a human soft-right. Healthcare at all costs, even in countries where it’s feasible, is not a human weak-right due to the opportunity cost of providing it.
As Henry N. observed, untold numbers suffer and die from preventible or easily treatable conditions because of our unwillingness to make comparatively small sacrifices to prevent it. We are thus violating the soft-rights of many of the poor around the world. Because I don't care about Americans all that much more than non-Americans, I'd like to see us put a healthy share of our GDP into promoting basic healthcare abroad. Think vaccines, contraception, and antibiotics + roads, schools, and hospitals.
** I’m in two classes that advocated posting to this Question so I think I’m justified in having 2X the desired response.
*** To respond to Andy Hardt first few sentences: It seems reasonable for me to have a right to free speech regardless of whether it’s actively being infringed upon at any given moment.
A great deal of the discussion so far seems to have focused on whether every person has a right to health care. However, I'm not sure that this is the right question to be asking. In a world where we know that health care will be provided, the question we need to consider is whether any person has more right or claim to this care than any other. My view is that no person does, except as a result of need, and that a system in which access to healthcare is dependent on financial status is therefore morally unjustifiable.
My first comment was trying to get at what George Wheeler said. To me, a healthcare system that relies on financial resources more than need is morally injustifiable. In that same vain, I believe the health care should be a human right - I would argue that we have the right to live (ie killing humans is illegal) and healthcare is another aspect of the right to live.
Being provided with health care cannot possibly be as basic of a right as not being killed, or owning property, but it is a strong enough interest that it should be accounted for where possible. In developed countries today, quality of healthcare is at least partially determined by wealth, and I see that as unfair to the point of being morally wrong. Since there is a healthcare system in place, and there are doctors and nurses and hospitals, deciding to provide adequate healthcare to everyone would be a matter of increasing taxes, which would be a relatively small price to pay compared to saving and/or improving many lives. I think that while healthcare itself may not be a basic human right, equal access to healthcare can be considered a human right, or at least something very close.
I think human rights can be defined as what one is entitled to by virtue of being a person. Presumably, one is entitled not to be killed or harmed by another person, not to have things stolen from them, and possibly, to be rescued from danger, if the act of rescuing causes little to no inconvenience or risk. This last right is up for debate in my mind. It does not seem obviously true to me that just because a person is born, and continues to exist, they are therefore entitled to any and all medical treatment, should some ailment threaten their existence. This seems especially true when considering that many medical treatments require a great deal of effort from doctors, and are often very expensive. Even with universal health care, the money would have to come from somewhere. Is a poor person, just by virtue of being a person and not having money, inherently entitled to the use of a wealthy person's money to pay for whatever ailments might happen to befall them? I don't think they are.
But that doesn't mean I don't support providing universal health care. For me, the question of universal health care is not answered by human rights, but rather, broader considerations of what I want to world we live in to be like. This is also true of my support for public education. I don't intuitively believe that, just by virtue of being a person, one is entitled to having other people go out of their way to teach you things for free. I would, however, rather live in a world where there are opportunities to overcome wealth gaps, and where intellect is not bought.
Similarly, I would prefer to live in a world where corrupt insurance companies are not profiting from others' misfortune, and where people without expendable incomes do not suffer unnecessarily from treatable illnesses.
After reading through all of these comments, I think I'd have to agree with those who say healthcare access isn't a human right. When I think of a human right, it needs to be taken in context of everyone's rights. In the case of healthcare, there is an action, a use, required of others in order to fulfill the rights of someone else. By this, I mean to say that the doctor, the nurses, the taxpayer all need to give something up in order to fulfill the right of the patient. I don't think I agree that only wealthy people should receive healthcare, but I think it's a stretch to make the claim that someone has a Right to healthcare based on the simple fact they are human.
A lot of the previous posts have discussed how it is impractical to say that healthcare is a human right for monetary reasons. I do not believe, however, that a human right should at all be related to things that are out of our control. If I was born into a royal family, does that give me more of a right to healthcare than if I was born into a family that lives below the poverty line? I do not believe that this is true. While the income that you personally make is partially in your control in terms of how hard you work, a lot of it is out of your hands. Our income is based on multiple outside factors, such as our family's income (because that is often where we start), the connections that we have, the opportunities we are given, etc. I think that healthcare is a human right despite the fact that many are unable to afford it and that if health care was a human right, people who are making above a certain income would have to pay even more taxes to cover those who cannot pay for it on their own. I think that a right is something that each and every person is born with, regardless of any outside sources. Healthcare should be a human right even though in practice, it would be difficult to accomplish.
The discussion so far has been really excellent. Thank you to all who have contributed! To this point, there has been a lot of focus on the question of what makes something a right. In light of that discussion, a number of people have wanted to say that even if access to healthcare is not a basic human right, it is nonetheless true that everyone, at least everyone in the United States, should have access to healthcare. We might even say that it is a right of all citizens (or all people in the country), even if it is not a basic human right.
In light of this idea, and the fact that President Obama's healthcare bill is in front of the Supreme Court, let me then shift the discussion slightly by asking two questions:
I agree with Daniel Groll that a useful discussion to have is to return to the United States, where current political and moral discussions make this topic extremely relevant to the well-being of all the people posting here. Both of the questions he raises seem to bring up the idea of the overall health of the population, which can be distinguished from the health of the individual. To propose a third (perhaps linked) question, I think it is important to consider the case where what one individual perceives as their “health” conflicts with the health of another person, or to make a stronger example, the population.
An example of this is the current debate on vaccination and links to autism. Some individuals claim that receiving a vaccine is against their health (or, more typically, the health of their children) because of speculation that vaccines can cause autism, which negatively impacts the health of a child. However, this has implications for “herd immunity,” which is where enough vaccines must be given to provide protection for those individuals who either cannot have the vaccine (e.g. allergic) or for whom the vaccine does not work. If too many people elect not to get vaccinated, this compromises herd immunity and can infringe on the rights of an individual for whom the vaccine failed or, more seriously, cause a deadly epidemic of a disease. In this case, does the health of the population supercede the right of the first child to their health (as they perceive it)?
Obviously, this is a case of someone electing out of receiving health care. But in other cases, where the desires of one individual might impact the population as a whole, is it their right to have that provided by the government? What about if the impact on the population (as is relevant here) is the monetary cost?
I think this last issue (cost) can prompt a discussion of personal choices and how they are linked with health care. One major component of the current healthcare debate has to do with the responsibility of an individual for their own health. For instance, does an individual have the right to be obese by personal choice (e.g. provided no metabolic disorder preventing them from losing weight) and then have a heart transplant provided by the government or the money of other citizens? What about a woman who wants to have children but cannot afford to pay for their healthcare or her own? What about someone who smokes a pack a day and gets lung cancer? What about an “average” person who could run for an hour a day but chooses to watch television instead? What about a scientist who in the race for a cure for AIDS accidentally pricks themselves with a needle loaded with HIV and contracts the disease?
All of these people made choices that could have limited their health. If it is agreed upon that there are cases when one is responsible for their own illness (a view that I by no means necessarily endorse), this raises the discussion of who is at “fault” for disease, and whether they should therefore be financially responsible for that disease. is a difficult question because disease would happen even if everyone behaved “ideally.”
Therefore, where does one draw the line between the fault of the individual in failing to protect their own health and the right of that individual to autonomy? Surely we could all do things better for our health, but who decides when someone is not doing “enough” for their health?
Finally, one additional question I would like to raise is also related to the idea of monetary cost. In the event that healthcare should be allowed for all as citizens of the US, “who pays for what?” If everyone deserves access to healthcare in the United States, is that to say that people who cannot pay for it should have it provided for them (e.g. paid for), or that EVERYONE (including people who could reasonably afford it without great impact to their overall well-being) should have it provided for them? Does someone with less money have more claim to have healthcare fully provided by the state than someone with more money?
Although I am not sure it is monetarily feasible, I do agree with many of the others that healthcare is something everyone should have access to. People should be able to receive vaccines (such as for the flu or for preventing sexually transmitted diseases) that would not only help the individual person but society at large. People should be able to seek advice from medical professionals but it is difficult on where to draw the line to what a person is entitled to. People should be examined by a case by case basis but by what factors is unclear. At the very least I will say that everyone should be entitled to preventative medicine such as vaccines, treatment for minor wounds, etc.
In the healthcare debate, I feel there are several distinctions to make. First, we can consider the question of whether access to healthcare is a human right. By access to healthcare, I mean the right to obtain healthcare—that is, to purchase it at a fair price—in the absence of unreasonable prejudices and unnecessary burdens. For instance, in the U.S. today if a father has healthcare from his employer, and his child is diagnosed with a serious, chronic condition (such as pediatric leukemia), if the father loses his job or chooses to leave his job for a position at a different company, it may be excessively difficult for the father to find a new insurer. People in this position often choose to continue working a job which they are overqualified for, dislike, etc. in order to avoid possible loss of healthcare insurance. I feel that this prejudice unjustly restricts the rights of individuals with serious health conditions (and/or their legal guardians), and thus that fair access to healthcare is a human right.
A second question to ask is whether all humans are entitled to healthcare itself. I would like to leave this question open but suggest that if we assume it is a right, it be a limited right. Many human rights are limited. For instance, we have the right to freedom of speech provided that it does not seriously compromise the safety of others. Similarly, we have access to many public goods and services (roads, parks, the school system, fire and police departments, etc.) but in order to use them we often must comply with set conditions for their use. Healthcare should be treated no differently; if we are to provide all individuals with healthcare, we must also set specific terms for their use in order to maximize utility and justice. For instance, all individuals should have to be properly vaccinated. If individuals refuse to comply with vaccination, as Katie Benson suggested, they pose a risk to other individuals who may not be able to be vaccinated for medical reasons.
I think Rousseau's "Social Contract" is helpful when trying to articulate my personal views about healthcare functioning as a human right. When speaking of the individuals that make up a state, the Enlightenment philosopher writes, "As soon as the multitude is united thus in a single body, no one can injure any one of the members without attacking the whole, still less injure the whole without each member feeling it." (Rousseau, 63) Rousseau's point is invaluable in this debate - an attack on one is an attack on all. Our nation is only as strong as our weakest link, and if people aren't getting the medical attention they need, the whole suffers, not just the individual parts. Ideally, healthcare includes preventative measures, therefore keeping the population as healthy, happy, and productive as possible. It should be remembered "a man cannot work for others without at the same time working for himself." (75) Ensuring good health of one’s fellow citizens is crucial in making sure the nation achieves its potential, both ethically and economically. Because "a whole less a particular part is no longer a whole," we must make certain healthcare is available to all. (81) A population consents to live under the same social contract, so everyone should be entitled to benefit from the same rights.
I think Professor Groll poses an important question in regards to the 'extent that it is legitimate to demand that some people's access to *some* services be limited, or even taken away, so that everyone (more or less) can have access.'
However, I think it is important to point out that such a compromise is not necessarily the product of universal access to healthcare. I recognize that Professor Groll was likely not making such an assumption but I fear, and it seems our voting patterns illustrate, that many Americans are.
Resisting the temptation to berate this concern in light of the widespread improvement such a system would allow, I would like to turn our attention to certain countries that successfully provide healthcare to all their citizens without limiting access to 'certain services.'
My Junior year I spent time in Australia and New Zealand studying comparative welfare regimes. Most of of our class discussion and research centered around the provision of healthcare. Healthcare in Australia is available through both private and public institutions (Medicare). As a result of this system all Australians have access to healthcare (including primary, secondary and tertiary care) however, those who have the means to pursue faster treatments or those not offered by the public institutions have the option to do so through private clinics. Australia ranks among the healthiest countries in the world and has successfully kept healthcare costs (for tax payers) relatively low.
As the discussion continues I think it is important that we keep such examples in mind and remind ourselves that universal healthcare does not inevitably require monetary or physical sacrifices. I apologize for the tangential nature of this comment but maintain the importance of acknowledging the assumptions that serve as obstacles to embracing a universal healthcare system in the U.S.
I think that Lily brings up an important point about examining the assumptions that underlie our perceptions about what universal access to healthcare would entail. In light of Dr. Peter Ubel's convocation, it is clear that we all have subconscious biases that influence the way we understand health care policies and, subsequently, which policies we support. Framing the issue of access to health care as a human rights issue must certainly influence the way that people understand the debate and the controversy around universal access.
On the one hand, framing it as a human rights issue might make it harder to create a health care plan that denies any individual access to care. Then, such a plan would not only be taking away a helpful and potentially life saving service, but it would be depriving that individual of a human right. There's not much disagreement in the U.S. about the importance of protecting human rights, so framing the debate this way could increase its appeal.
However, as is clear from this forum, there is a lot of debate about whether access to health care is a human right. If politicians were to frame this debate in that context, those who disagree may end up attacking that proposal on the grounds that this is not in fact a human right. This type of debate could distract attention from the pressing matter at hand: how to create policy that provides more Americans with guaranteed access to affordable health care.
When reviewing the above posts, it seems as though humanity has not graduated far beyond the fabled ideal of achieving immortality. The privilege of living long and comfortably preventing/treating illness still depends on the monetary accessibility. Taking care of your health should not depend on your wealth, but cultures do not require the extreme selflessness necessary to provide universal coverage. That is, if money is the only way we can repay physicians for their work, health will always be about money.
Given the permanence of such an issue, universal health care is an unrealistic ideal. The problem Groll (and students in subsequent posts) highlighted is that US health care is currently not as accessible as it could be. I cannot provide a solution to this, but I can endorse the direction Benson started us in, identifying treatments like vaccines that are necessary for the wellness of a community.
I hope it won't upset everyone too much if I problematize things a bit (as I think Daniel Groll was suggesting in both of his questions). When considering health care as a right, I'm sure that we all have in mind the embarrassingly high portion of the population that is unemployed, struggling from paycheck to paycheck, etc. and now faces a very unfortunate and [plausibly nearly] unavoidable strike of disease. These sorts of situations are robust, not few, and may well be guiding some of our good policies.
Molly notes, however, that monetary and pragmatic concerns should be distinguished from the question of whether it is a human right. I agree. While pragmatically we may need a blanket cover to ensure these sorts of situations are met, we have others that are not so squeaky clean. Consider the middle-upper class family that chooses to eat out at a fast food chain every night. They are not too busy, let us say, to cook; rather, they just love the taste. Let us further stipulate that they also know the risks of this diet. When those risks come to fruition, through heart disease, diabetes, and other [let's say] preventable effects, should they have someone else foot the bill?
For that matter, what sorts of operations, procedures, etc. should count as proper? Should a hypocondriac have unlimited access to the valuable and scarce time of a physician? Furthermore, we would probably hesitate including plastic surgery; but the case gets more murky when a patient is in a condition (depends on her looks for her job, fears losing her husband because of a disfiguring accident) when it might be no less appropriate than our paradigm cases for universal health care.
Finally, disparate levels of care may well emerge. What counts as sufficient health care? What standard of care, funding of hospitals and equipment, qualifications of staff, and so forth are sufficient to cover this human right? Are we all entitled to the very best doctors? Or are we entitled to just anything, because that's better than nothing? What counts as enough health care?
One thing I’ve been thinking about as I read these posts is the difference between individual rights and responsibilities, and communal or group rights and responsibilities. As many have said, even if healthcare is a human right, it may not be feasible for that right to be realized for every individual in society. James Stiles, at the beginning of the discussion, put it this way, “the requirement is not for each human to receive health care. Rather, the requirement is for us to proactively provide health care to the best of our ability.” So perhaps we should view the collection of individuals who we believe should receive healthcare as a group with a collective right to healthcare, recognizing that there may be instances in which a particular individual does not have the right to healthcare. Similarly, the responsibility to provide healthcare should be viewed as a communal responsibility. Society as a whole should do what it can to keep people healthy, but a specific individual does not necessarily bear this responsibility. Therefore, the doctor/carpenter in Prof. Decker’s island example does not have the responsibility to treat his misfortunate fellows. However, he might not be able to reasonably consider himself part of the community if he does not do his best to heal the others. It might not be the responsibility of a specific wealthy taxpayer to cough up the funds for others’ healthcare, but the community as a whole may decide that healthcare is a priority, and insist that its members share the burden. To me, it seems that healthcare rights and responsibilities are not those of individual humans, but of citizens as part of a community.
Healthcare is a human right – just one whose implementation and precise definition are complicated. First of all, it seems clear to me that every human being has the right to free information about health, as well as treatment that is highly beneficial without being burdensomely expensive for society as a whole. Along with the general right to protection of life that all people have, access to any easily provided and highly effective treatment should be a right for all. However, this applies to the lowest common denominator of healthcare: anything beyond that is subject to the complications of justice in resource allocation. Defining the lowest common denominator in the U.S., for example, might be done by examining what is already largely covered by most insurance companies. Providing these services for everyone would require reallocation of some resources; and yet, it seems very likely that improving the health of the population would be not only the moral thing to do, but also the economically beneficial action as well. Disease, particularly the easily treatable type, tends to be costly for society and have all sorts of externalities that would make it not only a moral imperative, but also a sound investment.
Life, liberty, and the pursuit of happiness are severely restricted by the suffering that results from treatable diseases. We admit that human rights include protection from the bodily harm resulting from warfare, torture, etc., and moving forward we might as well include bodily harm resulting from belligerent viruses and diseases.
As a previous commentator mentioned, “any right I have to swing my arm… ends when my arm reaches your face.” The whole question of basic healthcare becomes tricky when we consider differences in standards of living across countries. What exact standard of healthcare should be a human right? Do we all have a right to the most basic healthcare that our own country can provide? What about effective, very beneficial treatments with prohibitively high costs? No matter what we choose, there will have to be some weighing of practicalities. As of today, most countries ration treatment by income; universal healthcare would require an alternative form of rationing. But it seems to me that the morally reasonable option is to reallocate some money, pay our taxes, and give up some marginal consumer goods to save another’s life.*
* And maybe even our own if it’s contagious.
Healthcare is a human right – just one whose implementation and precise definition are complicated. First of all, it seems clear to me that every human being has the right to free information about health, as well as treatment that is highly beneficial without being burdensomely expensive for society as a whole. Along with the general right to protection of life that all people have, access to any easily provided and highly effective treatment should be a right for all. However, this applies to the lowest common denominator of healthcare: anything beyond that is subject to the complications of justice in resource allocation. Defining the lowest common denominator in the U.S., for example, might be done by examining what is already largely covered by most insurance companies. Providing these services for everyone would require reallocation of some resources; and yet, it seems very likely that improving the health of the population would be not only the moral thing to do, but also the economically beneficial action as well. Disease, particularly the easily treatable type, tends to be costly for society and have all sorts of externalities that would make it not only a moral imperative, but also a sound investment.
Life, liberty, and the pursuit of happiness are severely restricted by the suffering that results from treatable diseases. We admit that human rights include protection from the bodily harm resulting from warfare, torture, etc., and moving forward we might as well include bodily harm resulting from belligerent viruses and diseases.
As a previous commentator mentioned, “any right I have to swing my arm… ends when my arm reaches your face.” The whole question of basic healthcare becomes tricky when we consider differences in standards of living across countries. What exact standard of healthcare should be a human right? Do we all have a right to the most basic healthcare that our own country can provide? What about effective, very beneficial treatments with prohibitively high costs? No matter what we choose, there will have to be some weighing of practicalities. As of today, most countries ration treatment by income; universal healthcare would require an alternative form of rationing. But it seems to me that the morally reasonable option is to reallocate some money, pay our taxes, and give up some marginal consumer goods to save another’s life.*
* And maybe even our own if it’s contagious.
Peter Joy points out that since "we are comfortable having tax-payer dollars go towards law enforcement, schools and roads," we should be just as comfortable subsidising healthcare for the poor and needy.
The analogy, though, isn't that straightforward in the case of healthcare. Unlike law enforcement, schools, and roads, all of which are clear 'public goods' (in the economist's sense of being non-rivalrous and non-exclusive), and which have clear positive externalities, healthcare is slightly more complicated. That the poor minority in a country does not have access to healthcare might not bother the rich as much as, say, a deficient police force or decrepit infrastructure.
When speculating about human rights, it is imperative to draw a distinction between the alternatives to rights. If healthcare is not a right, is it a privilege or is it a responsibility? Taking the privilege stance, how exactly does one secure the privilege of healthcare? Must one be employed, drug-free, or have a clean criminal history? Contrarily, does the responsibility stance impose responsibility on the government, on medical institutions, or on taxpayers providing the financial support?
It seems to me that most human rights are considered a protection of one’s individuality and freedom within our society. To consider healthcare a right is not only protecting one within our society, but it is taking an extra leap by imposing a financial burden on others in society, a health burden on other patients waiting for care, and a labor-intensive burden on healthcare providers. Healthcare cannot be a right if the right requires a duty or obligation by another. I do agree that everybody has a right to the access of healthcare – but not a basic, fundamental right to the care itself. There are too many anomalies in specific cases, with specific individuals, and a right to care could drive our health care system, as we know it, to even greater inefficiency.