The foundation and content of a moral right to health care
This thesis addresses the question "Is there a moral right to health care, and, if so, what does it entail?" In nearly all Western countries except the United States, the idea of a right to health care is taken for granted. However, since a right to health care has been assumed in most countries, the foundation of that right is unclear, and today, as health care systems are feeling ever-tightening budget constraints, difficult rationing decisions face all countries. Without a clear foundation for the right, countries are left with little guidance in these rationing decisions. A clear foundation should assist in the prioritization of health care interventions. The elements of health care which make it morally special and secure us a human right to it should be reflected in the prioritization of services. Chapter two attempts to clarify the concept of rights. The right to health care being discussed is a moral, positive in rem right, i.e., a morally justified, resource-intensive entitlement to health care which can be claimed against society at large. Rights have been given considerable moral status, and they are entrenched in our system of moral justification such that considerations of rights "trump" all non-rights considerations. However, positive rights are dependent on scarce resources to be fulfilled. As a result, the content of a positive right is dependent on the amount of resources available to a given community. Thus, positive rights entail different things in a developed nation than in a developing one. Chapter three examines several theories of justice for strengths and weaknesses vis-a-vis health care, and three arguments are identified as stronger than rest: the right to a decent minimum, Robert Veatch's egalitarianism, and Norman Daniels' Just Health Care. Chapter four presents Jack Donnelly's constructivist theory of human rights and applies it to health care. The priority setting mechanisms of the three main rival theories are compared to those of the constructivist theory. The central concept of the constructivist theory, dignity, contains the subtlety to yield a sensible prioritization of services. The moral importance of health care lies in its ability to maintain and enhance the dignity of individual lives. The constructivist theory suggests that health care interventions should be prioritized by their relative ability to allow individuals to live a life of dignity which calls for a community definition of dignity. Chapter five examines several rationing tools. Because low priority services also make some contribution to dignity, it is not enough to prioritize condition/treatment pairs and effortlessly fund the list as far as the budget allows. We should labour to fund as much of the list as possible by controlling costs high on the list. The concept of dignity assists us in this task: of each rationing device (e.g., waiting lists, technology assessment, etc.) we must ask "Does this method, as being applied, assist or detract from the health service reaching its goal of enhancing the dignity of individuals' lives?"
Advisor: Gillett, Grant; Campbell, Alastair
Degree Name: Master of Medical Science
Degree Discipline: Bioethics
Publisher: University of Otago
Research Type: Thesis