September 1993 XV/1IS THERE A HUMAN RIGHT TO HEALTH CARE?
Join in a discussion of any social problem, and frequently you will hear the words "human rights". Often, the term is used as an absolute, or as a weapon designed to settle all controversy. The impression is given that if one person has a human right to something, then others are morally obligated~ to do all in their power to assure that the person's right is fulfilled, no matter what the nature of that right. Obviously, a few distinctions are in order if the concept of human rights is to contribute to peaceful and productive human relationships. After discussing these distinctions, this essay asks whether health care is a human right and then offers some ethical considerations pertaining to health care as a human right.
Principles
Understanding the concept of human rights begins with an understanding of the concept of innate or fundamental goods of human life. Innate or fundamental goods are those goods toward which our instincts and powers are naturally directed. The term human right then is correlative with innate or fundamental good. If something is an innate or fundamental good, then there is a corresponding human right to pursue that good. The Declaration of Independence referred to these innate or fundamental goods as life, liberty and the pursuit of happiness. Philosophers and ethicists have formulated longer lists of fundamental goods than those contained in the Declaration of Independence. For convenience's sake, all fundamental goods can be reduced to these four: 1) prolonging life; 2) forming human communities; 3) providing for the future of human communities through generation and education of children; and 4) pursuing knowledge or wisdom.
Clearly, each innate or fundamental good has other goods closely allied with it. As we seek to prolong life, we realize that food is a necessary good. As we seek to create human communities, we realize that justice is necessary. As we seek to generate and educate children, the necessity of monogamous relationships between mother and father becomes evident. As we seek to acquire knowledge and wisdom, we realize that study and reflection are necessary human goods. Hence, an analysis of fundamental human goods reveals that there are several goods which are so closely allied with the four fundamental human goods that they also are considered to be fundamental or basic goods. Over time, a good which was not fundamental because it was not needed by a majority of people may become a fundamental good. For example, knowledge is a fundamental good because it is necessary for the well-being of individuals and society. Four hundred years ago, most people could acquire the knowledge necessary to lead a good and fulfilled life without going to school. But as life in society became more complex and more knowledge was needed to survive and to thrive, society determined that knowledge could best be communicated through schooling or "education." In time, education or schooling became a basic good, and now society agrees that there is a right to education for all. Hence, the first implication of the term "human right" is that persons have a relationship toward a good which is fundamental, that is, toward a good which is essentially connected with leading a good and fulfilled life. Of course, we also use the word "right" to connote a relationship to a good which is not fundamental, for example the right to a car or a piece of jewelry, but because these goods do not pertain essentially to human well-being, this type of right is not included in the term "human rights."
Achieving fundamental goods of life is so important for a person's well-being, both as an individual and as a member of community, that people have an obligation to strive assiduously to achieve these goods. In addition, because we are social beings, in the pursuit of these fundamental goods people should be aided by other members of the community. The community aids individuals by preventing others from impeding them in the pursuit of these goods and by supporting people when they need help to pursue these goods. Thus, the term "human right" implies a relationship or natural orientation to a fundamental good, but it also implies:
1) That human beings strive to acquire these goods. The human condition dictates that we will not always be successful in our quest for these basic goods. However our evolution, history, and culture bespeak a moral obligation to strive conscientiously for these goods in order to be a fulfilled member of society.
2) That persons should not be impeded by others in their quest for fundamental goods. We are social beings and will always have limited resources to fulfill the basic needs of all. Justice demands that one person is not impeded by another person as both strive for the goods of life. For this reason society needs laws and courts to assure equal access to fundamental goods, such as schooling and employment. Thus, the legal system is not a burden but rather a social necessity.
3) That if one cannot strive for a fundamental good through personal efforts, then the community of persons should help in this endeavor. This third implication also flows from our nature as social beings. When describing this third implication, let us realize that striving for the basic goods of life is not "an either-or" situation. Even when we exercise our personal responsibility, we often need the help of others as we strive to acquire basic goods. Though young persons may be conscientious in seeking knowledge, their success will also depend upon good teachers.
Discussion
What does the foregoing imply insofar as health care is concerned? Is there a human right to health care? Is health care intimately associated with leading a good and fulfilled life? If by health care we mean the assistance of persons and institutions in the health care professions, then it seems health care is so closely related to the good of prolonging life that it is a fundamental good. In times past, many people could seek to prolong life without the help of physicians and nurses or by being cared for in health care institutions. But due to scientific progress in the science and art of medicine, assistance from people and institutions representing the profession of health care is needed in order to strive for health and thus to prolong life. Hence, there is a human right to health care and state and federal governments should institute programs which protect this right.
After acknowledging a personal responsibility of people to strive for health and the access to health care, we must exercise caution. While many people are able to strive for health and health care more or less through their own endeavors, we must not conclude that those who need help are deficient in their exercise of personal responsibility. People do not get sick "because it is their own fault." Moreover, people in the United States who do not have access to health care are seldom responsible for their situation. For the most part, they are victims of an ineffective health care system. Finally, even if some people seem irresponsible in regard to health, the ethics and ethos of health care takes account of human weakness. Compassion is an essential quality of the profession of health care and must not be eliminated in the name of personal responsibility.
Society's obligation to prevent others from impeding the quest for health care will not require many positive programs on the part of state and federal governments. However enabling people to pursue health will require heroic efforts. There must be an effort to control the cost of health care and an effort to provide access to health care for all. Having affirmed the right of the general population to health care and having affirmed the responsibility of the state and federal government to promote programs which will improve the access to health care, several questions remain: Does affirming a right to health care imply that all persons in society should receive the same health care? What is the most fair and effective way to promote funding for the provision of health care: through employee funded insurance programs or through general taxation? Should the provision of health care allow a choice of physicians and health care facilities? Should payment for health care be based upon fee for services, or upon capitation in a health care organization? Simply affirming that there is a human right to health care does not answer all ethical questions in regard to fulfilling the right to health care.
Conclusion
There is a human right to health care because health care is required in order to strive for a good and fulfilled human life. As the effort to recognize the right to health care leads to legislation on the part of state and federal governments in the coming years, the need to factor in personal responsibility will be important. But the need to recognize compassion as an essential factor in the provision of health care will be even more important. There is indeed a right to health care for all because it is a basic good. But in making it possible for people to exercise this right and to strive for health, the nature of the health care profession must be respected.
Kevin O'Rourke, OP
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© Kevin O'Rourke, O.P.