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The Ethics of Healthcare

Clark Wolf, Director of Bioethics

In the debate over the Health Care Reform Bill that is currently before the U.S. Congress, it is often said that health care is a right.  Somewhat differently, one sometimes hears that health care should be a right.  While they sound similar, these are very different claims with unique moral and legal implications.  To say that health care is a right could mean either of two things:  On one hand, it might be claimed that health care is a legal or constitutional right, sanctioned or required by other rights that are expressly stated in U.S. law.  On the other hand, it might mean that the right to health care is a moral right or a natural right, like the rights to "life, liberty, and the pursuit of happiness," enumerated in the Declaration of Independence.

It is relatively uncontroversial to suppose that a right to health care would be a limited right.  It is unlikely that such a right would include a valid claim to elective procedures (pectoral implants or lasic surgery, for example), or that it would include a categorical claim to scarce resources that might also be needed by others.  In most discussions of the right to health care, therefore, the relevant question is whether there is a right to a decent basic minimal level of care, not a right to whatever health care services one might wish to have.  The discussion here, therefore, will consider the claim that there is, or may be, a right to a basic minimal level of health care.
In my comments below, I do not intend to assert that access to a decent minimal level of health care is a legal or moral right, nor do I provide a defense of the notion that there should be such a right.  In a short space, I can only briefly clarify what these different claims might mean, and cite some of the arguments that might be given in their support:
 

Health care is a legal right.

To say that there is a legal right to health care in the U.S. would be to say that guarantees in the Constitution or in U.S. law already provide a foundation for a legal right to health care.  While such a right is not specifically stated in the Constitution or the Bill of Rights, it might be argued that it is implied by other rights that are expressly stated.  For example, one might urge that a right to health care is among the rights "reserved to the people" in the 9th amendment, or that minimal health care access is necessary if people are to enjoy the equal protection of the laws.

The preamble to the Constitution states that one of the purposes for which the U.S. government was formed is to "promote the general Welfare, and secure the Blessings of Liberty to ourselves and our Posterity."  But it is more natural to read this provision as permitting rather than mandating a guarantee for universal access to a basic minimum of health care, and only if such a guarantee could reasonably be expected to be an effective means to promote welfare.
 

Health care is a human right (or a moral right).

Few legal scholars would propose that the Constitution or other provisions of U.S. law guarantee a right to health care.  But it has often been urged that people may have a moral right to a decent minimal level of care.  Like the rights to "life, liberty, and the pursuit of happiness" enumerated in the Declaration of Independence, people are thought to have moral rights prior to the creation of public institutions.  According to the Declaration, we are all endowed with these rights simply because we are human beings.  The purpose of governments and public institutions is not to create such rights, but to secure and protect them.  The Declaration of Independence clearly states that it is to secure these fundamental rights that "governments are instituted."

The claim that there is a fundamental moral or human right to a decent minimal level of health care can be supported by several different arguments:  1) Many of the same considerations that might be cited in support of public funding for basic education can also be marshaled in favor of a right to a decent minimal level of health care. Just as basic education is necessary for effective participation in today's society, basic health care also seems to be necessary.  2) Beyond this, health and basic care are necessary preconditions for the exercise of most other fundamental rights. 3) Health care needs are among the most basic of human needs.  It is difficult to think of competing interests that are more pressing or more significant than our interest in basic health.

Finally, it is noteworthy that the U.N. Declaration of Human Rights expressly includes a human right to adequate medical care in Article 25, which states, "Everyone has the right to a standard of living adequate for the health and well-being of himself and of his family, including food, clothing, housing, and medical care and necessary social services, and the right to security in the event of unemployment, sickness, disability, widowhood, old age or other lack of livelihood in circumstances beyond his control."
This statement in the U.N. Declaration provides strong support for the view that health care is usually regarded to be among our basic human rights, and the statement in Article 25 constitutes a reason for those nations whose representatives voted in favor of the Declaration to ensure that all citizens have access to basic health care.
 

There should be a right to health care.

Some people are not persuaded that there is a moral right to a basic minimal level of health care.  Even if there is no such right, however, we might take steps to create an institution that would create and guarantee such a right.  If the present Health Care Reform Bill were passed, more people could effectively demand health care services as a matter of right, but this is not to suppose that they can make such claims at present, or if the bill should fail to pass.  

 Those who believe that there is not any present right to health care might still urge that there are compelling reasons to put in place institutional provisions that would enable people to claim a right to health care services.  Thus, some defenders of health care reform urge that we need to provide health care in order to reduce the inefficiency of the U.S. health care system. Others urge that we need to provide basic services in order to maintain the competitiveness of U.S. industries in a global marketplace. Still others urge that we should provide basic services because existing institutions are unfair to those who are unable to gain coverage or who are denied services.  
 

The Current Public Debate

Public discussion of H.R. 3200, "America's Affordable Health Choices Act of 2009," has been heated and divisive.  Many of the hopes and fears people express about this bill reflect their misunderstanding of its content: H.R. 3200 would not guarantee federally funded health care for all Americans, despite the hopes of some of its advocates.  It would not mandate "death panels" or support health care claims for illegal aliens within U.S. borders, in spite of the fears of some of the bill's detractors.  We might hope to move toward a more reasoned discussion of this topic that is based on a clear understanding of the proposed reforms and on reasonable hopes concerning the objectives of reform.  

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Upcoming Bioethics Events

Thursday September 17, 7:00 p.m.
Great Hall, Memorial Union, "Torture, detention and the rule of law: A panel discussion."  Information

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Bioethics in Brief