Monday, December 9, 2013

What is a Right to Healthcare?

Recently Pope Francis released an encyclical that includes his vision that everyone has a right to healthcare, “beseeching politicians to guarantee all citizens dignified work, education and healthcare.”  That healthcare is a right is a common point of view, but what does it really mean?

The Declaration of Independence tells us that we have a right to life, yet everyone dies.  The right to life is not unlimited.  For the same reason we don’t have an absolute right to health, itself.  To understand a right to healthcare it’s important to understand the concept of rights.

Rights impose duties or obligations, not on the person claiming or exercising the right, but on everyone else that they not infringe on that right.  This is not the same as the old argument about rights coming with responsibilities.  Rights are only possible if the rights of one require all others to act in a way that allows that right to exist.  My having a right to life imparts on you an obligation not to kill me or in some other way cause my death indirectly or by negligence.  Society enforces that right and others with prescribed punishments.  A right to property implies punishment for theft or vandalism.  My right to free speech requires others to remain observers while I have my say, even if they disapprove.  In fact, there is no need to discuss rights unless people disagree.  Indeed, if everyone agreed on what we owed to them, the claims of women’s rights, gay rights or animal rights would never be raised.  If two people or two groups disagree, however, and no deal or compromise is reached, and one side is in a position to block the needs of the other, the establishment of rights may be the only recourse.  In that case rights are established, and those rights, and the concessions they require from others, become enforceable.

Healthcare is a broad and vague term.  It can mean anything from distributing aspirin to performing a heart transplant.  When the Pope or anyone else says that everyone has a right to healthcare, that statement has no clear meaning without specifying the duties and obligations it imposes on others:  physicians and other healthcare workers, hospitals, insurers, drug companies and taxpayers.  When rights are established the needs of recipients automatically take precedence over the choices of providers.  How are those needs distinguished from wants?  There is not enough money to give everyone everything he wants in terms of comfort and life-extending interventions.  People use the internet (and TV ads) to self-diagnose, then argue with doctors about what costly treatment may be right for them, especially when someone else is paying.  Does society owe the same obligation in terms of healthcare to those who abuse their bodies as to those who lead healthy lifestyles?  Is it smart for society to make it more rewarding for the brightest students to become lawyers who help sue the medical professionals rather than to become doctors and scientists who provide better services and the drugs? 

These important questions about implied obligations are left open.  A right to healthcare is easy to say, but the devil is in the details.

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