Introduction
It is widely recognized that there are certain goods that people need for survival. These goods might include things like food and clean water. There are also goods that promote human flourishing. These goods are not essential for survival, but are crucial for people to live good lives. Some of these goods might include income, freedoms of speech, and education.
Some argue that people have claims or rights to some of these goods. For example, people have a claim to have access to clean water, such that there would be something unjust if one did not have access. If one has a legal right to a good, then they have a legally enforceable claim to receive that good from the state. People also have certain rights that are not legally enforceable. For example, one might have a right to be told the truth, but generally one cannot pursue legal retribution if they are lied to.
Whether or not one has a legally enforceable right to healthcare is widely debated. On the one hand, health is seemingly necessary for human flourishing and access to healthcare is a component of maintaining one’s health. On the other hand, it’s not clear what would give people a right to healthcare. If there is a right to healthcare, then one still needs to determine what that right entails. What healthcare services would one have a claim to given this right? The concept of a basic decent minimum of healthcare was created as a policy-based term to identify what services such a right might entail.
During this seminar, participants evaluated positive arguments for a right to a basic decent minimum healthcare and discussed what might be covered in this basic minimum.
The graphic to the right shows a list of some of the types of rights. This list is not exhaustive, and there are many other categories of rights that people argue for. Note that some of these categories of rights are overlapping. For example, all natural rights are moral rights. Some categories of rights might be mutually exclusive.
Assigned Reading
Buchanan, A. E. (1984). The Right to a Decent Minimum of Health Care. Philosophy & Public Affairs, 13(1), 55–78. http://www.jstor.org/stable/2265199
- Thesis: Buchanan offers two arguments in favor of a system of enforced beneficence to provide a decent minimum of healthcare instead of a rights based approach. First, he argues that a decent minimum of healthcare is grounded in harm prevention principles implemented in other areas of public health. Second, he offers prudential arguments in favor of a decent minimum.
Discussion Questions
Seminar participants were asked to consider the following questions prior to meeting for discussion.
- Getting clear on terminology: What is a right? What is a universal right? What is a special right (and to whom might they might apply to)? What is a decent minimum of health care?
- Allen Buchanan thinks that instead, a legally entitled governmentally enforced decent minimum should be defended using a pluralistic approach bolstered by non-rights based arguments from principles of beneficence.Explain Buchanan’s arguments for this approach.
- What are the main objections to this approach and Buchanan’s reply?
- What is the content of the decent minimum under this approach?
- What are your views on Buchanan’s approach/arguments?
Reflection Points
In discussion, seminar participants reflected on the following points.
- Principles of beneficence might justify some level of healthcare, but does it support it to such a degree that a decent minimum is achieved?
- What constitutes a basic decent minimum of healthcare? This is particularly difficult because everyone has different healthcare needs, and a basic decent minimum might be different for different people.
- Does a government enforced decent minimum of healthcare give the government too much power or infringe on people’s personal liberties in an unacceptable way?
- Is there a right to healthcare beyond the decent minimum? How would we be able to determine what that entails?
Additional Resources
There are many great online resources available on both the philosophical concept of rights and the right to healthcare.
Arras, J. (2014) The Right to Healthcare. In: Arras J., Fenton E., Kukla R. (eds) The Routledge Companion to Bioethics. Routledge, New York, NY.
Brody B.A. (1991) Why the Right to Health Care is Not a Useful Concept for Policy Debates. In: Bole T.J., Bondeson W.B. (eds) Rights to Health Care. Philosophy and Medicine, vol 38. Springer, Dordrecht. https://doi.org/10.1007/978-0-585-28295-4_6
Daniels N. (2001). Justice, health, and healthcare. The American journal of bioethics : AJOB, 1(2), 2–16. https://doi.org/10.1162/152651601300168834
Wenar, L. (2021). Rights. The Stanford Encyclopedia of Philosophy. Edward N. Zalta (ed.), URL = <https://plato.stanford.edu/archives/spr2021/entries/rights/>.
MacKay, D. & Sreenivasan G. (2021). Justice, Inequality, and Health. The Stanford Encyclopedia of Philosophy. Edward N. Zalta (ed.), URL = <https://plato.stanford.edu/archives/win2021/entries/justice-inequality-health/>.
Daniels, N. (2017). Justice and Access to Health Care. The Stanford Encyclopedia of Philosophy. Edward N. Zalta (ed.), URL = <https://plato.stanford.edu/archives/win2017/entries/justice-healthcareaccess/>.
Velasquez, M. et al. “Rights”. Center for Applied Ethics at Santa Clara University. https://www.scu.edu/ethics/ethics-resources/ethical-decision-making/rights/