In what sense is health a universal right?
In an audience with members of Doctors with Africa, Pope Francis asserted that “health is not a consumer good, but rather a universal right, and therefore access to health care services cannot be a privilege.” Doctors with Africa is a non-governmental organization which shares the priorities of the United Nations, which are at times morally problematic. But the Pope’s greatest emphasis (as would be expected) was on the inclusion of the poor in health care “at the most basic level” and for “the most essential primary care.”
The emphasis of Pope Francis and other Catholic leaders on the “right” to health care can be confusing, especially in an era in which new rights are invented by the day. Back in 2009, I pointed out that the nature and quality of the health care to which everyone has some sort of “right” will vary with the nature of medical care and the obstacles (including costs) to making such care widely-available (see The Bishops, Justice, Health Care and Social Change). This is why it showed intelligent restraint for Francis to emphasize “basic” and “primary” care.
After all, with respect to modern medicine, we are to some extent hoist with our own petard (a fitting but archaic expression which signifies being blown up with our own bomb). Because health care is so advanced and so costly nowadays, it is clearly impossible in at least some world regions (and probably in all) for the State to guarantee that everyone will receive the highest possible level of care. If health care becomes yet another fief of the bureaucratic State, “rationing” must inevitably rear its ugly head. Moreover, we may ask—as with so many things—whether assuming that the State ought to be responsible for health care is reasonable, or even desirable. There are many prudential question surrounding the optimum delivery of health services.
But these questions ought not to cause us to bristle, as I know I am tempted to do, at the Pope’s assertion. There really is a difficult-to-specify right to health care. Despite the fact that “rights” language is so often abused today that I think we should stop using it, this “right” to health care derives from the moral duty we have to assist our neighbors when they are suffering from ill health. It is exactly analogous to the right to life.
True human rights discovered in moral duties
In one sense, nobody has the “right” to life. In bodily life as we know it in this world, human persons are by nature mortal. Nobody has a right not to die, nor will we argue, if someone succumbs to cancer or falls off a thousand foot cliff, that the right to life has been violated. All human rights are finite and conditional. Nonetheless, everyone has a right to life with respect to the corresponding moral duty of each one of us to do two things: (a) Refrain from unjustly taking anyone’s life; and (b) Preserve the lives of our neighbors, if reasonably possible, when they are threatened.
Similar duties apply to the general question of health. We have a moral duty to take ordinary care of our own health, to avoid engaging in actions which are predictably injurious to the health of others, and to assist our neighbors when they are plagued with ill health, insofar as we are able to do so. In correspondence with this duty, everyone has a right to health which may not be willingly violated—in the same sense that everyone has a right to life.
Moreover, because both life and health are goods common to all, they are necessarily part of what we call the common good. Everyone is bound to respect the common good, and this includes appropriate public responsibility as discharged through politics. In this context, we recall that political legitimacy depends in large part on the care which a government shows for the common good, which raises (among many other things) questions of what we call “public health”. We also recall that each person has a specific political responsibility to use his vote, his influence, and/or his office to foster the common good, of which conditions affecting both life and health are obviously significant parts.
This, then, is the context in which the “right to health” is to be discerned and considered. It tells us almost nothing about how, in our particular social situation, we will define either "health" or the minimal level of care necessary to fulfill our moral duties, nor about how best to deliver such care as an aspect of the common good. But Pope Francis is right when he says that health must never be reduced to the status of “a consumer good.” Similar in many ways to the case of education, as cultures prosper and health services become widely available, at some point the failure to provide that care to particular groups takes on the character of a moral decision. And while the provision of health care for profit is not at all bad, it does not fulfill that particular moral duty which gives health, like life, the character of a right.
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