This is a lecture I created for my Medical Ethics Online course, Summer 2011, at Bowling Green State University. It is mostly about what a right to health care properly is, or could be, and it reviews some arguments in favor of such a right.

1. Is there a Right to Health Care? Eli Weber-Instructor Medical Ethics Online Summer 2011

2. Lecture Goals Consider what it might mean to claim that there is a “right” to health care. Examine arguments for a right to health care. Note some problems with claiming that there is a right to health care. Discuss two ways to approach the question of a “decent minimum of care.”

3. What Kind of Right is a Right to Health Care? Positive vs. Negative -negative rights are rights of non-interference -positive rights impose more specific, and more demanding, obligations on others Legal vs. Moral -legal rights are bestowed by the state -moral rights are (or at least are typically thought to be) a consequence of things about the rights-bearer

4. A Positive, Moral Right to Health Care A negative right to health care doesn’t guarantee access to health care Legal rights are often, though not always, conceived of as tracking moral rights Englehardt-there can’t be a positive moral right to health care, because such a right would impose obligations upon others which violate their property rights

5. Argument from Collective Social Protection Collective resources are frequently used to protect citizens against common threats like fire, pollution, and crime. Protection of health is similar to these common threats. Therefore, consistency requires that collective resources be used to protect the health of citizens. *But, many people think governments are not obligated to provide these protections.

6. Utilitarian Argument To the extent that access to health care has positive welfare benefits overall, providing this access is something that we ought to do. Is this even a right to health care? Not clear that the utilitarian analysis justifies heavy investment in health care, as opposed to other social enterprises Objections to cost-effectiveness analysis

7. Argument from Fair Opportunity Institutions are just to the extent that they counteract inequalities that are a result of luck, chance, and other factors over which agents have no control. Ill health and disease is an inequality that is (mostly) beyond a person’s control. Therefore, justice demands that the inequalities imposed by a person’s poor health be counteracted. *Englehardt: This imposes obligations on others to compensate for injuries for which they are not responsible. Though such circumstances are unfortunate and unfair, this doesn’t imply that others must give up their property to provide compensation.

8. Other Problems with a Right to Health Care What is the content of this right? Who is obligated to act so as to bring this right about? What are they obligated to do? What’s the best system for ensuring this right is protected? Is there a way to respect this right, while still allowing people to purchase better health care if they want to? Should self-imposed ailments be covered?

9. A “Decent Minimum of Care” One thought is that, if equality of opportunity does imply a right to health care, all that is required is that a system be put in place which tends to restore people to something like “normal” functioning. -This standard is universal. -Coverage limited to basic health and catastrophe coverages -Compromise formulation

10. A “Decent Minimum of Health Care” Others suggest that what constitutes a decent minimum of health care must be determined socially, and will have content that varies wildly. This is because: -there is widespread disagreement about things like moral obligations, and the minimally good life, both within and across societies -in the absence of a shared morality, agreement is the only way to legitimately impose obligations on others to pay for the health care of those who can’t afford it

11. A “Decent Minimum of Health Care” Is there really as much “widespread disagreement” as Englehardt claims? -Rawlsian primary goods Neither of these conceptions are neutral with regard to one’s theory of justice. Daniels’s view would be unacceptable to a libertarian, while only a libertarian is likely to agree with Englehardt.

12. The Bottom Line The debate about whether there is a right to health care is properly a debate about whether there is a positive moral right to health care. The strongest argument in favor of such a right seems to be by an appeal to equality of opportunity. There are still numerous issues surrounding a right to health care, particularly how to conceive of the notion that this is a right to a decent minimum of care.