Health in the Name of Justice: Does Justice Require a Right to Health
Upholding and seeking justice in society has been important for philosophers and religious thinkers throughout the ages. Debates of different conceptions of justice have ranged from Plato’s conception of the just individual, to Aristotle’s just community where individuals receive what is owed to them according to their merit, to Kant’s claim that justice concerns the “… exercise of will among people; and it is concerned with the possibility and freedom of the exercise of will …” (Hudson, 2003, p. 11). Interpretations of justice and the value of justice in society vary. Fundamentally, however, theories of justice are concerned with answering the question, what do we as a society owe each other by determining the set of rights that are inalienable and vital for a just society to protect. Theories of justice hope to inform us of the rights that are essential for society to defend and uphold. The ever increasing amount of medical knowledge and sophisticated medical treatments now available raise questions of social justice in health and has prompted many to argue whether or not there is a right to health. As Charles Fried (1976) explained over thirty years ago, extending certain medical treatments to the poor seemed possible and inevitable during a period when certain medical advances in treating illness and disease, such as the introduction of antibiotics and vaccines, made a huge difference to the health of the population. He claims that in this “ ‘Golden Age’ we could unambiguously afford a notion of a general right to medical care because there were a number of clear successes available to medicine, and these successes were not unduly costly” (p. 29-30). However, as Fried recognised in the 1970s, and is even truer today with the costs associated with chronic illnesses, extending universal medical care to all in society in cases where treatment is expensive and marginally beneficial is problematic at best.
Some dilemmas in health care policy.
Neither patients nor physicians are doing a great deal about growing costs, improving the rationality of medical services, or asking hard questions about the value of existing patterns. They have little incentive to do so, and when they do, it is with the clear awareness of their own economic interest. If budgetary cuts have to be made, they inevitably occur at the points of least political resistance-the poor, the old, and the chronically ill. The "middle course" of government intervention-between the harsh realities of a private medical marketplace and the bureaucratic consequences of a rationally planned system of care-has been a costly and inefficient regulatory muddle. Constructive compromises in future policy will be complicated and fiercely political.
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