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.
Has Freedom a Future
Preface An Era in Travail Emancipation in Historical Perspective The Present Stage of Emancipation Balancing Freedom and Order: Some Historical Models A Viable Tomorrow The Specter of Technological Unemployment Behavior in the Private Domain: The True Private Interest Behavior in the Public Domain: Controlling the Controllers Toward a Communal Ethics The Prospect of Freedom
Therapist-case managers: more than brokers of services.
For satisfactory adjustment into the community, the long-term patient often needs assistance in dealing with a bureaucracy of agencies and departments. Some professionals have suggested establishing the role of case manager, but the case manager system is susceptible to becoming an impersonal bureaucracy itself. The author suggests that case management functions are part of the normal duties of a conscientious therapist, and that only through significant therapeutic involvement does a case manager acquire the in-depth knowledge of the patient to adequately assess his needs and facilitate the processes for meeting them. Thus the case manager should be not simply an intermediate broker of services but the patient's primary therapist. With the "therapist-case manager," the functions of therapy and case management would be combined. If therapists fail to do case management or to treat long-term patients altogether, this problem should be dealt with directly rather than simply by adding another member to the team.