A just social arrangement must guarantee a right to health care for all. This right should be understood as a positive right to basic human functional capabilities. The present article aims to delineate the right to health care as part of an account of distributive justice in health care in terms of the sufficiency of basic human functional capabilities. According to the proposed account, every individual currently living beneath the sufficiency threshold or in (...) jeopardy of falling beneath the threshold has a legitimate claim to justice. People's entitlements to health care should not be determined on the basis of brute luck and their efforts to maintain healthy lifestyles. The prioritization of competing claim-rights of individuals is guided by two allocation principles: number and benefit-size weighted sufficiency (among people beneath the threshold) and need-weighted utilitarianism (among people above the threshold). (shrink)

Do we have a legal and moral right to health care against others? There are international conventions and institutions that say emphatically yes, and they summarize this in the expression of “the right to health,” which is an established part of the international human rights canon. The International Covenant on Social and Economic Rights outlines this as “the right of everyone to the enjoyment of the highest attainable standard of physical and mental health,” but (...) declarations such as this remain tragically unfulfilled. According to recent figures, roughly two billion people lack access to essential drugs or to primary health care. Millions are afflicted by infections and illnesses that are easily avoidable or treatable. In the developing world many children die or grow stunted and damaged for lack of available treatments. Tropical diseases receive little or no attention by the major pharmaceutical companies’ research departments. Is this a massive violation of the right to health? And if so, why does it attract so little attention? Is it because our supposed commitment to human rights and the rule of law is hypocritical and hollow? Or is it because the right to health is a special case of a right, so that these tragedies are no violation at all? Jennifer Prah Ruger summarized this puzzle when she wrote: “one would be hard pressed to find a more controversial or nebulous human right than the right to health.” In this essay I discuss three different theories of a right to health care. I conclude by offering my own reconstruction of one such theory. (shrink)

There is increasing consensus that the right to health can provide ethical, policy and practical groundings for health systems development. The goals of the right to health are congruent with those of health systems development, which are about strengthening health promotion organizations and actions so as to improve public health. The poor shape and performance of health systems in Chad question the extent of realization of the right to health. (...) Due to its comprehensiveness and inclusiveness, the right to health has the potential of being an organizational and a normative backbone for public health policy and practice. It can then be understood and studied as an integral component of health systems development. (shrink)

A basic human right to the delivery of health care, even to the delivery of a decent minimum of health care, does not exist. The difficult with talking of such rights should be apparent. It is difficult if not impossible both to respect the freedom of all and to achieve their long-range best interests. -/- Rights to health care constitute claims against others for either their services or their goods. Unlike rights to forbearance, which require others (...) to refrain from interfering, rights to beneficence require others to participate actively in a particular understanding of the good life. Rights to health care, unless they are derived from special contractual agreements, depend on the principle of beneficence rather than that of autonomy, and therefore may conflict with the decisions of individuals who may not wish to participate in realizing a particular system of health care. If the resources involved in the provision of health care are not fully communal, private owners of resources may rightly have other uses in mind for their property than public care….[T]he principles of autonomy and beneficence that lie at the foundations of justice will spawn conflicts within any portrayal of a just allocation of health care resources. (shrink)

The question whether rights to health care should be altered by smoking behaviour involves wideranging implications for all who indulge in hazardous behaviours, and involves complex economic utilitarian arguments. This paper examines current debate in the UK and suggest the major significance of the controversy has been ignored. That this discussion exists at all implies increasing division over the scope and purpose of a nationalised health service, bestowing health rights on all. When individuals bear the cost of (...) their own health care, they appear to take responsibility for health implications of personal behaviour, but when the state bears the cost, moral obligations of the community and its doctors to care for those who do not value health are called into question. The debate has far-reaching implications as ethical problems of smokers' rights to health care are common to situations where health as a value comes into conflict with other values, such as pleasure or wealth. (shrink)

Discussions concerning whether there is a natural right to health care may occur in various forms, resulting in policy recommendations for how to implement any such right in a given society. But health care policies may be judged by international standards including the UN Universal Declaration of Human Rights. The rights enumerated in the UDHR are grounded in traditions of moral theory, a philosophical analysis of which is necessary in order to adjudicate the value of specific (...) policies designed to enshrine rights such as a right to health care. We begin with an overview of the drafting of the UDHR and highlight the primary influence of natural law theory in validating the rights contained therein. We then provide an explication of natural law theory by reference to the writings of Thomas Aquinas, as well as elucidate the complementary “capabilities approach” of Martha Nussbaum. We conclude that a right to health care ought to be guaranteed by the state. (shrink)

This article begins by clarifying and noting various limitations on the universal reach of the human right to health care under positive international law. It then argues that irrespective of the human right to health care established by positive international law, any system of positive international law capable of generating legal duties with prima facie moral force necessarily presupposes a universal moral human right to health care. But the language used in contemporary human rights (...) documents or human rights advocacy is not a good guide to the content of this rather more modest universal moral human right to health care. The conclusion reached is that when addressing issues of justice as they inevitably arise with respect to health policy and health care, both within and between states, there is typically little to gain and much to risk by framing deliberation in terms of the human right to health care. (shrink)

In 2006, a WHO survey found evidence of a substantial increase in patient-led litigation against health authorities and funders over access to medicines around the world. New Zealanders have seldom litigated denials of access to health care. Part of the explanation lies in the fact that New Zealand has a legislated patients' "bill of rights", with enforcement through a complaints mechanism. Although the separate regime does not afford patients substantive legal protection in respect of complaints about lack of (...) access to care, this form of alternative, low-level resolution of health care disputes does condition disgruntled patients not to turn to the courts for legal redress in relation to their rights. But given the increasing need for prioritization arising from serious concern about the sustainability of the public health system, as well as a trend towards greater explicitness when it occurs, increased disappointment on behalf of patients and the public when care is denied or limited seems inevitable. This may well translate into increased patient-led litigation against health boards and funders. Part 1 provides an overview of the New Zealand health system, with a focus on the points at which resource allocation decisions are made, the identity of the decision-maker, and the methods by which priority-setting occurs. Part 1.1 describes inequalities between population groups in New Zealand, both in health outcomes and in access to health care. Part 2 describes the legal framework surrounding the health and disability sector, and discusses the lack of legislated rights to health and the limited right of access to health care in legislation, despite the existence of a legally enforceable Code of Health and Disability Services Consumers' Rights. (shrink)

Poland has faced two waves of migration: the first was of irregular asylum seekers, which led to the humanitarian crisis on the eastern EU–Belarusian border since 2021; the second was of Ukrainians fleeing the Russian invasion. Although there are noticeable differences between these situations, and between the different reactions of the Polish authorities, it is possible to juxtapose them in terms of the right to health. The normative content of refugee and human rights law is the starting point (...) for reconstructing the meaning of the terms ‘refugee’ and ‘right to health’. A refugee is a person who needs international protection because of a well-founded fear of harm, which is not limited to persecution as defined by the Refugee Convention but also includes situations of international and non-international armed conflict. The right to health, which includes, inter alia, entitlements to a ‘system of health protection’ and ‘underlying determinations of health’, is reconstructed on the basis of human rights law and refugee and migration law. There are no legal and moral grounds to grant the right to health differentially to different groups of refugees. Nondiscriminatory health policy requires that refugees have the same access to health care as nationals, although their specific health needs resulting from past experiences and refugee situation require special treatment, that is, an appropriate refugee health policy. The broad understanding of the underlying determinants of health demonstrates the importance of overall migration policy for refugees’ health, which can jeopardise the fragile good of refugee health. (shrink)

Although the right to health is universal, many nations that honor it fail to do so in the case of non-citizen immigrants. In this essay, we argue that the reasons typically given for not extending the right to health to immigrants are without merit and that there are good reasons for nations to protect, respect and fulfill the health right of all immigrants. Contrary to the standard view, we argue that health can be (...) understood as a global public good. Two important points follow: because health is non-excludable and non-rivalrous, it is in the health interests of nations to respect, protect and fulfill immigrants’ right to health. Furthermore, meeting the health needs of immigrants is an important way for receiving nations to meet the duties that may be generated by the benefits they incur as a result of health’s global public good dimension, thus ensuring that receiving nations are not free riders. We then argue that because citizens and immigrants dwell together, nations have duties of solidarity to immigrants with respect to health. Using the insights of social psychology, we show that solidarity among diverse people is both a reasonable expectation and a morally desirable one. (shrink)

Do people who cause themselves to be ill (e.g. by smoking) forfeit some of their rights to healthcare? This paper examines one argument for the view that they do, the restoration argument. It goes as follows. Smokers need more health‐resources than non‐smokers. Given limited budgets, we must choose between treating everyone equally (according to need) or reducing smokers' entitlements. If we choose the former, non‐smokers will be harmed by others' smoking, because there will be less resources available for them (...) than if no‐one smoked. This is unfair: why should non‐smokers suffer because of others' unhealthy lifestyle choices? We should therefore choose the latter and reduce smokers' entitlements. This paper criticises the restoration argument on the following grounds. In order to avoid generating unpalatable conclusions elsewhere, it must be combined with a principle according to which activities which are sufficiently ‘socially valuable’ (e.g. parenting) are immune from restoration claims. This however means that what was supposed to be one of the argument's most attractive features, its compatibility with ‘liberal neutrality’ with respect to the value of different lifestyles, doesn't really exist. Hence, the restoration argument is nowhere near as attractive as it at first appears to be. (shrink)

Domestic litigation has become a principal strategy for realizing international treaty obligations for the human right to health, providing causes of action for the public’s health and empowering individuals to raise human rights claims for HIV prevention, treatment, and care. In the past 15 years, advocates have laid the groundwork on which a rapidly expanding enforcement paradigm has arisen at the intersection of human rights litigation and HIV/AIDS policy. As this enforcement develops across multiple countries, human rights (...) are translated from principle to practice in the global response to HIV/AIDS, transforming aspirational declarations into justiciable obligations and implementing human rights through national policies and programs. (shrink)

Domestic litigation has become a principal strategy for realizing international treaty obligations for the human right to health, providing causes of action for the public’s health and empowering individuals to raise human rights claims for HIV prevention, treatment, and care. In the past 15 years, advocates have laid the groundwork on which a rapidly expanding enforcement paradigm has arisen at the intersection of human rights litigation and HIV/AIDS policy. As this enforcement develops across multiple countries, human rights (...) are translated from principle to practice in the global response to HIV/AIDS, transforming aspirational declarations into justiciable obligations and implementing human rights through national policies and programs. (shrink)

This chapter contains sections titled: Is There a Right to Health Care? What Does a Right to Health Care Include? Choice or Consent and the Exercise of our Right to Health Care References.

There are two discourses that are used in connection with the provision of good healthcare: a rights discourse and a beneficial design discourse. Although the logical force of these two discourses overlaps, they have distinct and incompatible implications for practical reasoning about health policy. The language of rights can be interpreted as the ground of a well-designed healthcare system stressing the values of equality and inclusion, but it has less application when dealing with questions of cost-effectiveness. This difference reflects (...) the distinction between the deontological status of rights claims and a teleological approach presupposed in the language of beneficial design. However, the value of the separateness of persons contained in the discourse of rights can impose constraints on the adoption of a simple maximizing principle when thinking about the allocation of healthcare resources within a social contract for health. Throughout these issues are discussed by reference to the work of Peter Jones. (shrink)

Background The world is urbanizing rapidly; more than half the world’s population now lives in urban areas, leading to significant transition in lifestyles and social behaviours globally. While offering many advantages, urban environments also concentrate health risks and introduce health hazards for the poor. In Bangladesh, although many public policies are directed towards equity and protecting people’s rights, these are not comprehensively and inclusively applied in ways that prioritize the health rights of citizens. The country is thus (...) facing many issues that raise moral and ethical concerns. Methods A narrative literature review was conducted between October 2016 and November 2017 on issues related to social justice, health, and human rights in urban Bangladesh. The key questions discussed here are: i) ethical dilemmas and inclusion of the urban poor to pursue social justice; and ii) the ethical obligations and moral responsibilities of the state and non-state sectors in serving Bangladesh’s urban poor. Using a Rawlsian theory of equality of opportunity to ensure social justice, we identified key health-related ethical issues in the country’s rapidly changing urban landscape, especially among the poor. Results We examined ethical dilemmas in Bangladesh’s health system through the rural–urban divide and the lack of coordination among implementing agencies. The unregulated profusion of the private sector and immoral practices of service providers result in high out-of-pocket expenditures for urban poor, leading to debt and further impoverishment. We also highlight policy and programmatic gaps, as well as entry points for safeguarding the right to health for Bangladeshi citizens. Conclusions The urban health system in Bangladesh needs a reform in which state and non-state actors should work together, understanding and acknowledging their moral responsibilities for improving the health of the urban poor by engaging multiple sectors. The social determinants of health should be taken into account when formulating policies and programs to achieve universal health coverage and ensure social justice for the urban poor in Bangladesh. (shrink)

The negotiations of the intergovernmental group known as the ‘IGWG’, undertaken by the Member States of the WHO, were the result of a deadlock in the World Health Assembly held in 2006 where the Member States of the WHO were unable to reach an agreement on what to do with the 60 recommendations in the report on ‘Public Health, Innovation and Intellectual Property Rights submitted to the Assembly in the same year by a group of experts designated by (...) the Director General of the WHO. The result of these negotiations was the ‘Global strategy and plan of action on public health, innovation and intellectual property’ which was approved by the World Health Assembly in 2008. The intention of the Global Strategy and Plan of Action (GSPOA) which was produced by the IGWG was to substantially reform the pharmaceuticals' research and development system in view of the findings that this system, whose purpose is to produce medicines for diseases which affect the greater part of the world population which lives in developing countries, had failed. The intellectual property rights imposed by the Agreement on Trade-Related Aspects of Intellectual Property Rights (TRIPS) and the recent trade agreements could become one of the main obstacles to access to medicines. The GSPOA makes a critical analysis of this reality, and opens the door to searching for new solutions to this problem. (shrink)

On the grounds of the fundamental value of the human rights, which is the human dignity, this article describes a basis of the right to health care in terms of quality, discloses its concept, reviews the spheres of health system in which this right is exercised: health care and public health. The right to health care is stressed as one of the fundamental rights, without which the person will not able to enjoy (...) other rights: economic, political and social rights. It comprises the right to enjoy the best physical and mental health. The right to health care is not absolute in itself: efficiency of its implementation depends upon both ability of administrative and institutional systems, which were created by the state, to properly implement the assigned functions and upon the individual, its state of health and lifestyle. (shrink)

A moral right to health or health care is a special instance of a right to fair equality of opportunity. Nation-states generally have the capabilities to specify the entitlements of such a right and to raise the resources needed to satisfy those entitlements. Can these functions be replicated globally, as a global right to health or health care requires? The suggestion that “better global governance” is needed if such a global right (...) is to be claimed requires that these two central capabilities be present. It is unlikely that nation-states would concede these two functions to a form of global governance, for doing so would seriously compromise the authority that is generally included in sovereignty. This claim is a specification of what is often recognized as the “sovereignty problem.” The argument of this paper is not an “impossibility” claim, but a best guess about whether the necessary conditions for better global governance that supports a global right to health or health care can be achieved. (shrink)

In recent years, there has been increasing recognition of both the philosophical questions engendered by the idea of a human right to health and the potential of philosophical analysis to help in the formulation of better policy. In this article, I attempt to locate recent work on the moral right to health in a number of historically established conceptions, with the aim of providing a map of the conceptual landscape as to the claims expressed by such (...) a right. (shrink)

Linkage arguments, which defend a controversial right by showing that it is indispensable or highly useful to an uncontroversial right, are sometimes used to defend the right to health care. This article evaluates such arguments when used to defend RHC. Three common errors in using linkage arguments are neglecting levels of implementation, expanding the scope of the supported right beyond its uncontroversial domain, and giving too much credit to the supporting right for outcomes in (...) its area. A familiar linkage argument for RHC focuses on its contributions to the right to life. Among the problems with this argument are that it requires a positive conception of the right to life that is not uncontroversial and that it only justifies the subset of RHC that seeks to prevent loss of life. A linkage argument for RHC with better prospects claims that a well-realized right to health care enhances the realization of a number of uncontroversial rights. (shrink)

Although not legally established, the idea that every American has a right to some level of health care has gained wide acceptance. Support for this right has developed primarily in the 50 years since the end of World War II. No mention of health care can be found in either the Declaration of Independence or the Constitution; indeed, there was little anyone could to improve health care or health outcomes in colonial times. During the (...) 19th and early 20th centuries a government role in improving public health developed when certain services, such as clean water, or certain demands upon its citizens, such as quarantine for disease, were instituted in order to achieve better and safer conditions for the health of the general populace. (shrink)

To what extent can individuals make a claim on their community to provide for upkeep and healing of their bodies? Can the philosophy of natural rights that animates the American political tradition be applied usefully to the health care debate? With Michael Boylan, Helen John, and Patrick Sullivan.

This paper offers four arguments against a moral human right to health, two denying that the right exists and two denying that it would be very useful (even if it did exist). One of my sceptical arguments is familiar, while the other is not.The unfamiliar argument is an argument from the nature of health. Given a realistic view of health production, a dilemma arises for the human right to health. Either a state's moral (...) duty to preserve the health of its citizens is not justifiably aligned in relation to the causes of health or it does not correlate with the human right to health. It follows that no one holds a justified moral human right to health against the state.Education and herd immunity against infectious disease both illustrate this dilemma. In the former case, the state's moral duty correlates with the human right to health only if it demands too much from a cause of health; and in the latter, only if it demands nothing from a cause of health (that is, too little). (shrink)

Is there a human right to health? If so, what are its grounds? Can a legal or moral human right to health provide any practical guidance when it comes to making decisions about, for instance, the allocation of scarce health resources? There are many possible answers to these questions in the literature. This article surveys some of these replies. First, however, it examines the distinctions between legal and moral human rights and rights to health (...) vs. health care. It then surveys the literature on potential grounds for a moral human right to health. It concludes by considering replies to several common objections to the existence of a human right to health. (shrink)

In recent years, there has been increasing recognition of both the philosophical questions engendered by the idea of a human right to health and the potential of philosophical analysis to help in the formulation of better policy. In this article, I attempt to locate recent work on the moral right to health in a number of historically established conceptions, with the aim of providing a map of the conceptual landscape as to the claims expressed by such (...) a right. (shrink)

The human right to health is crucial in the fight against global poverty. Health and an adequate standard of living are intimately connected. Poor health can make it difficult to overcome poverty, and poverty can make it difficult to attain good health. For the human right to health to be effective, however, it must have sufficient content to do the important normative work of rights. In the first part of this paper I give (...) plausible arguments against the very existence of a human right to health based on its lack of content and extend this to other social rights such as the right to adequate income, housing and education. In the second part of the paper I provide a defense of human social rights, including the human right to health, by arguing that these human rights, though abstract, have enough content to function as rights. (shrink)

This article challenges the widespread contention - promoted by the World Health Organization, the U.N. Human Rights Commission, and certain non-governmental organizations - that health care should be regarded as an individual human right. Like other "post-modern" rights, the asserted individual right to health care is a positive claim on the resources of others; it is unlimited by corresponding responsibilities; and it pertains exclusively to the individual. In fact, an individual human right to (...) class='Hi'>health, enforceable against either governments or corporations, does not currently exist in law. If established, such a right would portend a dramatic expansion of government control over health care, with negative consequences for efficiency and patient welfare. Voluntary efforts based on partnership, rather than the imposition of legal requirements, are the most productive means of expanding access to health care while preserving incentives for continued development of innovative health technologies. (shrink)

While universal healthcare provisions are the global norm rather than the exception, the United States exists in the latter category. The paradox remains that while the right to health is both increasingly implemented and recognized on a global scale, the United States seems to run farther away from the arguments and global examples that might pave its way. I suggest that an understanding of the imposition of healthcare as “coercive,” and hence as an impingement on individual agency, activates (...) its criticism as an inhibition of freedom that in turn motivates the libertarianism at the heart of the dominant, market‐based approach to health insurance provisions. At least one of the underlying assumptions of this view is that universal healthcare would impose or impinge on individual rights, and that such an impingement is a violation of autonomy. In this article, I aim to challenge this assumption by suggesting that the pitting of individual health rights against collective burdens stems in part from a related assumption of general health or welfare on the part of the collective: that disability and debility alike are anomalies or anomalous to the general health of the population. In other words, it will be my contention that individual health rights are only at odds with “collective rights” when the collective is perceived to be able‐bodied. (shrink)

The obligations set by the individual right to health are likely to conflict, at least if states are its addressee, with the obligations set by the collective rights to self‐determination that certain sub‐state communities have (or should be recognized). In this paper, I argue that conceiving of the right to health and of collective rights to self‐determination as both aiming at the promotion of individual agency might help us alleviate this particular problem. To do so, I (...) first explain how we can conceive of the right to health and of collective rights to self‐determination as protecting crucial aspects of individuals' agency. It is because both health and the capacity to participate in particular collectives are important ways in which our agency is enabled. I then argue that this conception of the purpose of those rights offers a principle to guide our practical deliberation when the protection of health and the protection of collective self‐determination seem to conflict. Finally, I specify how I think this principle might guide us when it comes to understanding the obligations that the right to health sets for the state towards members of selfdetermining sub‐state communities, both in terms of the provision of healthcare goods and services and the provision of the underlying determinants of health. (shrink)

The argument has been made that future generations of human beings are being harmed unjustifiably by the actions individuals commit today. This paper addresses what it might mean to harm future generations, whether we might harm them, and what our duties toward future generations might be. After introducing the Global Health Impact (GHI) concept as a unit of measurement that evaluates the effects of human actions on the health of all organisms, an incomplete theory of human justice is (...) proposed. Having shown that the negative GHIs of our current generation cause unfair harm to future generations, I argue that each human being must be allocated a fair threshold of negative GHIs that should not be exceeded. By emphasising the need to consider all the GHIs of human actions, the theory of human justice developed here is highly relevant to evaluate human actions that might affect future generations, for example those related to climate change. (shrink)

From the late 1970s through the mid-1980s, a number of philosophers carefully worked out theories of justice in health care. Most of those still working on these issues have turned to clinical applications of the philosophical frameworks developed earlier. Although theories have not received much recent attention in this debate, this paper will offer a new theoretical framework for approaching issues of justice in health care. There are two reasons for thinking that returning to theory would be worth- (...) while. One concerns the fact that our society remains very far from realizing justice in health care. While there are several well-argued theories of just health care whose implementation would take us into the neighborhood of justice, it would also seem - in pluralistic spirit - that adding to the arsenal is helpful. The more good arguments there are for a given conclusion, the more likely it is to be correct and, ultimately, to persuade. -/- It will be contended that a limited right to health care can be grounded in self-respect. The argument will exploit Rawls' key insight that self-respect is a primary social good and will depend on the assumption that, at least in moderately affluent nations, one has a right to the primary social goods. This assumption is not defended here. But it should be noted that a right to the primary social goods is not of interest only to Rawlsians and other liberal deontologists; an enlightened utilitarianism might also vindicate it. The second reason for advocating a return to theory is that self-respect is especially fruitful as a focal concept for addressing issues of justice in health care (and other issues). (shrink)

The human right to health is crucial in the fight against global poverty. Health and an adequate standard of living are intimately connected. Poor health can make it difficult to overcome poverty, and poverty can make it difficult to attain good health. For the human right to health to be effective, however, it must have sufficient content to do the important normative work of rights. In the first part of this paper I give (...) plausible arguments against the very existence of a human right to health based on its lack of content and extend this to other social rights such as the right to adequate income, housing and education. In the second part of the paper I provide a defense of human social rights, including the human right to health, by arguing that these human rights, though abstract, have enough content to function as rights. (shrink)

Journal of Social Philosophy, EarlyView.

United States Atomic Energy Commission (USAEC) and UN agencies utilized techniques of power and negotiation to implement radiation exposure regulations. USAEC affiliated scientists’ expertise was cultivated while establishing a radiation protection regime based on classified experiments. World Health Organization (WHO) leadership sought to manifest a human right to health, including a right to protection from radiation contamination. The careers of a few technical experts and interagency UN correspondence shows how American risk models of radiation regulation traveled (...) and ultimately inhibited WHO attempts to frame radiation as a public health threat. The USAEC and the International Atomic Energy Agency (IAEA) navigated WHO’s way of perceiving radiation with technical experts and bureaucratic and legislative means. This paper shows the underpinning at the UN of competing models of radiation regulation, one state centric and the other, an individual right to health. This narrative provides insights into the nature of the UN’s current conceptualization of radiation regulation and argues for further research into UN, radiation, and human rights history. (shrink)