Ethical Principles for Everyone in Health Care

Abstract

It is fortunate that Dr Hanlon concludes his report on the April 2000 Cambridge symposium on ethical principles in health care with the statement “there is clearly a great deal of work yet to be done.” Better he had written “the participants need to return to first principles and start anew.” Any set of “ethical principles” that begins, “Health care is a human right,” is a statement of political and economic viewpoints, not a statement of ethical principles. “Health care” is not an abstract. “Health care” is a combination of goods and services produced by the labor of individuals. Those individuals have a right to be treated as autonomous persons, not as a means to an end. Kant established the philosophical basis for this more than 200 years ago. That premise underlies our political system and our health care system. Informed consent rules, for example, are a manifestation of that principle. If a right to health care did exist, then, without question, a right to the labor of the individuals producing it would be a required corollary. In a society where each autonomous individual establishes through voluntary contract the terms under which his or her labor will be provided, no such “right” can exist. Attempts to avoid this conflict through taxation systems, making the provision of labor indirect rather than direct, do not eliminate the basic immorality of forcing one person to labor for the health care of another. One can usefully determine the validity of a proposition by examining the extreme example, by reducing it to the “absurd.” Let us suppose a population with 100 persons who need lung transplants to survive, but only 50 lungs are available. Does the right of the other 50 patients who need transplants permit them to demand the removal of a lung from an unwilling donor? If the reader happens to be an appropriate genetic match, would the reader agree to having a lung removed? If the answer is “no,” that refusal should not be trumped by a “right to health care.” The refusal is final because the rights of the lung patient extend only to voluntarily offered benefits. Of what value is the so-called “right to health care” in that case? It has no value because there is no such right. The next symposium must reconsider this issue. A statement to the effect that a concern for humanity mandates that provision of quality health care for every person should be a primary goal of all would convey an ethical message.