The issue of universal health care remains more controversial than ever before, as President Obama’s new plan goes into effect in 2014 and continues to generate heated debate. On one level, the controversy is somewhat removed from ethical considerations, in that any such shift to the traditional model of United States health care translates to a virtually inestimable change in an immense industry. Health care comprises a vast array of commercial interests, ranging from the pharmaceutical companies to the insurance carriers and hospitals themselves, so commerce figures importantly in any discussion of the subject. At the same time, there also remains the inescapable ethical issue of determining to what extent, certainly in a prosperous a developed nation, health care may be seen as essentially a privilege or service available only to those who can afford it. This issue has long been at the core of the debate, and the new plan, while debated, expresses the conviction that all Americans are entitled to basic health care as a right. Not unexpectedly, then, many of those in the position to pay perceive the measure as unjust, in that they will be called upon to subsidize the care for all.
It is tempting to assess the new plan as defining the ethical “sides”, but this is misleading. To fully comprehend the ethical reality here, it is necessary to distance all concerns of actual commerce, which eviscerates those concerns regarding inequality of burden of expense. The question is simple: is health care a fundamental right or a privilege earned by those able to pay for it? It is arguable that the importance of the subject is such that all who desire health care may be expected to be motivated to provide it for themselves. This ignores, however, the element of a functioning society as attending to its own survival and addressing its obligation to act in an ethically responsible fashion. That element in place, it will be seen that a utilitarian ideology best supports the necessity of health care as a basic right.
Various ideologies are applicable to the health care issue, and perhaps the most likely to be most relevant is that of virtue ethics. What renders this so likely, in fact, is how the philosophy pertains to all health care practitioners; compelled to do what is good for others translates to doing what is good for all. Virtue ethics centers upon practical wisdom as being the instrument complementing the need to do good, at least in the Aristotelian view. The ideology is centered, moreover, on the individual’s efforts and largely unconcerned with absolute maxims (Morrison, 2009, p. 23). At the same time, the ethics are fundamentally lacking in the parameters necessary for supporting health care as a right, chiefly because of the reliance of the individual upon their own wisdom and determination of what is virtuous. The doctor guided by virtue ethics, for example, may seek to treat all regardless of ability to pay. The hospital administrator, however, must consider all practical matters, and the “virtue” of being able to provide excellent care to a limited number of people may seen as better than providing less than ideal care for the multitude.
Similarly, deontology nears being an answer here, but ultimately fails. Deontology is very much about moral absolutes, and this would seem applicable in the case of all persons morally receiving the good of health care. The problems arise in the inherent disregard of consequences of deontology, which becomes a significant dilemma when the thinking actually is applied to the subject. In Kantian deontology, only the moral absolute has meaning, but health care contains many gray areas. Consequently, the issue is then not of the universality of the care, but the ways in which it is practiced. If, for example, deontology affirms health care as a right, it does not determine whether mental health care or abortion services are within that right, and deontology can then only be useful here when it is linked to virtue ethics. Put another way, both philosophies partially support health care as a right, but each suffers from limitations weakening that support.
It is only utilitarianism that fully affirms health care as a universal right. Utilitarianism is a concept long wrestled with as contradictory, insoluble, and sometimes meaningless. It seeks to address actual matters of usefulness while defining them at least partially in terms of measures highly subject to interpretation. Happiness, for example, is critical within the ideology, yet it is the utility aspect of that state of being which must apply for the ideology to succeed. The logic does not, in plain terms, follow (Kolm, 2002, p. 402). Consequently, and as has been extensively explored, utilitarianism is most viable when it is tempered or modified. In regard to health care, distributive justice is needed to complete the utilitarian formula and render it correct for the right of health care.
In utilitarianism, the greater good for the greater population is the emphasis, and this may seem to support health care as a right. Nonetheless, this ideology presents dilemmas. It is argued, for instance, that the minority is disregarded when the happiness of the majority is the focus (Taylor, Pinczuk, 2006, p. 253), and traditional models of health care in the U.S. appear to reinforce this problem. Most people work to pay for their own health care, through deductions from their employment compensation or through individual efforts. This being the case, the majority is achieving the end of the greater good without health care established as a right for all. There are, as is well known, issues with expense, coverage, and a variety of other factors going to the health care access for this population. The process, however, points to utilitarianism as still actually in place with health care as ancillary, or as a privilege.
What alters this, and what more firmly establishes utilitarianism as the proper philosophical foundation for health care as a right, is a more thorough understanding of happiness and that “greater good.” The terms are inherently subjective, no matter the issue at hand, yet there are criteria that apply with great relevance here. In plain terms, health is essential for well-being. There may be happiness when illness or physical distress is present, but these are atypical cases, and for most a sense of contentment relies upon being healthy. Even those who feel that health care is not a right must concede that it is a vital component within happiness, insofar as human happiness is generally defined. Consequently, and obviously, when more people within the society are “happy,” the greater good inevitably is served. The answer to the problem noted of utilitarianism, then, is the elimination of the minority population itself; as all are seen as within the society, all become the majority, so to speak, and utilitarianism is at its most ideal state.
This then leads to the need for distributive justice, in order for the utilitarian good to be properly administered. As with other theories, distributive justice is often viewed incorrectly, and usually as being wholly recipient-oriented (Giersson, Holmgren, 2000, p. 189). The reality, however, is that the concept accords very well with utilitarianism, in that the giver is as benefited as the recipient. Distributive justice in health care does not necessarily equate to an even distribution of services to all, but to the needed care provided based on the actual need. When this concept is infused within the larger ethics of utilitarianism, it becomes evident that health care is very much a right. To begin with, justice in any sense is not a quality subject to restriction; its nature demands that it be applicable to all if it is to be valid in any sense. Then, there is the matter of the reciprocal aspect of distributive justice, which goes to serving utilitarian ends. The society must, in no uncertain terms, serve itself. It must promote its own well-being in rational and ethical ways. This is in fact the core of utilitarian theory and, as noted, the “greater” measure of a greater good served, the ideology is completely validated. With health care as a right, a reality reinforced by distributive justice principles, all individuals are assisted in achieving higher states of well-being. When all individuals are thus attended to, the society must prosper and the utilitarian goal be achieved. Viewed in this way, there is no undue emphasis on recipient because both giver and recipient, equally components within the society, are working toward the same fulfillment or end.
It is then all the more interesting to contrast this argument of modified utilitarianism with the concept of ethical egoism. In a very real sense, it may be held that ethical egoism is something of a foundation for health care as a privilege. It is a belief system in which the individual, morally obligated to attend to the self first, is intrinsically less concerned with the needs of others. This being the case, health care cannot be a right because it is unreasonable to require that an individual cooperate in a way not directly benefiting the self, which universal health care must in some form demand.
Closer analysis, however, presents a different perspective, and the contrast fades dramatically. Certainly, there is an apparent conundrum in applying ethical egoism to health care as a right. On one level, and apart from the dilemma cited above, the health care practitioner is not expected to be guided by such a morality. The nature of the work, in fact, demands that the practitioner place the best interests of the patient above their own (Morrison, 2009, p. 7). Then, there is the matter of individual opinion or belief as prompting the self-interest, which further distances ethical egoism from the subject, More exactly, when the individual is paramount, there are limitless estimations made as to what constitutes appropriate health care. Ethical egoism is inherently removed from social concerns, so it seems to strongly oppose any idea of health care as a right. It is critical to understand, however, that ethical egoism actually reinforces utilitarianism in this matter because it applies an individual basis to a widespread concern. In ethical egoism, as noted, the individual holds to the attending of individual needs as primary. What is important, however, is that the best interests are served here because it is felt they should be served (Giersson, Holmgren, 2000, p. 59). This implies a fundamental and moral imperative, which in turn brings into question what is in the best interests of the individual. It is certainly reasonable to assume that any individual within a society is served, and in a variety of ways, when the needs of others are addressed. Social pressures ease, there is greater stability, and the individual enjoys the advantages of a better society. Then, there can be no discounting of the importance of the individual as enhanced through acting in an ethically correct way, and supporting health care as a right is an ethical good. Consequently, and even as ethical egoism may be argued as being in stark contrast to a utilitarian promotion of health care as a right, it is equally valid to assert that it may work to support such a thing.
Conclusion and Personal View
At the outset, it was offered here that the ethical dimensions of health care as a right must be viewed as removed from financial or commercial considerations. This is difficult, but it is nonetheless essential, because for too long the focus has been incorrectly inverted; the ethics of the situation have been subject to economic strategies and potentials, which have inevitably fueled dispute. For many, it has come down to money and the potential burden of those with more to subsidize those with less, just as the many industries within health care are fearful of the drastic restructuring universal health care must bring. Nonetheless, the issue cannot be properly gauged in so backwards a fashion, for to emphasize the financial difficulties of health care is to disregard the most crucial element of it, which is the correct ethical foundation.
In plain terms, there is little more essential to either individual or society than well-being, and an emphasis on finances also – and ironically – ignores the immense repercussions to the economy resulting from health care as privileged. Virtue ethics and deontology somewhat support the right of health care but, as has been seen, only a modified utilitarianism truly provides the needed foundation. The utilitarian exists to create the most good for the most people and, when distributive justice is incorporated here, it is clear that all must benefit from establishing health care as a right. Individuals are uniformly protected, which translates to a society no longer fragmented by inequality of care. Individuals within the society are then better enabled to pursue their own self-interests, and a stable formula of mutual advantage is in place. Ultimately, then, a utilitarian ideology fully supports the necessity of health care as a basic right.
Dunham-Taylor, J., & Pinczuk, J. Z. (2006). Health Care Financial Management For Nurse Managers: Merging The Heart With The Dollar. Sudbury: Jones & Bartlett Learning.
Giersson, H., & Holmgren, M. (2000). Ethical theory: A Concise Anthology. Orchard Park: Broadview Press.
Kilm, S. C. (2002). Modern Theories of Justice. Cambridge: MIT Press.