Background:

This week’s readings covered the idea of national or public health care. Public Health care, if one were to take a utilitarian point of view, according to Beauchamp and Childress is often argued to be beneficial to society as a whole as without a healthy work force  a nation cannot prosper. Thus to ensure that everyone has a fair chance to work a minimum level of health care is often provided to the public. Almost every “modern” nation has some sort of health care system in place for the masses. These programs are often funded by the tax payers money making this a very socialistic scheme despite most “modern” nations these days following a capitalistic model.  In a fully capitalistic society there would theoretically be no such service as if a person could not provide the necessary capital for health service then they would not be able to receive any. Thus a minimum level of public healthcare seems to be just.

Both a utilitarian and egalitarian view of justice fully support public health care.  Utilitarians arguing that the cost of health care is off set by the overall benefit it brings to society by healing those who cannot work, and preventing them from worsening. as well as giving a safety net which provides comfort. The egalitarians on the underhand support public health care because it distributes a universal right “equally” to the most people. However if one were to take the libertarian point of view the issue that this is infringing on peoples free choices comes up.  To a libertarian public health is unfair because you are given no option of choosing if you will participate or not. However according to Allen E. Buchanan rational libertarians would argue that public health care would still exist due to voluntary payments as the concept of beneficence would ensure this. The only problem is sometimes beneficence needs to be “coaxed” out of society for it to be realized.

Dilemma:

The problem we run into is the idea of enforced beneficence. Why if public health care is morally correct do we need to make taxation to pay for public health care? The first argument is that there is a prisoner’s dilemma at play. While it would be beneficially to society as whole to volunteer a minute amount of wealth and it could be done if everyone participated no one will participate. The reasoning being that since so many people are participating one persons contribution is so small they can skip out on this minimum payment and instead maximize the use of that funding for other beneficent deeds. However since everyone will think this and act in the way that gives the most beneficent. The minimum will not be reached. The second argument is that this public health care is the most important however only if I have assurance that enough people will fund this will I myself pay. Thus for both cases we need to enforce beneficence, but is it truly beneficence anymore and can we morally enforce this?

The second dilemma as brought up by the issue of minimum. Where do we draw the line for minimum health care. Beauchamp and Childress acknowledge that there is an ideal and a reality when it comes to providing health care. Thus the idea of minimum health care comes up, however the moment one states minimum the questions of how do we judge the value of a persons life, and who get’s to decide come up immediately.

Discussion

In regards to the first dilemma, I do not think beneficence can be enforced. Beneficence according to Beuchamp and Childress represents “ideal, rather than obligatory, conduct,”(204).  Also beneficent actions “generally do not provide reasons for legal punishment when agents fail to abide by them”(204). Yes, there is the idea of obligatory beneficence but those fall more closer to the principle of non-maleficence. If you do not follow the obligatory beneficence you are likely to incur harm upon another. This is what should be enforced, ie try to stop others from kill others if you know what they are planning. However beneficence represents what goes beyond that minimum moral duty. If that duty is enforced then it is no longer going beyond what is required, it is simply following what is expected of you. Furthermore if one does not fund healthcare in the enforced beneficence model one does face legal reprimand. This turns health care from being grounded into beneficence into more of a non-maleficence issue and make it a matter of justice rather than morality. To address the issue  of enforcement one can argue from the non-maleficence point of view. That public health care is needed because if we do not provide it we are harming and hampering not only those who cannot get it but those around them. For example if a person is sick and they cannot get treated then they are likely to spread that sickness to those around them. Thus for the safety of the whole there should be public health.  As for is public health just, all 3 views of justice presented in Beauchamp and Childress seem to have no problems with the idea of public health. It is only in implementation in which they differ.

This leads to the second dilemma of minimum level of public health care. There is no real moral justification one can give to reach minimum. Minimum infers a physical quantity that should be given to all. In this way this moves into a justice issue. What quantity that we define as minimum is just? For the utilitarian this would involve a cost benefit analysis. To do that one would need to measure the value of a life? In an article in the Globalist it is stated that according to the US Office of Management and Budget the value of an average human life is approximately 7-9 million dollars.  So we must begin factoring in race, income, social class, etc… into the whole utilitarian equation which goes down a slippery slope of further dehumanizing patients into just numbers. Thus the minimum becomes even harder to set as more factors need to be introduced. If one were to take an egalitarian point of view, then it would be to divide the amount of money allocated to public health care by the number of US citizens. Thus to be equal everyone get’s that amount, however since the number constantly fluctuates and the quality of health care varies a more complex formula would be required which would have to take into account location, age, and more. Again we find the minimum to be dependent on the variables. The libertarian model would be to have the rich with their obligated beneficence donate money and that money would be used to help those in need. However the issue of who is in need comes up as well, how do you define those in need? In the end I would argue there is no morally correct way to decide a minimum as it becomes arbitrary dependent on the  factors that is included in it’s making. Is this perfectly just and morally correct? No, but who makes the law is who decides the minimum, in that way public health care cannot become fully moral or just. We as a society can only try to reach that ideal.

Citations

Beauchamp, Tom L., and James F. Childress. Principles of Biomedical Ethics. 7th ed. New York: Oxford UP, 2013. Print.