Inequalities in health care access are apparent. They warrant a response from the community. We all run the risk of becoming ill during the course of our lives. Brody suggests that how able we are to address these crises is just chance of a social lottery. Beauchamp and Childress state that based on the principle of need that essentially social resources including healthcare should be distributed according to need. This is in line with distributive justice earlier described by them: that is fair distribution of burdens and burdens determined by norms that structure the terms of social cooperation. This is done in line with the principle of non-maleficence: if the person will be harmed without it they should be distributed to said individual. I would like to challenge this notion. There are instances in which this is not applicable. For instance if a person seeking transplant if found to be non compliant they can be removed from a transplant list regardless of need. With regards to the principle of non-maleficence, implanting into a non-compliant individual does more harm.
Cases like B and C are easier to agree upon with regards to material principles of justice. They are issues of financial resources. If we can agree that healthcare should be accessible to all, the question lies to what extent do we mean accessible? With cases like Ms. B this question is exemplified. In her case transportation was a factor as to why healthcare couldn’t be accessed. It is important to note that it is her five-year-old son is the one suffering in the situation. A child this age lacks the ability to make autonomous decisions and care for himself. It is his parent’s job to provide this care, and in some cases the state’s responsibility as well through social services. The case suggests that her issues with providing healthcare to her son could be mitigated if she had a car. So does the public then have a moral obligation to provide a vehicle to her?
The fair opportunity rule in essence states that social benefits of life should be distributed equally. People should not receive social benefits based on undeserved features. The fair opportunity rule can be used to minimalize the effects of life’s lotteries through the rule of redress. Justice can only be achieved by this measure when life’s lotteries stop being the basis for distribution of recourses. Increasing accessibility to social benefits such as education and health care could increase autonomy of individuals who live lotteries have not been in favor of. On the other hand this becomes problematic because some social benefits are scarce and a flooded market can be problematic. It could be argued that Mrs. B has been systematically socially disadvantaged from birth. Sharecroppers often live in rural areas, which are economically and socially isolated. She probably lacks both the recourses and time involved with taking her child to the hospital via the bus. With regards to the principle of justice and to minimalize harm, she should then be given a car. However, I think it is impossible to provide a service like this to every individual. Further I do not believe that society has a moral material obligation to provide vehicles to people. This frame point of material principle is very tricky. Where is the cut off? Do we make special cases for special people and populations? Is that just? As Brody mentions, it is sometime hard to balance social goals with individual rights. Maybe this it would be good to look at how countries with higher-ranking healthcare systems address problems of access of rural populations.
Beauchamp, Tom L., and James F. Childress. Principles of Biomedical Ethics. New York: Oxford UP, 2009. Print.
Brody and T. Engelhard, “Access to Health Care,” Bioethics: Readings and Cases