By Ronald Pies, MD
As a psychiatric physician for nearly thirty years, I am always surprised when I hear politicians claim that the U.S. health care system is “the best in the world.” To be sure, we are among the most advanced nations when it comes to medical technology, and we are second to none when it comes to the dedication of our doctors, nurses, and allied professionals. But if we examine indices of public health such as infant mortality and preventable deaths, we are far from having the best health care “system.” For example, according to a 2002 study by the Institute of Medicine, 18,000 Americans die every year because they don’t have health insurance. And in a 2008 Commonwealth Fund-supported study comparing “preventable deaths” in nineteen industrialized countries, the United States placed last.
There are social, political, and economic factors that enter into the American health care debate, but the issue is rarely discussed from the standpoint of religious and moral obligations. Perhaps our political leaders are hesitant to bring religious viewpoints to bear on this topic, fearing that they will further polarize the already contentious interest groups involved in the debate. And arguably, religious obligations by themselves cannot be used as the basis for formulating an economically feasible system of health care. Nevertheless, we should be under no illusions: Health care is fundamentally a moral issue — and religion has a good deal to contribute to the discussion.
I wonder if our political leaders are aware, for example, that the three Abrahamic faiths — so often invoked to support “conservative” values — are largely in favor of making health care universally available. Indeed, most Christian, Jewish, and Muslim authorities endorse the proposition that basic health care is a fundamental human right — a principle also endorsed in the 1948 Universal Declaration of Human Rights, adopted by the General Assembly of the United Nations, and signed by 48 countries. I also wonder how many of our political leaders are aware that the United States is a signatory to this declaration.
What do the three Abrahamic faiths have to say on the matter of health care as a basic right? As you would expect, there is a spectrum of opinion, and not all congregations or churches within a given faith explicitly endorse a “right to health care.” Nevertheless, there is a developing consensus that government must play a key role in ensuring that basic health care is both accessible and affordable to all — and particularly, to the elderly, disabled, and minority communities.
For example, Bishop William Murphy of the U. S. Bishops’ Committee on Domestic Justice and Human Development was quoted in a 2009 National Catholic Reporter article as saying that health care reform efforts “must begin with the principle that decent health care is not a privilege, but a right and a requirement to protect the life and dignity of every person.” Indeed, the Catholic Church has been consistent in viewing the provision of health care as a human right. Similarly, while some conservative Christian congregations oppose the role of government in the provision of health care — considering it “not part of God’s plan” — most Protestant denominations support the concept of health care as a human right.
Many Jewish scholars have also endorsed this principle. For example, Rabbi Elliot Dorff, a pre-eminent authority on Jewish medical ethics, wrote in a 2009 Jewish Journal article, “The fact that more than 40 million Americans have no health insurance is, from a Jewish point of view, an intolerable dereliction of society’s moral duty… we are duty-bound to find a way for all American citizens to be able to afford health care.” And in 1993, the United Synagogue of Conservative Judaism concluded, “Jewish values demand that we work to create a society where no one is denied proper medical care.”
Islam was perhaps the first of the Abrahamic faiths to put these ideals into practice, as far back as Muhammad’s time. Some sources note that the first public hospitals arose in Islamic cultures, and that there was generally a moral imperative to treat all patients regardless of their financial status. Dr. M. H. Al-Khayat pointed out in 2004, “All human beings, whatever their status or affiliation, were, in the Islamic state, entitled to equal health care, preventive or curative. This is indeed the essence of the goal advocated fourteen centuries later by the World Health Organization.”
In the final analysis, I can’t prove that health care is a basic human right. But the three Abrahamic faiths – which often agree on very little — are largely in accord on this point. As Dr. Paul Farmer has put it, “I can’t show you how, exactly, health care is a basic human right. But what I can argue is that no one should have to die of a disease that is treatable.”
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Ronald Pies, MD, is Professor of Psychiatry and Lecturer on Bioethics at SUNY Upstate Medical University, Syracuse, New York, and Clinical Professor of Psychiatry at Tufts University School of Medicine in Boston, Massachusetts.
Photo: Detail of Giuseppe Moretti’s 1922 Bronze Hygeia Memorial to World War Medical Personnel, Pittsburgh. By Jim Kuhn [CC-BY-2.0 (www.creativecommons.org/licenses/by/2.0)], via Wikimedia Commons
Ethical analysis must certainly consist of something besides saccharine if it is going to get us somewhere – a somewhere in which people have some reasonable freedoms and opportunities that do not lead to increased morbidity/mortality. We will always have a 1%, but the 99% can lead fulfilling lives we want to believe. In the news sources I frequent the Jewish religion and its 2 heresies cause widespread misery in the name of religion/politics. The Founders/Framers of the US Constitution, and other Enlightenment jurists, rode on a wave of secularism that we should recapture … we must find meaning in life itself, not the ideologies that are so eager to determine meaning for us, meaning that creates structures of domination and war. Sure we can find religious people who say all kinds of stuff, and some of them are in fact real spiritual people; but we can find spiritual people who spread peace and compassion without religious ideology, without holding that this or that book is the only Book. Neti, neti. Religion is a problem, and the more government is open to its wiles, the more our freedom is at risk. A secular state can certainly embody tyranny and oppression, but when those acts are done by the secular state we are not led to confusion about peace and compassion. When the Church or the religious state justifies its stand against abortion, against birth control, against the Palestinian and the Jew, against the protestant or the catholic, against terrorism and for war, by its god, then what are we taught about Life? If we want a decent state, then the religions are the last place we should look for ideas.
It is beyond doubt that universality of health care can be derived from a moral discourse and substance as we know it. It supports the idea of a right to health or any other right of a similar destiny quite successfuly. Connecting it to religious postulates and churches as “practitioners” or “developers” of moral standards may be convincing to certain people, and might make sense as an argument in favour of health as a human right. I am not sure however, that it contributes to understanding and development of health as a justiciable, legitimate and adopted human right in international law. Of course that equal access to basic health care is a moral duty of every society and of the international community, and so by its own content and value, anything contrary to that is plain anti-humanism and political shamefulness.
Thank you for this article. I think Dr. Pies’ brief reference to faith-based considerations is interesting and valuable, as this is very important to understanding how we can actually implement this right in specific cultural and religious environments. However, his confession that he cannot prove that health care is a basic human rights indicates what Jon Mann used to call ‘the ignorance of each other’. Jon was referring to how lawyers were ignorant of how medical doctors viewed the world of human rights and how medical doctors were ignorant of the fundamental principles of international human rights law. Had Dr. Pies looked at the American Declaration on the Rights and Duties of Man and the jurisprudence of the Inter-American Commission he would have found unequivocal proof that the body entrusted by the US government and 34 other governments in the Americas as OAS Member States, viewed the right to health as human right. Asking an American to look beyond their own borders , however, is difficult. However, if Dr. Pies had looked at even the Constitutions of about a third of the States of the United States of America he would have found recognition of the right to health or at least the value of health.
It is troubling that the number of States recognizing this right has decreased in recent years, but this unfortunate phenomena only shows that once again the US is moving in the direction of violating international law, instead of upholding it. Dr Pies is wise to conclude that all faiths support the right to health, but he also could have found his own faith in the right to health even if he had looked to the more humble origins of such a right in treaties that create legal obligations and have been voluntarily agreed to by almost all States in the international community.
Both the author and the observer have meaningful opinions in their arguments. However, I think that the observer missed the message in the short academic article: he concentrated on the means instead of the end… Even though the observer may find religion distasteful, he forgets that the voice of religion still appeals to majority of Americans – who may also not completely agree with the four corners of his religious opinions…
The point is that the right to health is fundamental to a dignified life. And when a society is economically and technically capable of providing it to all, it becomes morally imperative for that society to ensure that everyone enjoys ‘the right to health’. I refer the observer to the quote of Dr Paul Farmer in the last paragraph of the academic essay.
I would like to inform readers of my standard and long-standing policy regarding internet communications: I respond only to fully signed communications that adhere to standards of collegial civility and genuine willingness to exchange views. I appreciate your understanding, and I look forward to a good discussion.–Ronald Pies, MD
My thanks to Milan Markovic. I agree that religious postulates
are not necessarily translatable into human rights
under international law; the latter tend to be drawn more
from “natural law” doctrines associated with Enlightenment
figures, such as John Locke. Locke believed, e.g.,
that man’s natural rights are life, liberty, and
property. And, of course, I would endorse Mr.
Markovic’s view that “equal access to basic health
care is a moral duty of every society.”
I thank Dr. CFJ Doebbler for pointing out
that several treaties and U.S. state constitutions
recognize a “right to health” or the “value
of health”; unfortunately, with the possible
exceptions of Vermont and Massachusetts, it
is hard to find any state that has attempted
to put this belief into practice. My personal
view is that a single-payer universal insur-
ance system is the best way to bring this
about, as PNHP (Physicians for a National
Health Program) have advocated. Nonetheless,
I am not sure that any of this will satisfy
a philosopher that the right to health care
has been “proved”. I believe that choosing to
endorse health care as a right is really
an existential decision that every society
must face, without any sort of a priori
or logical “proof.”
Best regards,
Ron Pies MD
I would like to recommend to all readers a recent issue of The Journal of Medicine & Philosophy (Vol. 36, issue 6, Dec. 2011), which contains many valuable perspectives on health care as a basic human right. The articles span the range of opinions, from the libertarian to the liberal. I especially recommend the article by Eberl, Kinney, and Williams, entitled “Foundation for a Natural Right to Health Care.”
Clearly, my article is intended to focus on the religious perspective, and cannot hope to address all the moral, legal, and economic complexities inherent in a discussion of “rights” in general, or a “right to health care” in particular.
One argument I would like briefly to address is the notion–mistaken, in my view–that when we posit a “right”, we necessarily posit an “absolute” or unlimited right. Clearly, given the scarcity of health care resources, there must be limits of some kind on any putative “right” to receive health care. This is often addressed under the rubric of “rationing”. Philosopher Leonard Fleck (op cit) puts the problem this way:
“No matter what conception of health care justice we endorse, that conception will not be complex enough to address all the complexities (moral, medical, economic, technological) that would necessarily be part of rationing decisions that must be made in clinical practice…”
But, as the organization PNHP (Physicians for a National Health Program) point out, in the U.S., we are, effectively, already “rationing” care–by providing it largely to those who can afford it, or who have adequate health insurance. Others are systematically denied health care in the U.S.
Fleck goes on to make the important point that no solution to the problem will be “ideal”:
“We have to satisfied with outcomes that are non-ideally just, or “just enough.” Such outcomes are always open to criticisms as being “unjust” from some theoretical perspective.”
I believe that in the U.S., we are capable of creating a “just enough” system of universal health care, which will be far from ideal, but will be much better than what we now have. It will be based on the premise that while we aspire to optimal health care provided to all (e.g., under a single-payer plan such as proposed by PNHP), we will be unable to provide ideal care at all times, to all individuals. Moreover, universal health care does not eliminate a role for individual responsibility, in so far as he or she is able to provide for self-care and maintain good health habits.
Rather, universal health care would aspire to a “baseline” of feasible medical services for all, realizing that difficult decisions will still have to be made, with respect to extremely costly procedures, experimental treatments, etc. But such complexities do not get government “off the hook.” There is still a robust moral sense in which state, local and federal government are duty-bound to care for the health of their citizens. In this sense, a “right” to health care–albeit not an absolute right–may reasonably be held to exist.
Respectfully,
Ronald Pies MD
YES HEALTHCARE IS A “RIGHT” FOR EVERY AMERICAN CITIZEN! YES HEALTHCARE IS A MORAL ISSUE! WOULD YOU ALLOW YOUR MOTHER TO DIE BECAUSE SHE COULD NOT AFFORD PROPER CARE? OR YOUR SON OR DAUGHTER? OR NEIGHBOR? WHAT STATE OF SELFISHNESS AND EVIL HAVE WE COME TO IN THIS GREAT NATION THAT WE WILL JUSTIFY PEOPLE DYING BECAUSE OF THE OUTRAGEOUS EXPENSE OF HEALTHCARE????? JESUS NEVER ASKED ANYONE FOR INSURANCE! HE HEALED PEOPLE AND CARED FOR THEM! HOW WOULD WE EXPLAIN OURSELVES TO GOD KNOWING WE COULD HAVE GIVEN EVERYONE HEALTHCARE BUT DID NOT????
Readers may be interested in the interview in the March 6, New York Times, with Victor Fuchs, often considered “the dean of American health care economists.” Dr. Fuchs believes that using a “value-added tax” system and accountable care organizations, we can create a viable “…basic health care system for everyone” and “universal coverage.” Surely, we owe such a system to our fellow citizens as a moral duty. –Ronald Pies MD
For a much more detailed presentation of the Abrahamic faiths and their views on healthcare, please see:
http://www.hektoeninternational.org/Is-healthcare-a-right.html
Regards,
Ronald Pies MD