Advocating Basic Minimum Medical Care: A Case of Justice Denied

Dyck, Arthur J.

doi:10.1007/978-3-030-21707-5_3

Advocating Basic Minimum Medical Care: A Case of Justice Denied

Arthur J. Dyck⁹

Chapter
First Online: 06 July 2019

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Part of the book series: Library of Public Policy and Public Administration ((LPPP,volume 13))

Abstract

There is a widespread assumption that it is just to guarantee all individuals access to a basic minimum of healthcare. I contend in this chapter that this is based on a flawed concept and application of justice: it fails to use the generic concept of justice—namely of what we owe one another, that is, all moral demands, such as avoiding existing harmful practices and drawing upon the enormous amount of money generated by providing medical care to pay for that care. Omitting any references to these moral demands leads the proponents of minimal medical care to not even consider the possibility of achieving needed medical care for all. Thus they leave intact a system of healthcare that violates the impartiality justice demands—fair, equal treatment for everyone.

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Notes

1.
In this chapter, we will analyze the works of three such notable scholars: Norman Daniels , Just Health: Meeting Health Needs Fairly (New York: Cambridge University Press, 2008); Martha C. Nussbaum , Frontiers of Justice: Disability, Nationality, Species Membership (Cambridge, M.A.: Harvard University Press, 2006); Amartya Sen , The Idea of Justice (Cambridge, M.A.: Harvard University Press, 2009).
2.
Medicare and You (U.S. Department of Health and Human Services, 2011), 46.
3.
The Patient Protection on Affordable Care Act (On Hundred Eleventh Congress of the United States of America: H.R. 3590, January 5, 2010).
4.
Daniels, Just Health; Nussbaum, Frontiers of Justice; and Sen, The Idea of Justice.
5.
One notable exception to the practice of finding the moral basis for universally accessible healthcare in a concept of distributive justice is the appeal to beneficence made by Allen Buchanan, “Health-Care Delivery and Resource Allocation,” in Robert M. Veatch , ed., Medical Ethics (Subury, M.A.: Jones and Bartlett Publishers, 1997), 321–361.
6.
As noted in Chap. 1, the neurosciences provide evidence for such natural proclivities. For this, see Martin L. Hoffman, Empathy and Moral Development: Implications for Caring and Justice (New York: Cambridge University Press, 2000); and Allan N. Schore, Affect Regulation and the Origin of the Self: The Neurobiology of Emotional Development (Hillsdale: N.J.: Lawrence Erlbaum Associates, 1994), 348–354.
7.
Hoffman, Empathy and Moral Development, refers to work with juvenile delinquents that uses techniques to evoke empathy and thus awaken inhibitions against aggressive and violent behavior.
8.
That shame and the anticipation that certain behaviors would be shameful is an essential ingredient in moral development, is documented by Schore, Affect Regulation and the Origin of the Self, 349–350.
9.
William K. Frankena, Ethics (Englewood Cliffs, N.J.: Prentice-Hall, Inc., 1963), 39.
10.
John Rawls , A Theory of Justice (Cambridge, M.A.: Harvard University Press, 1971). For his final work, edited by Erin Kelly, see Justice as Fairness : A Restatement (Cambridge, M.A.: Harvard University Press, 2001).
11.
Daniels, Just Health.
12.
Rawls, A Theory of Justice, 92; Rawls, Justice as Fairness, 174.
13.
Rawls, A Theory of Justice, 250.
14.
Ibid., 83.
15.
Ibid.
16.
Ibid.
17.
Daniels, Just Health, 11.
18.
Ibid.
19.
Ibid., 37.
20.
Ibid., 30.
21.
Ibid., 56–58.
22.
Ibid., 30, Footnote 1.
23.
Ibid, 63.
24.
For a definition of community and universal community, see Arthur J. Dyck, Rethinking Rights and Responsibilities: The Moral Bonds of Community (Washington, D.C.: Georgetown University Press, 2005), 95 and 199–200.
25.
Daniels , Just Health, 57.
26.
Ibid., 63.
27.
Ibid, 143–144.
28.
Ibid., 135.
29.
Ibid., 136.
30.
Ibid.
31.
Ibid.
32.
Ibid., 137.
33.
Ibid., 135.
34.
See, for example, Peter A. Muennig and Sherry A. Glied, “What Changes in Survival Rates Tell Us about U.S. Health Care,” Health Affairs 29:11 (November, 2010), 2105.
35.
Daniels , Just Health, 127.
36.
Ibid.
37.
Ibid., 128. However, there is some support for cost-effectiveness in the U.S. Congress. Cost-effectiveness appears as a criterion for care-giving in the Patient Protection and Affordable Care Act.
38.
Daniels, Just Health, 128.
39.
Robert Jay Lifton , The Nazi Doctors: Medical Killing and the Psychology of Genocide (New York: Basic Books, Inc., 1986), 500.
40.
Ibid.
41.
Edmund Pellegrino , “Rationing Health Care: The Ethics of Medical Gatekeeping,” in Health Care Ethics: Critical Issues for the 21st Century, John F. Monagle and David C. Thomasma, eds., (Gaithersburg, Maryland: Aspen Publishers, Inc., 1998), 415.
42.
Ibid., 416.
43.
Ibid.
44.
Nussbaum , Frontiers of Justice, 38.
45.
Ibid., 74.
46.
Ibid., 75.
47.
Ibid., 76–77.
48.
Ibid., 70.
49.
Ibid.
50.
Ibid.
51.
Ibid., 285.
52.
Ibid., 337.
53.
Martha C. Nussbaum, Women and Human Development: The Capabilities Approach (New York: Cambridge University Press, 2000), 75.
54.
Ibid., 86.
55.
Ibid., 87.
56.
Ibid.
57.
Nussbaum, Frontiers of Justice, 79–80.
58.
Daniels , Just Health, 64–71.
59.
Nussbaum, Frontiers of Justice, 85.
60.
Nussbaum, Women and Human Development, 81.
61.
Nussbaum, Frontiers of Justice, 294.
62.
Nussbaum, Women and Human Development, 155.
63.
Nussbaum, Frontiers of Justice, 347.
64.
Ibid., 76.
65.
Ibid.
66.
Washington v. Glucksberg, 117 S. Ct. 2258 (1997), 2272.
67.
Federal Constitutional Court of West Germany, in Ethics in Medicine, Stanley Joel Reiser , Arthur J. Dyck, and William J. Curran, eds. (Cambridge, M.A., 1977), 417.
68.
Ibid, 419.
69.
Nussbaum , Frontiers of Justice, 168.
70.
Ibid.
71.
Ibid., 408–414.
72.
Ibid. Note that Nussbaum does not attend to the existing natural expressions of the empathic emotions that make individual and communal life possible. Care, nurture are key natural expressions of empathy; that she overlooks.
73.
Ibid., 372.
74.
Ibid.
75.
Ibid., 372–373.
76.
Ibid., 294–295.
77.
Ibid., 292–293.
78.
Ibid., 293.
79.
Ibid., 293.
80.
Nussbaum, Women and Human Development.
81.
Nussbaum, Frontiers of Justice, 160 and 356.
82.
Ibid., 162.
83.
Ibid., 78.
84.
Sen, The Idea of Justice, 226.
85.
Ibid., 227.
86.
Ibid., 228.
87.
Ibid., 231.
88.
Ibid.
89.
Ibid, 233.
90.
Ibid.
91.
Ibid.
92.
Ibid., 291.
93.
Ibid., 295.
94.
Ibid.
95.
Ibid., 226.
96.
Ibid., 227.
97.
Ibid., 282.
98.
Daniels , Just Health, 314.
99.
Ibid., 316.
100.
Ibid.
101.
Ibid.
102.
Ibid.
103.
Ibid., 317.
104.
Ibid.
105.
Ibid., 103.
106.
Ibid., 316.
107.
Ibid., 118.
108.
Ibid, 118–119.
109.
Nussbaum, Women and Human Development, 97.
110.
Ibid.
111.
Ibid.
112.
Ibid., 98.
113.
Ibid.
114.
Ibid., 99.
115.
Ibid., 100.
116.
Ibid.
117.
Ibid, 101.
118.
Nussbaum , Frontiers of Justice, 284.
119.
Ibid.
120.
Ibid., 285.
121.
Ibid, 285.
122.
Ibid, 287.
123.
Ibid., 74.
124.
Ibid., 75.
125.
Ibid., 78.
126.
Ibid.
127.
Ibid., 292.
128.
Ibid., 287.
129.
Sen, The Idea of Justice, 143.
130.
Ibid., 357–358.
131.
Ibid., 363
132.
Ibid., 366.
133.
Ibid., 367–368.
134.
Ibid., 368.
135.
Ibid.
136.
Ibid.
137.
Ibid., 369.
138.
Ibid., 42
139.
Ibid. 45.
140.
Ibid, 117. Although the reference of this juncture is to Wollencroft, the view is also that of Adam Smith .
141.
Ibid. 368.
142.
Ibid., 226–227.
143.
Nussbuam, Frontiers of Justice, 285.
144.
Ibid., 74.
145.
Ibid., 78.
146.
Ibid.
147.
Ibid., 293.
148.
Ibid., 294.
149.
Ibid., 295.
150.
Ibid.
151.
Daniels , Just Health, 112.
152.
Ibid., 118–119.
153.
Ibid., 110.
154.
Ibid., 113.
155.
Ibid., 118.
156.
Ibid.
157.
Ibid., 127.
158.
Ibid.

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The Divinity School, Harvard University, Cambridge, MA, USA
Arthur J. Dyck

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Dyck, A.J. (2019). Advocating Basic Minimum Medical Care: A Case of Justice Denied. In: Achieving Justice in the U.S. Healthcare System. Library of Public Policy and Public Administration, vol 13. Springer, Cham. https://doi.org/10.1007/978-3-030-21707-5_3

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DOI: https://doi.org/10.1007/978-3-030-21707-5_3
Published: 06 July 2019
Publisher Name: Springer, Cham
Print ISBN: 978-3-030-21706-8
Online ISBN: 978-3-030-21707-5
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