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16.12.04, 19:32
Pozwole sobie zamiescic pare mysli na ten temat autorstwa pewnego eksperta,
ktorego biogram jest tutaj:
ethicscenter.nd.edu/about/engelhardt.shtml
Strasznie dlugie, ale bardzo ciekawe.
H. TRISTRAM ENGELHARDT, JR.
Rights to Health Care
A basic human right to the delivery of health care, even to the delivery of a
decent minimum of health care, does not exist. The difficult with talking of
such rights should be apparent. It is difficult if not impossible both to
respect the freedom of all and to achieve their long-range best interests.
Rights to health care constitute claims against others for either their
services or their goods. Unlike rights to forbearance, which require others to
refrain from interfering, rights to beneficence require others to participate
actively in a particular understanding of the good life.
Rights to health care, unless they are derived from special contractual
agreements, depend on the principle of beneficence rather than that of
autonomy, and therefore may conflict with the decisions of individuals who may
not wish to participate in realizing a particular system of health care. If
the resources involved in the provision of health care are not fully communal,
private owners of resources may rightly have other uses in mind for their
property than public care….[T]he principles of autonomy and beneficence that
lie at the foundations of justice will spawn conflicts within any portrayal of
a just allocation of health care resources.
THE LIMITS TO JUSTICE AS BENEFICENCE
These fundamental conflicts between respecting the freedom and achieving the
best interests of persons are made worse by commitments to goals that, if
pursued without qualification, lead to even more elaborate tensions within any
concrete vision of a just health care system. Consider the following four
goals that are at loggerheads.
1. The provision of the best possible care for all
2. The provision of equal care for all
3. Freedom of choice on the part of health care provider and consumer
4. Containment of health care costs
One cannot provide the best possible health care for all and contain the cost
of health care. One cannot provide equal health for all and maintain freedom
in the choice of health care provider and consumer. For that matter, one
cannot maintain freedom in the choice of health services while containing the
costs of health care. One also may not be able to provide all with equal heath
care that is that same time very best care because of the limits on the
resources themselves. These tensions spring not only from a conflict between
freedom and beneficence, but from competing views of what it means to pursue
and achieve the good in health care (e.g., it is more important to provide
equal care to all or the best possible care to the least well-off class?)….
JUSTICE AND INEQUALITY
Interests in justice as beneficence are sustained in part because of
inequalities among persons. That have some little while others have so much
properly evokes moral concerns of beneficence to provide help for those in
need….[T]he moral authority to use force to set such inequalities aside is
limited. These limitations are in part due to the fact that the resources one
could use to aid those in need are often already owned by other people. One is
forced to examine the very roots of inequality to determine whether such
inequality and need constitute a claim against those in a position to aid.
THE NATURAL LOTTERY
Natural lottery is used to identify changes in individual fortune that are the
result of natural forces, not the actions of persons. It is not used to
identify the distribution of natural assets. The natural lottery contrasts
with the social lottery, with is used here to identify chances in individual
fortune that are not the result of natural forces but the actions of persons.
The social lottery is not used to identify the distribution of social assets.
The natural and social lotteries together determine the distribution of
natural and social assets. The social lottery is termed a lottery, though it
is the outcome of personal actions, because of the complex interplay of
personal choices. They are both aptly termed lotteries because of the
unpredictable character of their out comes, witch do not conform to an ideal
pattern. All individuals are exposed to the brutal vicissitudes of nature.
Some are born healthy and by chance remain so for a long life, free of disease
and major suffering. Others are born with serious congenital or genetic
diseases, others contract serious crippling fatal illnesses early in life, and
yet others are injured and maimed. These natural forces, insofar as they occur
outside of human responsibility, can be termed the natural lottery. They bring
individuals to good health or disease through no merit or fault of their own
or others. Those who win the natural lottery will not be in need of medical
care. They will live extraordinarily full lives and die painless and peaceful
deaths. Those who lose the natural lottery will be in need of health care to
blunt their sufferings and, where possible, to cure their diseases and to
restore function. There will be a spectrum of losses, ranging from minor
problems such as having bad teeth to major tragedies such as developing
childhood leukemia, inheriting Huntington’s chorea, or developing
amyelotrophic lateral sclerosis. These tragic outcomes, as the blind
deliverances of nature, are acts to God for which no one is responsible
(unless, that is, one wishes to impeach divine providence). The fact that
individuals are injured by hurricanes, storms, and earthquakes is often simply
no one’s fault. Since no one is to blame, no one can be charged with the
responsibility of making those whole who lose the natural lottery on the
ground that they are accountable for the harm. One will need a special
argument to show that the readers of this [article] should submit to the
forcible distribution of their resources in order to provide health care for
the individuals injured. It may very well be unfeeling or unsympathetic not to
provide such help, but it is another thing to show that one owes such help in
a way that would morally authorize state force to redistribute resources, as
one would collect funds owed in a debt. The natural lottery creates
inequalities and places individuals at disadvantage without creating a
straightforward obligation on the part of others to aid those in need.