Academic journal article The Hastings Center Report

Access to Health-Related Goods

Academic journal article The Hastings Center Report

Access to Health-Related Goods

Article excerpt

There are many good reasons for a merger between bioethics and human rights. First, though, significant philosophical groundwork must be done to clarify what a human right to health would be and--if we accept that it exists--exactly how it might influence the practical decisions we face about who gets what in very different contexts.

Bioethics has gone global. No longer primarily limited to the hospital or doctor's office, bioethics has expanded its purview to accommodate issues of global significance: pandemics, international drug trials, physician brain-drain, human genetic engineering, population control, and access to pharmaceuticals, to name but a few. In response to this shift, commentators have called for human rights--a ready-made, legally sanctioned, universal moral framework--to serve as the lingua franca of the new global bioethics. Claiming that traditional bioethical principles are excessively focused on the individual and lack universal traction, proponents of this movement argue that human rights can provide much-needed guidance on difficult health-related issues that affect whole nations, populations, and even humanity itself.

But before human rights is imported wholesale into bioethics (or bioethics into human rights), significant philosophical groundwork must be done to clarify exactly how human rights claims should be understood. In this paper, we attempt some of this philosophical spadework as a prelude to examining the potential usefulness of the human rights framework for discussions bearing on one global issue in which human rights are increasingly, but not always successfully, deployed: namely, access to health care and the allocation of health-related goods, such as the social determinants of health. (1) More broadly, we ask what exactly it means to assert that human rights can or should constitute the lingua franca of a globalized bioethics, and what we can reasonably expect from such a framework as we grapple with these important and difficult questions. (2)

Why Bioethics and Human Rights?

There are many good reasons for a merger between bioethics and human rights. Bioethicists with strong commitments to social justice should find it natural to embrace the language and political agenda of the human rights movement--precisely the prescription urged upon bioethics by such distinguished advocates of human rights as the late Jonathan Mann, Paul Farmer, and George Annas. (3) Although there might be some doctrinal nipping and tucking required in the transition from the philosophical languages of human capabilities, utility, or opportunity to the lingua franca of human rights, there are many advantages to be gained by making this move.

In the first place, as Henry Shue points out, the human rights paradigm focuses attention on the legitimate claims of individuals in their dealings with oppressive or negligent states, thus underscoring the individual's status not as a mere supplicant for favors from duty-bearing bureaucrats, but as a person who can stand up and speak in her own name. (4) Moreover, the human rights movement has both political and legal dimensions that mere moral appeals manifestly lack. In contrast to ivy-covered bioethics scholars scribbling away in their ivy-covered studies, (5) advocates for human rights enjoy the political support of a worldwide network of influential international organizations such as UNESCO and the World Health Organization and nongovernmental organizations such as Amnesty International, Partners in Health, Global Lawyers and Physicians, and Doctors without Borders, for whom human rights has become a kind of moral-political Esperanto. In addition, because the moral claims of the human rights movement are embedded in legally binding covenants that have been ratified by many state governments, they often pack a more effective punch than arguments from bioethics or individual state-based regulatory institutions that lack global influence. …

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