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Chapter 11

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Norman Daniels (11, Universal Healthcare Resources) argues for strong right to health care resources; appeals to Rawls Fair Equality of Opportunity Libertarian basis: fair opportunity such that everyone has equal access 1. Legal rights: there should be universal healthcare if we assume the position of legal positivist who maintain rights are only those that are outlined in laws 2. this implies most industrial democracies whose constitution outlines access to basic services also need to provide healthcare services; medically necessary services including preventive, curative, rehabilitative and long term care 3. Moral rights: a right to healthcare is construed as a positive right which requires the others to contribute resources/skills to the patients benefit 4. Daniels asserts that rights to equal opportunity are only violated when unfair state of affairs lead to the loss of competitive advantages in pursuit of reasonable life plans; inadequate healthcare could be viewed as an instance of this 5. Rights to healthcare, however, does not entitle an individual to a specific form of care; he is entitled only to that which, given realistic considerations, should belong to a system that reflect equality of opportunity through non discriminative principles; thus the right to healthcare is system relative 6. Treatment covered should be restricted to those proven to be efficacious and safe rather than the experimental 7. Services restricted to that which covers normal functioning rather than augmentary services such as cosmetic surgeries 8. abortion, infertility, growth hormone for those w/o deficiencies, mental health services are controversial cases since it is not clear which category they fall into 9. the distribution of resources in cases where a treatment which may modestly benefit a large number of people or significantly benefit a small number of people, or where the choice between treating the sickest is pitted against treating the less impaired are not clearly addressed by the normal functioning account 10. The cost analysis models also do not work since they may be based on controversial moral frameworks 11. Such choices will have to be made through fair, publicly accountable decision making processes 12. Basic services for normal functioning does not include services with high opportunity cost which consume resources that could be used to generate greater health benefits if used in other ways 13. Considering the possibility of a many tiered health system, priority should be given to the basic tier since it ensures the benefit of the majority 14. A supplementary tier of medical insurance may undermine the basic tier economically by drawing away quality care providers and politically by undercutting political support for the basic tier 15. It could also lead to two types of inequality: one in which the majority is served adequately while the rich have better service (not really objectionable) and one in which the majority buys supplementary insurance while the basic tier serves onlythe poorest (objectionable by the poor since they have been left behind, the supplementary tier is presumed to be better) 16. Of course, it is not problematic to have a supplementary tier if it does not undermine the basic tier and isnt objectionable Buchanan Chapt 11 argues that a policy to a decent minimum level of healthcare does not follow from the right to a decent minimum healthcare; it does follow from the combination of i) special rights argument ii) prevention of harm iii) prudential consideration and iv) enforced beneficence arguing that having a minimum level of health is everyones right such that resources should be dedicated towards it is not valid since health is not the only good which means resources of a society are claimed by competing goods It is also not possible to say that everyone should have the same degree of health since it is outside of the domain of social control the right to a decent minimum is theory dependent; it is not apparent independently, so it is inadequate 1. the attractions of a decent minimum includes i) the fact that the services provided are adjustable to relevant social conditions such as the availability of resources ii) and it avoids commitment to providing the best treatment available which drains resources; this leaves open the possibility of purchasing supplementary insurance if it does not interfere with basic package; thus, it is unnecessary to drop the level of care provided to below technically possible to avoid draining resources or raising it
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