Introduction
As far as healthcare rights are concerned, Tristram Engelhardt and Norman Daniels are on opposite sides of the aisle. Norman Daniel believes normal functioning can only be restored with minimum healthcare. He makes the case that denying people access to even the most basic healthcare violates their constitutional rights, though; as a result, the community is unfair. Tristram Engelhardt, on either hand, holds an overall libertarian position on healthcare, believing that individuals are not entitled to more than a basic level of treatment. He claims that perhaps healthcare freedom will deprive people of their liberty and invade their privacy. Engelhardt’s and Daniel’s arguments regarding overall privileges to healthcare and the application of their justifications about the libertarian sense of justice show various divergent viewpoints. Despite my hesitation to say that Daniels’ case for the freedom to primary minimal-based healthcare is entirely correct, I consider it much more persuasive because it gives a fundamental right towards healthcare while enabling access to far more expensive healthcare services for those who can finance them.
The freedom to choose alternative healthcare options over the ones provided by healthcare experts, particularly, the refusal of the traditional approach to treating healthcare problems due to the presence of specific personal beliefs and convictions can be viewed as a moral and ethical dilemma that the promotion of freedom in healthcare entails. On the one hand, as a healthcare expert, one must seek the ways of improving the quality of care and seeking the strategies for managing health issues in patients effectively, thus, following the principles of beneficence and non-maleficence. On the other hand, patients’ rights and freedoms in healthcare suggest that their demands in regard to the choice of treatment so that it could correspond to their beliefs and convictions dictates that thy should be provided with an opportunity of alternative treatment. Thus, as a healthcare practitioner, one is likely to face a dilemma that is exceptionally difficult to resolve, namely, the collision of the pursuit of patients’ interests and the need to encourage patient autonomy.
As a consequence of multiple ideas of distributive-based justice, the notion of an overall “decent minimum” in health care is defined differently. It is possible to negotiate to a certain extent that everyone has the unrestricted right to adequate and affordable healthcare, but disagreements emerge over how much healthcare is covered and what it covers. In their writings, three philosophers offer a different takes on the subject. This paper will discuss two philosophers’ perspectives regarding decent minimum healthcare, but they have conflicting opinions. Applying the theory in question to the scenario described above will allow determining the best course of action to be taken by a healthcare provider to ensure that a patient’s needs are fully met and that the health issue is managed in the best way possible.
Discussion on the Perspective of H. Tristram Engelhardt Jr. and Norman Daniels
H. Tristram Engelhardt Jr. and Norman Daniels are two prominent philosophers whose views on what constitutes a reasonable basic level of healthcare are opposed. Norman Daniels asserts that human beings have an affirmative entitlement towards health care, which he describes as follows: positive rights in this context alluded to the notion that the administration or government is compelled to continue providing healthcare services to its citizens. Throughout his reasoning, John Rawls’ equity concept of “fair equality regarding opportunity” is used in the context of the case in question. He argues that diseases and disabilities obstruct the “fair fairness and equality of opportunities” that Rawls refers to in his essay on justice (Daniels, 1998, p.739). “Healthcare coverage with all its manifestations, regardless of whether public-based health or overall medical, preventative or acute and chronic, tries to maintain individuals working as nearer to ordinarily as feasible,” he writes in his arguments (Daniels, 1998, p.739). He thinks that national healthcare preserves equilibrium among individuals. Daniels continues this argument by adding that the healthcare system maintains individuals and the scale of choices they possess, were they not sick or incapacitated, given existing qualities and capabilities.
Since the healthcare system, in most cases, restricts illnesses and developmental disorders and, as just a result, tends to increase the choices available, healthcare is essential for ensuring that this particular equality is maintained. Norman Daniels differs from H. Tristram Engelhardt Jr. In this regard, Engelhardt contends that there is no such thing as reasonable minimum healthcare freedom. According to him, “a fundamental human universal moral freedom of healthcare does not appear even when a ‘decent minimum regarding healthcare’” is sufficient to determine his point of view (Engelhardt, 1996, p.750). Engelhardt argues against an overall decent minimum level of healthcare, considering the funds and public resources associated with it as a collective unit. “It is impossible to provide or offer the best quality healthcare for everyone while also controlling healthcare expenses,” (Engelhardt, 1996, p.750). It is indeed possible that one will not be in a position to provide everyone with equivalent healthcare which is of the overall highest quality due to a lack of enough resource base (Engelhardt, 1996, p.752). As a result of these considerations, he believes that an unrestricted right to healthcare seems implausible. In contrast to Daniels, Engelhardt does not think healthcare is regarded as a positive right. As far as he is concerned, the society has the power to freely offer needy people the help they deserve regarding healthcare. He goes further to explain that there exists no legal obligation in providing the needy with healthcare services.
Applying the perspectives in question to the case under analysis, one will realize that the problem of introducing the required healthcare services to an individual whose perceptions concerning a certain solution, such as the possibility of a surgical intervention, have already been preset and currently affect the extent of the positive effect that the proposed change can make, is quite complex. Moreover, the issue under analysis is connected directly to the concept of patient freedom and reflects the juxtaposition of the perspectives offered by Engelhardt and Daniels, the latter supporting the concept of freedom and the former denying it. Specifically, Daniels (1988, p. 763) suggested that “a right to health care imposes an obligation on others to assist the right-bearers in obtaining needed and appropriate services.” Integrating the specified perspective into the discourse will suggest that the right to healthcare will also involve active patient education, which should be regarded as a solution to the dilemma under analysis.
Allen E. Buchanan is another philosopher who occupies a middle ground between the opposing viewpoints of H. Tristram Engelhardt Jr. and Norman Daniels. He begins by providing fundamental clarifications on the right to decent-based minimum healthcare coverage by stating three characteristics of such rights. The first line of thought is as follows: “To claim that individual A has the right towards something, X, they are first and foremost to declare that A possesses the right to X commodity.”(Buchanan, 2017, p.67). The first characteristic of any right seems to be that someone has a legal claim towards other things. He does, nevertheless, conclude that entitlement is not a factor in determining morality.
Buchanan states that “valid rightful claims can, at the very least throughout the instance of fundamental rights, be supported by penalties, involving coercion when necessary”(Buchanan, 2017, 56). According to the idea of Buchanan, compulsion is legitimate when used to obtain a legal right. Therefore, any right’s third and last characteristic is that any natural right will always win over utility. Encroaching the freedoms or rights for utility would not be an acceptable justification. With this definition of the characteristics of privileges, Buchanan expresses his position on the right to a reasonable minimum of health.
Buchanan contends, like Engelhardt, that the idea of an overall universal human right towards the decent minimum of healthcare cannot be used to justify an obligatory proper minimum legislation in the absence of such a right. Buchanan begins by considering the advantages of the concept of a reasonable minimum wage. On this particular case, he lists three of the following advantages: the ability for society to adapt to the quality of assistance supplied, avoidance of the overuse of the powerful equal opportunities principle, and restrictions of healthcare coverage towards the most basic-based services.
Therefore, after taking all of these advantages into account, he concludes that “the notion that everyone has a freedom to a better minimum of healthcare seems insufficient as an overall moral foundation for something like a coercive force enforced decent minimum legislation therein lack of a clear and persuasive legal doctrine” (Buchanan, 2017, p.79). According to him, they barely strengthen the weaker conditioned proposition that, if there is a need to healthcare coverage, it will become restricted more than the rights to substantial equitable opportunity (Buchanan, 2017). During his refutation of the benefits, he points out that healthcare freedom is contingent on the overall resource availability. This step is one of Engelhardt’s points against a reasonable minimum wage in his case.
In the case of Buchanan, he opposes a global decent minimum standard; he supports a required minimum standard for some groups of people. He backs up his allegation with several supporting arguments. Buchanan’s first point of contention is in the area of special rights concerns. In these particular freedom claims, the philosopher refers to three different types of persons, including harmed individuals, wrongly treated individuals, and committed individuals. Focusing on the first category, he begins by mentioning those who have been harmed by institutional inequities in history and now and then argues that the freedom to any decent minimum seems to be an effort to redress institutional inequality. The second set of persons who might fall into this category might be those subjected to wrongful treatment by several private entities. It would be appropriate to compensate for unfair injury by providing medical care.
The third category of persons described are those that have made lifetime commitments. Military men, for example, would fall into the third category of people because they have made extraordinary commitments for the good of the country. Soldiers are obligated to safeguard the citizens from several evils originating from the activities of humans living together under great numbers, he argues throughout his second-based argument for harm mitigation (Buchanan, 2017). Buchanan provides examples like cleanliness and vaccination to illustrate his point. According to Buchanan, there is a moral need to give some appearance of equal treatment under the law, and this act, therein the form of access to essential health care services, must not vary across the nation. Last but not least, his final argument in support of the assertion that the government should supply specific individuals with healthcare seems to be the wise reasoning that doing so would result in a somewhat more efficient labor market and a much more physically fit population. According to Buchanan’s three reasons (special rights or freedoms claim, mitigation of suffering, and pragmatic argument), particular persons should have the liberty of a decent or reasonable minimum of healthcare benefits under the Affordable Care Act.
Following the definitions of these three prominent philosophers’ perspectives on minimum tolerable health in place, it is evident which systems every philosopher believes to be superior. Mr. Daniels claims that there must be a right toward healthcare in almost every sophisticated industrial democracy worldwide and in this case, though, the United States stands apart (Daniels, 1998). His criticism of the United States’ overall healthcare system is based on comparisons with the techniques of other industrialized countries, as seen by this comment. He is firm in his belief that an overall decent minimum should be required. Daniels believes that a solitary payer healthcare-based system would be preferable.
The single payer-based system should ensure that all citizens receive a fair basic standard of living. The privatized healthcare-based system, on either hand, has been argued for through Engelhardt, with prospective public healthcare alternatives offered by the entire government. He contends that “it is impossible to give fair healthcare coverage for everyone while also respecting the rights of the people to seek with others their ideas of healthcare coverage or to spend their energies and resources therein any manner that they choose” (Engelhardt, 1996, p.762). Even if he opposes the government’s responsibility to provide a reasonable minimum, he believes that a negotiated program to assist needy people is morally acceptable in the long run.
A philosopher whose overall beliefs fall somewhere between Engelhardt and Daniels, Buchanan is presumed to support the healthcare system in the United States of America. As opposed to the decent universal minimum offered by the single payer-based systems, and a reasonable minimum for particular segments of the population, which is never provided by a wholly privatized, multi-payer program, he advocates for an overall decent minimum amongst all individuals. A hybridized healthcare system exists in America which meets the needs of Buchanan’s position while also being cost-effective for the majority of the population. Buchanan alludes to the “specific individuals” who can be covered by private insurance firms and public choices like Medicaid and Medicare.
The above-discussed viewpoints could also be used to conjecture and theorize about whether or not the mentioned philosophers would have been in favour of or against specific healthcare legislation, such as the Affordable-based Care Act. The people whose employment has not been insured, teenagers, children, and individuals who earn under 137% of the overall poverty level can get insurance through the excellent Affordable Care-based Act, which was signed into law by President Obama back in 2010 (Writers, 2022). Norman Daniels could very well support this legislative proposal to provide some individuals with an entire decent minimum standard of living. He would see it as a stage of the process toward a universal decent reasonable standard of living mandated by law. Still, he could critique the rule as insufficient, arguing that it does not go far enough.
Despite its best efforts, this initiative fails to offer everyone “fair equality in opportunity.” However, Engelhardt might consider this particular approach or program unethical and unacceptable on moral grounds. This initiative compels the federal government’s involvement and may not possess the general public’s support. It also harms the privatized insurance sector. If Buchanan’s point of view were applied, he would very certainly support this particular legislation. Besides, as a result of the excellent Affordable Healthcare Act, Medicaid and Medicare might be considered to be expanded. It takes a comprehensive approach to providing healthcare services to many people who could be classified as “particular persons.”
At the same time, despite the presence of an obvious conflict between the perspectives under analysis, opportunities for proper care can still be introduced into the target context while maintaining the principles of patient autonomy. Furthermore, the concept of patient autonomy does not necessarily have to clash with the idea of nonmalefience and patient beneficence once appropriate healthcare practices are introduced. Specifically, the dilemma under analysis can be resolved by reinforcing the focus on patient education as one of the core tools for addressing the problem of a patient refusing to accept the proposed treatment.
The suggested change aligns with the core principles of the theories under analysis seamlessly. Specifically, Engelhardt’s perspective is reflected in the specified approach quite accurately through the introduction of patient education tools as the framework for managing the problem of the lack of literacy in target audiences and, therefore, their inability to make an informed decision concerning their treatment. Similarly, the described change will allow managing another side of the standpoint defined by Engelhardt’s vision, namely, the possible incongruence between the patient’s philosophy and the principles of healthcare and nursing, namely, those of patient beneficence and nonmaleficence. Namely, the principles in question will be supported by the reinforcement of health literacy and the provision of opportunities for making an informed decision for a patient. Similarly, the offered solution aligns with the perspective offered by Daniels, namely, the one supporting the concept of the freedom of choice in the healthcare context. Specifically, in the proposed scenario, a patient will make the choice that will imply a health-oriented perspective while aligning with the patient’s concept of self and the related beliefs constituting the core of the patient’s identity. Thus, a sensible balance between the two perspectives can be maintained as long a patient education and health literacy are prioritized in the healthcare context.
The three discussed philosophers have contrasting perspectives on a reasonable minimum level of quality healthcare. Even though their points of view are comparable, each of these arguments pertains to a different section of the universal healthcare spectral range. Therefore, to speculate about these unique philosophers’ viewpoints, the perspectives could be adopted and utilized in numerous healthcare-based systems and laws, such as the well-known Affordable Healthcare Act. Whereas H. Tristram Engelhardt Jr. and Norman Daniels are on opposite sides of this argument over what constitutes a reasonable minimum wage, Buchanan falls somewhere in the midst, somewhat concurring with Daniels and partially with Engelhardt regarding the same case. Besides, after outlining healthcare benefits, Buchanan argues that such circumstances do not warrant the right or freedom to an overall decent or good minimum standard of living. Nonetheless, he believes that states would have to provide proper healthcare coverage for specific people by presenting three excellent arguments and providing evidence of individuals who either of them has touched. It is reasonable to assume that Buchanan’s point of view refers to the existing healthcare-based system in America and other parts of the world.
He believes that individuals are entitled to essential minimal-based health. Following an examination of the rights to healthcare services from a practical and libertarian perspective, he suggests creating an overall tier system. There are many ways to improve the quality of life for all people, but one of the most important is eliminating diseases and disabilities. Equality of opportunity will only be breached if unfair societal activities or avoidable or treatable diseases and disorders make it impossible for everyone to achieve their real-life goals.’ Somewhat of removing all gaps in capability, a just community will endeavour to alleviate the consequences of these disparities in a competitive edge in other methods. Using the concept of tiers of healthcare services, Daniels argues that the individual’s entitlement to fair opportunity justifies the right to excellent healthcare.
On the other hand, Tristram Engelhardt is staunchly opposed to universal healthcare coverage. There is no moral justification for a single-tier health care system because it ignores the range of ethical views that constitute health care concerns, the temporal boundaries of state power, and people’s control over themselves and their possessions. According to Engelhardt, it becomes difficult to respect everyone’s freedom while ensuring that everyone has accessibility to the finest available healthcare (1996). An overall just society acknowledges the diversity of ideas on what constitutes goodness, equality, and justice.
Consequently, the social-based lottery and the nature-based lottery are distinguished. Social and natural lotteries and individual free choices impact the allocation of social and natural resources (Engelhardt, 1996). There are two types of people: the few who win a natural lottery and those that lose. The latter will require healthcare services to alleviate their agony. Because these consequences are “deliverables of nature, over which nobody is accountable,” nobody is obligated to aid them. As a result, those blessed with good fortunes, such as friendships, affection, comradeship, and several other positive human relationships, have an advantage in the game of the social lottery and can win (Engelhardt, 1996). If someone wins or loses the lotto, it is not because of a lack of equality or inequality but because one had good or terrible luck (Engelhardt, 1996). For example, Engelhardt argues that while harmful conditions and diseases caused by the natural forces are sad, and illnesses caused by the nonconsensual activities of other people are unjust, the community is not accountable for any state and so, as a result, is under no obligation to correct them.
Thus, to begin with, libertarianism believes that individuals have no freedom to public healthcare, which is the exact reverse of what Daniels is advocating, and therefore a libertarian could vehemently disagree with his position. Individual liberty and property rights might be violated if healthcare resources were compelled to be provided under threat of government compulsion. Engelhardt’s libertarianism shows a shocking lack of consideration for the disabled and the impoverished needs. When it comes to fairness, the libertarian perspective is severe in its indifference to those who need assistance and its emphasis on the belief that providing basic-based healthcare through contributions towards the allocation of services is a breach of one’s right to liberty.
Conclusion
In conclusion, the right to primary healthcare is essential to all individuals. Therefore, for a society to work successfully, all individuals must be expected to contribute to well-being or health; this necessitates the notion that everyone will provide and receive in equal measure. Using Daniels’ tier healthcare-based system, it appears to be possible to strike a balance between society’s moral obligation to provide treatment to individuals in need and offer protection of a citizen’s right or freedom to choose their healthcare provider. Even though Norman Daniels’ proposed tier system enables those individuals in a position to afford it to acquire better medical care than the basic tier, this system also provides greater freedom within healthcare while somehow taking into account the medical needs of the needy who cannot afford it. The specified issue is also inextricably linked to the problem of low health literacy in patients, as well as a conflict between a patient’s belief system and the proposed treatment strategy. Namely, when having to face the dilemma of choosing between a patient’s autonomy, specifically, the right to freedom in regard to the rejection of the proposed treatment options and the selection of alternative treatment strategies, and the need to ensure patient beneficence, a healthcare provider is likely to encounter a substantial moral issue.
References
Buchanan, A. E. (2017). The right to a decent minimum of health care. Health Rights, 41–64.
Daniels, N. (1998). Is there a right to health care and, if so, what does it encompass? A Companion to Bioethics, 362–372.
Engelhardt Jr, H. T. (1996). Rights to health care, social justice, and fairness in health care allocations: Frustrations in the face of Finitude. The Foundations of Bioethics, 375–410. Oxford University Press.
Writers, S. (2022). Understanding the Affordable Care Act.