The American College of Physicians, the country’s premiere organization devoted to Internal Medicine, has issued a position paper describing its commitment to health as a “human right”. It’s appended below so you can read it independent of my comments about its worth and coherence. The ACP and the authors of the paper are serious both on knowledge and so-sophistication. Their problem is they are dealing with an issue of such complexity that it is well beyond their ken. It’s an issue that would likely defeat any commentator or group of observers.
The initial problem with the paper, and a relatively minor one compared to the rest is that its authors do not define the most important terms they discuss. What does it mean to hold that health is a human right? If you fall down and break your leg have your human rights been diminished? The logical extension of this simplistic belief is that death is a denial of a human right. There are no healthy corpses. Then there’s the definition of healthcare which is held to be an ethical obligation of a just and equitable society. What’s included in healthcare? Cosmetic surgery hair transplantation, chemotherapy for a 105 year old patient? The authors are aware of these problems but stay away from them as much as possible as they are afraid to offend a constituency. Alas, there is always such a constituency that will be offended irrespective of what position they take. So they remain as soft and camouflaged as possible.
When the ACP discusses rights it cites United Nations documents rather than US law. It repeatedly uses the UN as a source for proper behavior. Searching for justification of human rights at the UN is like looking for virtue in MS13. Iran’s envoy just served as the chair of the UN Human Rights Council meeting in Geneva. The ACP doesn’t seem to worry about the company it keeps.
The authors and their ACP overseers are aware of the difference between positive and negative rights. The distinction doesn’t seem to trouble them. The best discussion of the two kinds of liberty is Isaiah Berlin’s Two Concepts of Liberty. It too is appended below.
Briefly, Berlin divided liberty into negative and positive expressions. The former is the degree to which the individual should be left alone to do as he pleases. Positive liberty is involved in the answer to the question `What, or who, is the source of control or interference that can determine someone to do, or be, this rather than that?’ It is from Rousseau that the well of positive liberty springs. It is the realm of utopianism. The desire to force people to behave in a way that seems beneficial to society is always bad – there are rules and regulations that make civilized society possible. It is when this concept is carried to what seems extreme to some, but loathful to others that the problem arises.
When society or a component of it defines rights that must be paid by others at pain of property and liberty the problem hits like a hailstorm. Who decides who gets what, at what cost, and who pays? The ACP offers no thoughts on how their lofty goals of positive liberty might be enacted. They go on to say they are “agnostic as to whether legal mechanisms are necessary or sufficient to ensure the means for health.” How do they expect their goals to be met? They want physicians to have an unwavering commitment to human dignity. Who doesn’t? Pure pablum.
They’re all for ethical and evidence-based medicine to support health. They cite the UN again as their source. But they don’t define what either is. They then go on the admit that there are limits to how much medical care (not the switch from health the medical) can be provided. But they present no method for elaborating these limits.
Then not unexpectedly they go into a foray about clean water and air, education, climate change, and the root causes of ill health. Then having medicalizing social issues they warn not to do so. They also briefly touch on self-identified gender, but quickly back off this minefield. They favor the establishment of patient and family advisory councils – as if we needed more committees.
In their final proposition, they concede that right-based approaches have limits. Many readers likely started out with this view. They then inevitably fall back on an appeal to social justice. The obvious response is to ask how social justice differs from unmodified justice.
Having spent an entire article on health and healthcare as a human right The paper concludes with: “Equitable and universal access to appropriate healthcare is an ethical obligation to a just society. But a just society also recognizes that health-related obligations are not only answered by reference to the concept of health as a human right, that other concepts of fairness, just priority setting, virtues of caring, and other ethical values are still needed. There will still be resource allocations … that require more comprehensive approaches to social justice.” Integrate all of this soaring gibberish if you can.
Doctors have more than enough on their plates just trying to deal with the myriad medical problems that afflict their patients without sailing deeper into the Seaweed Sea of both governmental and self-imposed bureaucratic chains. As I’ve mentioned here before, practicing physicians have never been further separated from the leadership of their profession than they are today. The ACP Position Paper as well-meaning as it is is another example of this distance.
The purpose of medicine is straightforward. It’s to prevent premature death and relieve pain and suffering. What this position paper has to do with either is obscure.