Ethical Issues in Health Care

¶ … James Du Bois brings up a point that is pertinent to each and every one of us who has to pay taxes knowing that a good part of these taxes will go to paying for the health care of the less-fortunate others. More than one of us has asked "Am I morally obliged to make sacrifices to ensure that all who live in the U.S. have access to health care?" And "If so, why?" And politicians, thinkers, activists, social workers and so forth have frequently relied on the notion of social justice to support their reasoning that we are morally obliged to work for the welfare of others. Du Bois shows the emptiness of this argument.

Aristotle recommends that "equals be treated equally." Few argue with this. The problem comes about when defining what "being treated equally" means and how to set into effect the implications.

The welfare theory of justice views people as largely determined by their genetic make-up, their upbringing, and their social environment. Things happen to them. Those who are intelligent, rich, born into wealthy families, or born healthy are simply luck. They are not meritoriously better or worse than those who lack these benefits. Welfare liberals thus consider no one to be better than another or to deserve more booty than the other due to his advantages; rather "to each an equal share."

Libertarians, on the other hand, perceive humans as free and responsible for their fate. Regardless of their aptitude or conditions, a human can -- would he so wish -- raise himself from his plight by dint of labor and perseverance. If he does not do so, he only has himself to blame. Robin Hood, in this view, is a thief, since property belongs to he who worked for it, and the state should intervene as little as possible -- this would be called interference -- to rob the laborer of his reward. The reward belongs to the laborer alone and is to be apportioned to noon without his consent.

Both views -- Du Bois shows -- have their limitations. The welfare view is correct in establishing limitations for that which we can choose in life. It is not always our fault that we were born handicapped, illiterate, or poor. On the other hand, people do, t times, need to be held accountable for their actions. The welfare view fails to do this. The libertarian perspective, on the other hand, takes the opposite stance and overlooks the debt that he wealthy and well-educated person owes to society. It is not merely his own efforts that have helped him; society has done a lot to push him on his way.

The greater question too, is: what about those who knowingly harm their health, or willingly remain unemployed despite their capacities to find labor? Do we have to support these people too? The only answer for this is recourse to Charity. Sine it would be complex to found secular Justice on persuasive reasons of Charity and since it would be even more ethically complex to enforce these ideas of charity, the only way that health care reformers can attempt to persuade the American public to salvage some of their hard-won money for the health concern of people who earn less than they is to find extremely compelling reasons to persuade them to do so.

Du Bois' article is not only interesting but he also presents a pertinent question and answers it in a compelling, logical way.

We all have had the question about why we have to dole out some of our money to others. Du Bois shows that there are two opinions on this. He refrains from showing his allegiance to either opinion, merely helping us understand them and showing us their merits and demerits. He shows us how neither of them stand, nor do they provide an answer to the ultimate question: what about those who refuse to work or who persist in harming their lives.

This is a very good question.

Du Bois proceeds to mention charity and here we think he may be stepping on slippery ground since charity is a religious theme. However, as he shows us, charity cannot be enforced on a secular public. There would be too many complications were it done so. Others such as Leibniz have done so in the past. Today's government where state and religion is separated would suffer from the consequences. The only recourse, therefore, is for health care reformers to create compelling reasons for imposition of taxes. Unless America continues in its bumbling way to the subject as it has done until now.