Is Health Care a Human Right?

You’re in the last week of your one-month rotation in El Salvador. The clinic’s housekeeper brings in her 2-year-old son, Javier. He is small for his age, gets tired very easily, and since birth has had episodes in which he turns blue and passes out. You and your attending determine that he has a serious congenital heart defect that will lead to heart failure and death if untreated. Your attending tells you that no doctor in El Salvador has the skill or tools to perform the surgery Javier needs, so you should send him home with prayers. Your last preceptor in Charlottesville performed the surgery for this condition frequently.

Before your rotation began, you personally fundraised $7000 from friends and family so that you could invest in something worthwhile for the community where you are working. With this money you can fly the boy and his mom to the US to have the surgery. What choice do you make? How will you spend your money?

Someone with insurance in the US can easily have this surgery performed. Are you morally and ethically responsible to Javier, given that other children in his situation would die? Should he receive the same quality of care that your nephew in the US may receive? Using an ethical framework, is health care a human right?

Moderator: You Have the Right to Remain Uninformed

This case turned out to be less controversial and more informative, at least for me. I had never thought that anyone would NOT want to know the details of her care, but it happens more often than one might think.

Although there was some disagreement among commentators concerning hospital policy, we all agreed that Mrs. Z's right to make decisions about her own care extends to include a right to not make decisions about her own care. As Beauchamp and Childress put it, "Autonomous choice is a right, not a duty of patients." In delegating her right to choose to her son and the doctors, Mrs. Z has made her choice and this must therefore be respected. Autonomy does not override other bioethical considerations: it is but one among such principles as beneficence, nonmaleficence, and justice. Consideration of beneficence must also dictate what is ethical in this situation, and according to her son, forcing the information on Mrs. Z would be detrimental to her physical and emotional health, thus also violating the principle of nonmaleficence.

The hospital ethics committee's solution to this problem was convenient, but did not take any of this into account. Morally and ethically the decision to know or not know rests with the patient. Had they not found this loophole it is unclear how they would have handled the situation. Their chief concern was obviously legal, but if our current laws are so rigid as to force hospital administrators to undertake this level of fancy footwork just to respect a patient's wishes, then maybe its time to reevaluate how we think about/legislate patient autonomy. Traditional Russian families are not alone in diverging from the Western individualism inherent in our country's approach to healthcare and issues of consent. Ethnicity has been shown to be a primary factor in patient attitudes about autonomy and decision making. For example, one study cited by Beauchamp and Childress noted that "Korean Americans (35%) and Mexican Americans (48%) were less likely than African-Americans (63%) to believe that a patient should be told of a terminal prognosis and less likely to believe that the patient should make decisions about the use of life-supporting technology (28% vs 41% vs 60% and 65%)."

Work Cited
Beauchamp & Childress: Principles of Biomedical Ethics, ed 5, 2001. p. 62-63.