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?
First of all, the way that this prompt is written makes it seem unethical to argue that the money should not be used for Javier, but, if one were to argue that health care is not a basic human right, then, ipso facto, the money should not be used on Javier.
ReplyDeleteIn fact, there are two separate issues presented here that need to be addressed: 1) Should the money raised for the purpose of investing in the El Salvadorean community be used to help this one, sick child? and 2) Is health care a basic human right?
In response to the first issue, whether this money should be used on Javier, that depends on several unknowns. Is this the kind of project for which the donations were intended? Is there another alternative effort that would benefit more people or have a greater impact? I find it hard to believe that there are not many, many options for the use of this money in a country like El Salvador, of which Javier it just one very worthwhile cause. Nevertheless, the decision can be made ethically that this money should be used to help him.
The second issue is that of whether health care is a basic human right. I say no. To avoid any religious overtones to this argument, I will base this argument on a comparison to the Declaration of Independence and the self-evident truths it proclaims: that we all have a right to life, liberty, and the pursuit of happiness. Compared to these principles, a right to health care is a subordinate issue, mainly because it is an issue decided by a society and a government and their agreed upon position regarding health care. Health care is a policy issue and costs money. By making it a human right and presumably a universal human right, then it becomes a violation of that right for a rich country to not do everything in its power to provide health care to a poorer country. This position, while noble, is unreasonable and unfeasable.
As a society, Americans have decided on an understanding of what kind of health care everyone has a right to in our hospitals - an evaluation to determine an emergency medical condition and life saving, stabilizing care for that condition (most recently codified in the EMTALA law).
Why can't this law be made universal? Who will pay for it? Even the richest country in the world would only be able to afford this for maybe a generation, at which point it would not longer be able to afford to provide this care to its own citizens, leaving the world in a worse position than before. A reasonable ethic should not promote the bankrupting of one society to help every other.
What about all the other people in the village that you could help with $7000? Helping Javier is a good thing to do, but why is it better than, say, paying for a public health measure that would help the whole village? (For example, purchasing a well so the people can have a clean water supply) Perhaps it could be argued that it is immoral to help only one person when you could help many instead.
ReplyDeleteWhat is a human right? Is it something that affords one the freedom to provide for them-self, or is it something that other people in the community owe them? Most of our freedoms seem to be derived from the first theme. Freedom of speech without oppression from others or the government, same as freedom to private property, freedom or religion etc.
ReplyDeleteThis is interesting because in this case, some people think that it is a right to be provided with some service. That is like saying that if it is human right to own private property, then one expects the government to give them that property. Or if it is a right for a citizen to own a gun, then one expects the government to give them that gun.
To me, human rights in pure form, are capable of penetrating all societies. Any society, no matter how primitive, could understand the right to private property. How else could one depend on their home one day, being there home again the next, or their shirt one day being their shirt, and not someone else's the next. If you were on a deserted island with group of others, what could you institute as rights that permit freedom? It couldn't be what you would get from others (because others wouldn't have much to give), but rather developing standards that permit personal freedom (what one can do for them-self). Only in a developed nation, do we have the luxury to consider this.
I think this idea of healthcare being a right is a farce. This does not follow the logic of a "right" serving as a legal standard preserving an individuals freedom. This is the idea that one is owed something from their community and their government. I am passionate about helping the undeserved receive health care, but when we start to speak of rights, we expect the government to get involved, and the government tends to spoil everything it puts its hands on. Not to mention that I do not feel all that charitable on tax day.
hmmmm, it's my last week, I have 7000 that is burning in my pocket and I see a child in need. questions i would ask myself . . . if i fly this child home and he is cured, what will he be coming home to? will the family be able to care for him post surgery? what else will this child lack other than access to life saving surgery? does it make sense to fix his heart if when he comes home he will suffer from hunger, disease from contaminated water, or other sources? Could I better invest in a school or a hospital? if i made an investment somewhere else would it really benefit the community or would i run the risk of making an investment in something that will not be seen to thruition for reasons of corruption or lack of funds, skilled people, or motivation? Will I get to see the end result and consequences of my decision? will my contribution make a lasting difference in the quality of someone's life or within in the community? This child has made an impression on me and assuming that my 7000 would be enough to meet his pre/post opperative care including support for the family . . . I would do it. That is, assuming that the likelihood the child would have access to proper post opperative care in El Salvador would be adequate for his survival ie, the family would be able to feed and clothe him . . . and that the only thing they are lacking is the skill of a heart surgeon in their country . . . than I would without a doubt do it.Even if my decision benefits just one person and their family by eleviating the sorrow of watching their child deteriorate and die solely because they lack medical care is more lasting . . .
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