We live in an age where rights are the ethical trump card, though there’s no rational justification for the ethics of rights to trump the ethics of duties,virtues, justice, consequences, or difference, all of which are useful ways of thinking about how best to provide health care. Rights are not the best (and are certainly not the only) ethical defence for health (or the environment for that matter), but they’re so dominant that they appear to be the blunt instrument taken from the ethical tool box every time.
Why is that?
On June 29th 2009 Gordon Brown announced that he was going to use Human Rights not simply to allow people to access private health care, but to force PCTs to send people to private providers.
He announced that patients are to have “six new rights to health” and “Primary Care Trusts will be forced to send people to a hospital in another area or, in extreme cases, for private treatment if they cannot deliver it in NHS facilities.”
No New Labour/ corporate health statement has failed to emphasise that choice is at the heart of how things will be in the new NHS. This makes a lot of sense when you consider that ‘choice’ and ‘rights’ are the ethical pillars on which corporate healthcare is justified. Choice and Rights are invoked because they are automony-dependent faculties and corporations like people to imagine that they are free agent consumers. This free-market ideology of capitalism is the model on which most western governments, under corporate guidance are forcing upon every aspect of civic life.
Rights as a concept go back to Roman times; it was rights over slaves that really got the Romans going, but the modern conception of rights, and the one that’s so appealing to corporate interests is the version of rights laid out by the Geneva Convention after the second world war to protect individuals from the abuse of repressive states. They have risen as the dominant ethical paradigm since then (coincidnetally since the inception of the NHS) hence its no surprise that they also been widely used to justify the behaviour and legal status of corporations. The World Health Organisation has stated that far from individuals needing protection from the state, an effective state is essential for healthcare provision.
One serious problem with rights is that they are much less effective for anyone who really needs them (the sick and the powerless) whilst being relatively superfluous to the powerful (who can have everything they need, and can get what they want without having to appeal to rights) “The Rights of Man become the rights of those who have no rights, the rights of bare human beings subjected to inhuman repression and inhuman conditions of existence. They become humanitarian rights, the rights of those who cannot enact them, the victims of the absolute denial of rights” Jacques Rancière
How can the ethics of care, duties, values, consequences, or difference add to a useful conception of health care, its provision and application?
To be continued…
A Better NHS 
“The NHS is the greatest expression of social solidarity found anywhere in the world: it is as much a social movement as it is a health system. It is not just that we stand together but what we stand for: fairness, empathy and compassion. It is for these reasons that we all care so deeply about its future; and it is why I stand ready to contribute to ongoing efforts to invest in and improve the NHS, in any way I can.”
Professor the Lord Darzi of Denham KBE; resignation letter to Gordon Brown. July 13th 2009