"health care is not a human right"
I am glad to see that Barlow (1) has taken issue with the draft
document of the Tavistock Group over the ethical principle that "Health
care is a human right."(2)
The terms 'health' and 'health care' are not interchangeable, though
frequently confused, and it is 'health' that is taken as a fundamental
human right in the constitution of the World health Organisation. Health
care is a reflection of social history.
As ethics is the system of morality, then is this document a
reflection of the current morality and ideology in North America, and part
of the recent ideology of finding holistic solutions for global problems?
I raise this question as it appears that a majority of the Tavistock Group
are from the U.S.A. and the preamble of the document looks no further back
in history than the last 150 years. In Europe there are many earlier
examples of well organised health care - in Paris the united management of
hospitals and charitable institutions after 1789; in Germany the
formation of the "collegium sanitatis" in the 15th century and then the
College of Health in 1762.
There are some significant omissions. For example little is said
about an individual's responsibility for their own health by pursuing a
healthy lifestyle. Nor is there reference to the wider aspects of health
care. In the 1991 edition of "The Nation's Health" the areas where health
is getting worse over the last decade are stated as - social disparities;
alcohol consumption; senile dementia; and illicit drugs.(3) Little is
said in the document about the 'quality' of life of the individual - a
subject which Palliative Medicine has brought to the forefront in care of
The preamble also refers to "changes in health care systems
throughout the world". If the intention is to produce a document of global
significance, then why are there no representatives from developing
countries? I have spent many years working with senior medical and
government officials in a number of developing countries and it is
arrogant to think that we in the West can decide what is best for their
countries - they have in many cases firmer general ethical principles than
we do in modern 'developed' countries.
(1) Barlow P. Health care is not a human right. BMJ 1999;319:321 (31
(2) Smith R, Hiatt H, Berwick D. Shared ethical principles for everybody
in health care: a working draft from the Tavistock Group. BMJ
1999;318:248-51 (23 January)
(3) Jacobson B, Smith A, Whitehead M. The Nation's Health. London: King's
Fund Centre, 1991
Competing interests: No competing interests