On the Putative Right to Health Care

John  e-mails and I comment in blue:

 

I found your most recent post on a right to health care very interesting. It seems to me that much of the discussion of rights, not only about putative rights to health care, but about rights in general, depends on a certain controversial principle, namely:

 

If x has a right to y, and if z is a means of achieving y, then x has a right to z.

BV:  We should distinguish between weaker and stronger versions of the principle:

P1. If x has a right to y, and if z is a means of achieving y, then x has a right to seek to acquire z.

P2. If x has a right to y, and if z is a means of achieving y, then x has a right to be given z.

Consider the following straightforward argument in support of gun rights:

(1) I have a right to life and security of my person. (2) If I have a right to life and security of my person, then I have a right to the means whereby these rights may be secured and protected. (3) Guns may be used to secure and protect my right to life and security of my person. (4) Therefore, I have a right to own a gun.

BV: On 10 November 2009 I gave a more careful detailed argument along the same lines.  See Deriving Gun Rights from the Right to Life.

This seems to me very plausible, but of course (2) relies on the controversial principle identified above.

BV:  I would say that the argument relies on (P1) but not (P2).

In similar fashion, any argument for the claim that each of us has a right to health care will probably have to rely on a similar premise. I can imagine an argument going something like this:

(1) I have a right to life and security of my person. (2) If I have a right to life and security of my person, then I have a right to the means whereby these rights may be secured and protected. (3) Affordable health care may be used to secure and protect my right to life and security of my person. (4) Therefore, I have a right to affordable health care.

As before, premise (2) relies on the controversial principle identified earlier. And, as you point out in your post, similar arguments could be run to establish that each of us has a right to food, shelter, and clothing.

BV:  But again, all one needs is the weaker principle, (P1).  If I have a right to life, then I have a right to sustain my life.  A necessary means to that end is food.  So I have a right to food.  But all that means is that I have a right to seek to acquire food (by hunting, fishing, foraging, growing, buying, bartering, begging, etc.)  It does not mean that I have a right to be supplied with food by others.  I have no positive right to be fed.  What I have is a negative right not to be impeded in my quest for food and other vital necessities.  (Adults are under discussion, not young children.)

Here, then, is my question: what ought we to think about the controversial principle?

BV:  The first thing we should think about it is that it is ambiguous as between (P1) and (P2).  I would say  that (P1) is very plausible if not obviously true.  But it needs qualification. Do I have a right to biological or chemical weapons?  I have the right to repel a home invasion using a shotgun, but presumably not the right to repel such an invasion using biological agents that are likely to spread throughout the neighborhood.  So consider

P1*.  If x has a (negative) right to y, and z is a minimally efficacious means of achieving y,then x has a (negative) right to acquire z.

By 'minimally efficacious' I mean a means to an end that is an efficient and effective means to the end in view but not so powerful or extensive as to bring with it negative consequences for others.   My right to buy food would then not be a right to buy all the food in the supermarket. My right to repel home invaders does not translate into a right to lay waste to the entire neighborhood in so doing.  No doubt further refinements are needed, but (P1) strikes me as on the right track.

Although I am inclined to think that the principle is false, what is of interest to me is a more troublesome question. Any false general claim may have true instances. Are there true instances of this false general principle? How do we go about deciding which instances of the principle are true and which not? Can the principle be used to establish gun rights but not rights to health care or food/shelter/clothing?

BV: I should think that guns and butter are on a par.  More fully, guns, food, shelter, clothing, certain medicines, bandages, certain medical appliances, e. g. sphygmomanometers for the hypertense, etc. are all on a par.  Given that I have the natural negative right to life, then surely I have the right to pursue and acquire those things that I need to defend and sustain my life.  What I don't have is the positive right to be given them by others or by the government, especially given the fact that the government produces no wealth but gets its wealth by coercive taking.  (Not that I am opposed to governmental coercion, within limits.  There simply cannot be a government that is not coercive.  I am very pleased that the government has forced Bernie Madoff into prison, thereby doing to him what it would be a crime for me to do to him.)

So I don't think my gun argument suffers from probative overkill, 'proving too much.'  The pattern of argument extends to food, shelter, and clothing, etc.  But contemporary liberals are in the same boat: their pattern of argument extends to food, shelter, clothing, etc.  But their extension does amount to probative overkill and a reductio ad absurdum of their original argument. If there is a positive right to health care services and health insurance (these are of course not the same), then a fortiori, there is a positive right to food, shelter, and clothing.  But this is absurd, ergo, etc.

Related articles

Minorities Can't Be Expected to Have Photo ID, but Can be Expected to Navigate ObamaCare Sites?

Subsidiarity and the Left's Assault on Civil Society

A Right to Health Care?

Politics as Polemics: The Converse Clausewitz Principle

It's the Welfare State, Stupid

Comments

[Tully Borland]

As has already been noted, the right to health care is a positive right if a right at all. As such it's a right that one has against other people to have one treated in such and such a way (rather than a negative right which permits one to do certain things or be a certain way).

Given that, I think it's pretty easy to see why one doesn't have a natural human right to government health care (moreover it should be easy to see why a number of the "rights" listed in the U.N. Declaration of Human Rights are just plain silly.)

A natural human right is one that all humans have by being human. But on an island (or in the "state of nature") with no health care system there is no coherent sense to be made of one having a right to health care--at least in the sense under discussion. I do not have a right to a free doctor's check up when there are no doctors! Thus if health care is a positive moral right it would seem to be only when a legitimate authority (say God, or a government in some contexts) confers on one a right to health care. But no one that is pro-Obama Care seems to be arguing that U.S. citizens have a moral right to health care conferred on them by the government, by God, or by anyone else.

Having said all that, I'm less inclined than the Maverick at least seems to be to think that there is no positive right AT ALL to food, shelter, minimal health care, etc. Perhaps there's a positive right one has against one's parents, family, neighbors, etc. to some minimal care with respect to one's health; and it would be an unjust mother who didn't feed her baby; but there's no human right to governement health care, and thus it can't be a natural human right (I'm certainly skeptical there are very many positive natural human rights of this kind for the sorts of reasons mentioned above).

[BV]

Tully,

As I implied in my post, children do have a right to be fed, clothed, sheltered, and given health care by their parents. By having children, people assume duties, and these duties with respect to their offspring generate in the latter rights. Just as my right to life induces in you the duty not to harm me, my assumption of the duties odf a parent induces in my offpsings the rights to be fed, etc.

It is also clear, I think, that one who denies that there is a right to health care from the gov't is not logically committed to denying that it would be good to have a governmental safety net to help the truly indigent who have no other resource.

Nets, however, can become traps.

[Tully Borland]

Bill,

I agree with you about the gov't issue completely (nets becoming traps and so forth). I disagree, however, in the explanatory relation of rights and duties. I think that rights ultimately come from having worth and rights ultimately explain duties but not vice versa (this I believe I share with Kant). I think that the worth of a child is a necessary explanatory condition for why he/she has a right to be fed and also why the parents have a duty to feed him/her. If the child had no worth, the parents would have no duties TOWARD the child (they'd just have 3rd party duties perhaps, duties to someone or something else to care for the child). True-- the child's worth does not BY ITSELF explain why it is that the PARENTS have the duty to feed him/her, but neither does the duty of the parents explain why the child has a right to be fed. The child would have a right to be fed by any person with the practical means to do so in proximate circumstances to the child even if the parents died. It would be unjust for me to see the child on my doorstep and let it die because I was not responsible for the child's coming into being. (I do not think this duty extends to everyone, however, and I have no detailed theory according to which one person has such a duty but not someone else--case by case is the best I can do).

That being the case I suppose I'm inclined to think that some persons also have positive duties to adults in matters of life and death--even if such adults are not, e.g., mentally handicapped. If my neighbor lost his job (and let's suppose there's no welfare and he can't get work--for the sake of argument!!) I think it would be not only a failure of charity but also failure of justice on my part if I allowed him to starve to death. His worth as a human being demands of me, if I have the means, to see to it that he does not starve. A man might be a rock, but no man is an island.

For clarification, that is my view which I offer up for criticism, though I obviously have not done much above to defend it.

[BV]

Excellent comments, Tully. I need to think this through more carefully. Granting the correlativity of rights and duties, it is a further question whether rights explain duties or vice versa. And there is indeed something fishy about my shoot-from-the-hip suggestion that, while my right to life grounds your duty not to harm me, the duty of the parents grounds the child's right to be fed.

What is a right anyway? Do you have a definition?

I think it is also the case that benevolent behavior toward sentient beings needn't be supported by the imputation to them of rights. I consider the wanton destruction of living things to be morally wrong, and this includes plants, even though I don't think they have rights.

I would even say that there is some low-level moral wrongness to the wanton breaking apart of a rock even though I would not ascribe to rocks a right of physical integrity.

Animals don't have duties. Can they then have rights? Could there be beings with rights but not duties?

[Tully Borland]

I just saw this last comment, but since comments are still open here are some quick thoughts:

Justice isn't equality or fairness. If I give all my students A's, they are treated fairly, but it's only just if they deserve it. Justice and rights have everything to do with what is due (that's why I think, e.g., that Utilitarians have no conceptual space for justice and moral rights. Actions are right or wrong, but there are no moral rights since there's no conceptual room for what is SOMEONE deserves). Justice is a relation: it's rendering what is due or being rendered what is due. Justice from the passive side (from the side of one that can be wronged) consists of having rights; from the side of one that can wrong, it consists of having duties.

A right is roughly having a legitimate claim to some kind of treatment. It's a legitimate claim to some good (specifically some good state of affairs). Technically, I don't have a right to food, but I have a right to the state of affairs of being permitted to eat food or the state of affairs of my food not being stolen.

To have a (moral) right is to have worth, worth of such a sort that demands respect (or other sorts of positive aprobation depending on the circumstances).

A Kantian would say that such worth is grounded in autonomy. I'd say it's grounded in autonomy but not JUST autonomy. To exemplify a human nature is by itself to exemplify something of worth; to have a human nature is to be of worth--worth which grounds some rights (but perhaps not as many rights as autonomy). Of course figuring out all the things which grounds rights is a tricky business.
[Aside: As I see it, worth explains rights and rights explain duties. Moral laws, then, (which aren't of the hypothetical form which I would take to be necessary truths) are universal generalizations true in virtue of particular things with worth. "Humans shouldn't murder" is NOT true in virtue of the fact that it's an implication of a necessary moral principle, rather that principle is true because humans have worth. Individual things ultimately ground moral laws and not vice versa.]

I think animals have some rights. You shouldn't kick a dog just for fun even if (with Kant in mind) it's possible to psychologically separate that act from how you treat other humans. Nonetheless I don't think dogs have such worth that they have all the rights of humans. I'm one those species chauvinists.

[John]

I think we should take care not to assume too close a connection between rights and desert. Consider my right to my life and bodily integrity. While I clearly have such a right, it is much less clear that I *deserve* my life or my body in any ordinary sense of 'desert'. For what did I do to deserve them? Nothing. I just happen to have them. Indeed, the question of whether I deserve them seems confused. Nevertheless, I have a right to them if I have a right to anything at all. (Nozick argues in similar fashion somewhere in Anarchy, State, and Utopia.) Likewise, it seems plausible to me that I might deserve something without having a right to it. Consider Judith Jarvis Thomson's example in which she is terminally ill and the only thing that could save her would be Henry Fonda flying across country to kiss her forehead. Assuming Thomson is a good person and so on and so forth, we might say that she deserves Fonda's lifesaving treatment, but it would be wildly implausible to say she has a right to it. (I am less sure about examples like this, especially the claim that she deserves Fonda's lifesaving treatment, but don't find the example immediately implausible either.)

At any rate, the idea that "worth explains rights and rights explain duties" is interesting. But it seems to me that on the notion of worth under consideration here, according to which simply exemplifying a human nature is to have worth, there will be more positive duties to others than either Bill or Tully is willing to countenance. This is because I don't see how exemplifying a human nature could generate a right to being permitted to eat food or a right not to have my food stolen, but not a right to food simpliciter.

With respect to whether rights ground duties or vice versa, I wonder if this isn't just one of the fault lines that divide liberals and conservatives. Off the top of my head, it seems to me that liberals would be likely to claim that rights ground duties, while conservatives would be likely to claim that duties ground rights.

[Tully Borland]

John,
When we say we have a right to "life" or "my body" or "food" I think these are elliptical ways of referring to states of affairs or ways of treatment we think we have rights to, and I think this takes the bite out of some of the worry about desert. I don't deserve food, but I deserve to have some food and to be able to eat what I have. I don't deserve life, but I do deserve to be able to continue living until my body expires because I'm of worth (even though I can do something such that I no longer deserve to continue living). Lord knows I don't deserve my (Arnoldesque) body (who could deserve such a thing), but I deserve to be treated in such a way that my body isn't mutilated.

I don't think it makes sense to deserve something you have no right to. Either Fonda really does have a duty to save her or she doesn't really deserve Fonda extending her life. I don't know how she could deserve having Fonda save her without having a right to Fonda saving her.

Re: the worth of a human nature, it's not clear to me how much value there is in having a human nature. How much value is there in being a wrecked Porsche instead of a wrecked Yugo or fully operational Yugo? I'd say for robust rights human value has to be grounded in things like autonomy or extrinsically in a certain relation to God.

Re: liberals/conservatives, I don't think that very many people on either side have thought much about the explanatory relation between rights/duties. N. Wolterstorff is one of the few (and politically speaking he seems to fall somewhere in the middle). But I think the liberal/conservative stance might be the opposite of what you say.

True, conservatives tend to be suspicious of all of the abuses of rights-talk and liberals tend to abuse rights-talk. As such conservatives perhaps tend to talk more in terms of duties than they do in terms of rights and the victimology that usually goes with it today.
But liberals also tend towards emphasizing the value/disvalue in structures, groups, and societies, I think, over rights of the individual. I get the feeling from many liberal elites that, in spite of how they talk about (e.g.) the poor, they really don't think that humans are really worth all that much. And when liberals talk about "social justice" they have mind promotion of the COMMON good; the chief purpose of the government for them is to promote the general welfare. Whereas a conservative I think would say that the chief purpose of the government is to ensure that individual citizens' rights are not violated. Conservativism seems to me more conducive to a theory according to which duties are grounded from the bottom-up, so to speak, rather than rights being granted from the top down.