rth and distributive justice

8/10/2019 Rth and Distributive Justice

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THE RIGHT TO HEALTH

ANDDISTRIBUTIVE JUSTICE

IN HEALTH CARE

Ade Firmansyah S, MD

DEPARTMENT OF FORENSIC MEDICINE AND MEDICOLEGAL

FACULTY OF MEDICINE UNIVERSITY OF INDONESIA


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Scope of Study

The Right to Health

The Theory of Justice

The Finiteness of Health Care Resources Decent Minimum of Health Care

Ethics of Rationing


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What would you do?

NEEDS RESOURCES

Market system will increase the price, thus creating lesser demand

to balance need-supply, creating group of people who could get the

resources based on the ability to pay.


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Determining Needs & Resources

Needs

ICU Organ transplants

Hemodialysis

Surgery

Ward

Emergency care

Ambulance

Etc.

Resources

Men

Doctors

Nurses

Money

Government, private insurance, ownmoney

Method

Diagnostic, therapy, rehabilitation

Tools

ER, ICU, Ward

Surgery equipment


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What makes health special?

Norman Daniel:

Diseases and disabilities diminish peoples

normal species functioning and thus restrict the

range of opportunities open to them.

General Comment No.14, ICESCR

Health is fundamental prequisite to theenjoyment of other human rights


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Everyone has the right to a standard of living

adequate for the health and well-being of

himself and of his family, including food,

clothing, housing and medical care and

necessary social services, and the right to

security in the event of unemployment,

sickness, disability, widowhood, old age orother lack of livelihood in circumstances

beyond his control. (UDHR)

Definition of Health


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Vulnerable and marginalizedgroups in societies tend tobear an undue proportion ofhealth problems.

Overt or implicit

discrimination violates afundamental human rightsprinciple and often lies at theroot of poor health status.

In practice, discrimination canmanifest itself in inadequately

targeted health programmesand restricted access to healthservices.

Discrimination manifests itself ina complex variety of ways, which

may directly or indirectly, impact

upon health.

For example, the Declaration

on the Elimination of Violenceagainst Women recognizes

the link between violence

against women and the

historically unequal power

relations between men andwomen

Principal of Free from discrimination


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The right to health does not mean the right to behealthy, nor does it mean that poor governmentsmust put in place expensive health services for whichthey have no resources. But it does require

governments and public authorities to put in placepolicies and action plans which will lead to availableand accessible health care for all in the shortestpossible time. To ensure that this happens is thechallenge facing both the human rights community

and public health professionals. United Nations High Commissioner for Human Rights,

Mary Robinson

The Right to Health


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The Right to Health

Not only developing

comprehensive health care

facilities.

Including the fulfillment of

underlying determinants of

health: food, housing,

sanitation, clean water, etc.

THE RIGHTS TO HEALTH

UNDERLYING

DETERMINANTS

HEALTH CARE

Govern by Ministry of Health

Govern by Ministry of

Health, Education,

Environment, Labor, etc.


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Connection between Health and

Human Rights

Torture and lack of respect to human rightswill be resulted in serious health condition.

Health policy and regulation will further or

lower the human rights, depending on itsdesign and implementation.

Vulnerable society are tend to have lower

health status which could be reduced throughrespecting, protecting, and fulfilling humanrights.


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Information: Freedom to seek, receive and impartinformation and ideas of all kinds.

Privacy: No one shall be subjected to arbitrary orunlawful interference with his privacy.

Scientific progress: The right of everyone to enjoy thebenefits of scientific progress and its applications.

Education: The right to education,(14) includingaccess to education in support of basic knowledge ofchild health and nutrition, the advantages of breast-feeding, hygiene and environmental sanitation and theprevention of accidents.

Elements of Right to Health


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Food and nutrition: The right of everyone toadequate food and the fundamental right ofeveryone to be free from hunger.

Standard of living: Everyone has the right toan adequate standard of living, includingadequate food, clothing, housing, and medicalcare and necessary social services.

Right to social security: The right of everyoneto social security, including social insurance.

Elements of Right to Health


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State Obligation

To Respect :State obligation to developregulation which allow citizen to receivehealth care and prevent any restriction.

To Protect : state obligation to ensuring equalaccess to health care services.

To Fulfill: state obligation to ensuring the

rights of all citizen, especially those who arevulnerable to receive health care.


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Health facilities, goods and serviceshave to be accessible to everyonewithout discrimination

Health facilities, goods andservices must be scientifically andmedically appropriate and ofgood quality

All health facilities, goods andservices must be respectful ofmedical ethics and culturallyappropriate, sensitive to genderand life-cycle requirements

Functioning public health andhealth-care facilities, goods andservices, as well as programmes,have to be available in sufficientquantity

Availability Acceptability

AccessibilityQuality

Evaluating the Right to Health


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THEORY OF JUSTICELIBERTARIAN

Benefits and

burdens ofsociety are

distributedthrough

exercise ofrights of non-

interference

EGALITARIAN

Equal rights for

all Equal benefits

and burdens

UTILITARIAN

A just

distribution isone that

maximise sumhappiness

DISTRIBUTIVE

Fair

distribution ofbenefits and

burdens,advantage and

disadvantage


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Egalitarianism

People

right

People

right

People

right

People

right

Equal intrinsic right for every people, regardless their race, sex, social and economic

status.


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Utilitarianism

People

happiness

People

happiness

People

happiness

Sum

happiness

Utility: happiness and Sadness. Maximizing sum happiness as goal. Not counting

personal happiness as long as sum happiness is maximum.


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Rawls Distributive Justice

Every person are entitled to :

Fair equality of liberty

Fair equality of opportunity

Difference principle :

If the distribution of goods and services are

unequal, those who are vulnerable should benefit

the most


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Rawls Distributive Justice

Liberty

Economic status grants its

bearer liberty to choose

what kind of health careservices needed.

Place grants its bearer

liberty to choose where

they want to get services

Opportunity

Economic status grants

opportunity to receive any

services needed. Place grants people

opportunity to go to any

institutions for health care

services.

People whose low on liberty and opportunity are regarded as vulnerable. Thus

creating obligation for state to leverage their liberty and opportunityDifference

Principle


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The Goals of Health Care

Preventive

Curative

Rehabilitative

Immunization

Profilaxis drugs

Surgery

Medicine

Rehab medicine

Supportive therapy

To preserve the range of opportunities we would have, were not

ill or disabled, given out talents and skills.


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The entitlement theory

People are entitled to right to health

Right for someone, impose duties to others to

provide

Duties not to interfere with that persons

obtaining something

Duties to help person in their efforts to get

something


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What kind of entitlement?

Daniels: normal peoples functioning

Right to a good minimally functioning humans life

Right to a decent minimum health care

Decent minimum health care means preserve life

Everyone would have access to minimal basic

array of health care resources.


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Two Tier Health Care Services

Decent minimum

Preserve life

Prevent death

Advanced

Elective

Non-essential therapy

Health care that provide a decent minimum life should be universally available,

publicly supported, guaranteed.

Secont tier of additional health care services would be available in the free

marketplace for those who can afford them.


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Decent Minimum

Not all health care is of equal importance

Allocational priorities must be set witthin health

care

Right to health is not unlimited

Resources must be allocated not only to health

care

Decent minimum is a floor in which no oneshould be allowed to fall below it


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Ethics of Rationing

Who should get what share of limited health

care goods and services?

What criteria should be used?


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Ethics of Rationing

John F. Kilner:

Social criteria

Socio-medical criteria

Quality of life

Medical criteria

Prognosis

Imminent death


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Ethics of Rationing

Utilitarian approach to rationingQuality

Adjusted Life Years (QALY)

Measure objectively the benefits that a treatment

is likely to give each patient.

Selectively treat particular patients or conditions

to maximize total benefits.

One QALY is equivalent to one yea of life in goodhealth, and a year of life in poor health is equal to

less than 1 QALY.


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National Security Assurance

JKN

BPJS

Kesehatan

BPJS

Tenaga

Kerja


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[email protected]

Jakarta, 2014
mailto:[email protected]:[email protected]

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