Markkula Center of Applied Ethics

Access to Health Care for the Uninsured Chronically Ill

Response to the Case of Madisyn Whitfield
By Tessa Brown

At the age of twenty-five Maddy finds herself among the millions of Americans who are uninsured. She is caught in a vicious cycle of sickness and unemployment. She cannot pay for the treatment that she needs, but she feels too sick to work. Additionally, her Crohn's disease has unnecessarily prevented her from going to school. Maddy is caught up in an ethically indefensible situation.

Denying a person health care based on his or her ability to pay is unjust. Rights-based arguments claim that people have intrinsic worth and value. As beings of value, people are guaranteed certain rights which ensure the preservation of their dignity. The Universal Declaration of Human Rights is a document that outlines the basic inherent rights of all people. Among the rights it lists is the right to health care. A person's body is essential for social and intellectual prosperity. Without health people cannot thrive. Thus, as a valued human person, Maddy has a right to health care. To deny Maddy the right to health care is to neglect her fundamental worth.

The rights-based argument outlined above makes a convincing case for why Maddy should receive care. However, it does not specify who has the obligation to provide this care. The principle of utility suggests that the obligation to provide health care is a universal obligation. The responsibility to provide Maddy's health care falls on whoever can afford it. Right now many hospitals recognize the obligation to provide medical services to the needy, but are having more and more difficulty underwriting the cost of care for self-pay patients. Hospitals are going broke and can no longer afford to stay open. Thus, another payer has to step up to the plate. This payer should be the taxpayer. It is in the best interests of a society to pay for the health care of its uninsured citizens. When people are sick they frequently have to quit their jobs or reduce their hours and take on large amounts of debt. It is certainly not in the best interest of society to look the other way when people are unable to work. The repercussions of unemployment are not only personal. Unemployment affects the health of a society's economy and infrastructure. Furthermore, a 2005 Harvard study found medical bills to be the leading cause of bankruptcy. The taxpayer has a vested interest in paying for Maddy's treatments.

When one recognizes that society has an obligation to provide medical care for patients such as Maddy, a whole host of other ethically relevant questions arise. In this day and age there are hundreds of different medical procedures of varying cost and effectiveness. Does society have an obligation to provide all of them? The famous medical anthropologist Paul Farmer has argued that health care is not limited to medicine. People's health is dependent on their access to food, housing, sanitation, education, medicine, and employment. If society has an obligation to provide health care, does this include non-medical interventions as well? Maddy would certainly benefit from a supplemental income. Having extra financial support would help to keep her flare-ups down and her medical bills to a minimum.

Regardless of whether or not Maddy is provided support in addition to the medical treatment, there is no ethically defensible reason for her to be leaving the hospital AMA. She has a disease that can be managed. Acute medical care will not only have a significant impact on the quality of Maddy's life, it will also benefit society. As a person with inherent worth, Maddy has a right to health care and her fellow citizens have the obligation to provide it.

Tessa Brown was a 2008-09 Health Care Ethics Intern at the Markkula Center for Applied Ethics.

July 2009

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