Interrogating the “Right” to Health Care: A Brief Treatment Gunnar Almgren The School of Social Work Center for Studies in Demography and Ecology University of Washington

Interrogating the “Right” to Health Care: A Brief Treatment The Nature of Rights (Natural Rights, Positive Rights and Negative Rights) Alternative Justifications for a “Right” to Health Care The “Right” to Health Care from Alternative Social Justice Perspectives The Case for Health Care as a Social Right of Democratic Citizenship Some Lingering Questions… Gunnar Almgren The School of Social Work Center for Studies in Demography and Ecology The University of Washington

Interrogating the “Right” to Health Care: A Brief Treatment The Nature of Rights (Natural Rights, Negative Rights, Positive Rights) Natural Rights -Human rights that precede the formation of governments, rights that we are born with, or are “God-given” Negative Rights (aka Liberty Rights) -Rights that involve constraints against others (including governments) impeding or preventing the exercise of our actions and/or choices. Positive Rights -Rights that pertain to what is owed to us or what we can legitimately claim we should be provided under the principles and rules of an applicable political or moral theory. Depending on the theory of social justice applied, positive rights may include such rights as personal safety, basic education, employment opportunities, a minimum wage commiserate with some basic standard of material well-being, or some standard of basic health care. Gunnar Almgren The School of Social Work Center for Studies in Demography and Ecology The University of Washington

Interrogating the “Right” to Health Care: A Brief Treatment Alternative Justifications for Health Care as a Positive Right: Economic productivity/maximization of human capital (Nationalism and Neoliberalism) To act upon secular and/or faith-based humanistic moral imperatives (secular humanism in the former, and Islam, Judaism, Christianity in the latter) Fulfilling the preconditions for political citizenship in a democratic society (Liberalism) Maximization of the common good (Utilitarianism) Maximization of human capabilities (The Capabilities Approach) Gunnar Almgren The School of Social Work Center for Studies in Demography and Ecology The University of Washington

Interrogating the “Right” to Health Care: A Brief Treatment The Right to Health Care from Alternative Theories of Social Justice Two Ways of Thinking About Social Justice: As an idea that can mobilize people; making injustice visible, contestable, and changeable* As a coherent set of principles for the definition of the societal arrangements (e.g. governance structures, social institutions, universal rights) that are either preferable or ideal in accordance with a formal theory of social justice. Gunnar Almgren The School of Social Work Center for Studies in Demography and Ecology The University of Washington

Interrogating the “Right” to Health Care: A Brief Treatment The Right to Health Care from Alternative Theories of Social Justice A Framework for Comparing Alternative Theories of Social Justice Each theory’s fundamental claims pertaining to: The Nature and Overall Purpose of Civil Society What Obligations Flow Upward from Individuals to Society What Obligations Flow Downward from Society to the Individual The Essential Basis for the Just Distribution of Limited Resources Gunnar Almgren The School of Social Work Center for Studies in Demography and Ecology The University of Washington

Interrogating the “Right” to Health Care: A Brief Treatment The Right to Health Care from Alternative Theories of Social Justice TEN CENTRAL HUMAN CAPABILITIES From Martha Nussbaum. Sex and Social Justice (Oxford University Press, 2000) 1. Life 2. Bodily Health. 3. Bodily Integrity 4. Senses, Imagination, and Thought 5,. Emotions 6. Practical Reason 7. Affiliation. 8. Other Species 9. Play 10. Control Over One’s Environment See https://ethicshotline.wordpress.com/2013/08/01/martha-nussbaum-10-capabilities-or-substantial-freedoms/ for full description of Nussbaum’s list of 10 central human capabilities. Gunnar Almgren The School of Social Work Center for Studies in Demography and Ecology The University of Washington

Interrogating the “Right” to Health Care: A Brief Treatment The Right to Health Care from Alternative Theories of Social Justice As Requisite to Political Democracy TEN CENTRAL HUMAN CAPABILITIES From Martha Nussbaum. Sex and Social Justice (Oxford University Press, 2000) 1. Life 2. Bodily Health. 3. Bodily Integrity 4. Senses, Imagination, and Thought 5,. Emotions 6. Practical Reason 7. Affiliation. 8. Other Species 9. Play 10. Control Over One’s Environment See https://ethicshotline.wordpress.com/2013/08/01/martha-nussbaum-10-capabilities-or-substantial-freedoms/ for full description of Nussbaum’s list of 10 central human capabilities. Gunnar Almgren The School of Social Work Center for Studies in Demography and Ecology The University of Washington

Interrogating the “Right” to Health Care: A Brief Treatment The Right to Health Care from Alternative Theories of Social Justice Some Lingering Questions: Health Care as a Positive Right To what extent is health care an individual responsibility vs. a societal responsibility? What are the structural arrangements through which individual claims to health care are realized? What are the limits to a positive right to health care? If health care is primarily a societal responsibility, to what extent do societal interests claim dominion over individual health behavioral choices and collective economic activity? Health Care as a Negative Right To what extent and in what specific domains can society exercise authority over individual health care choices? Are Health Care Rights Universal or Selective If universal, how is the universe defined (citizens vs. non-citizens, documented residents vs. undocumented)? If selective, what are the criteria for exclusion and inclusion? TEN CENTRAL HUMAN CAPABILITIES From Martha Nussbaum. Sex and Social Justice (Oxford University Press, 2000) 1. Life 2. Bodily Health. 3. Bodily Integrity 4. Senses, Imagination, and Thought 5,. Emotions 6. Practical Reason 7. Affiliation. 8. Other Species 9. Play 10. Control Over One’s Environment See https://ethicshotline.wordpress.com/2013/08/01/martha-nussbaum-10-capabilities-or-substantial-freedoms/ for full description of Nussbaum’s list of 10 central human capabilities. Gunnar Almgren The School of Social Work Center for Studies in Demography and Ecology The University of Washington