Like the first post above says, emergency treatment centers cannot refuse care to anyone. This is because people able to provide treatment feel responsible for those seeking it.

The tug at our morals comes from the knowledge that we (as care providers, or as a society) have the ability to help others in a significant way. To deny that help when it is available goes against any moral person’s nature.

The Conservative gazed upon the poor woman and replied “No. Woman. All human beings have a right to life. Go and have your baby and forget about an abortion”

So the woman had her baby.
The baby was born gravely sick.
It needed a doctor and expensive medical care.
So the woman returned to the Conservative Republican
“Oh wise one. My baby is sick. My child needs expensive medical care. Can you help me.”
The Conservative lectured the woman sternly:
“Heath care is not a right. It is no ones fault but your own if you can’t afford the pay”

The newborn child died after much suffering

Is There a Right to Health Care – or a Right Attitude?

During the current debates over health care, there has been argument that health care is the right of every American, if not every human being. Is it?

Certainly everyone needs health care. Everyone wants everyone to have it. Everyone I know wants anyone who cannot access health care to have it made available at the expense of others.

Does this make health care a right?

I’m a doctor, not a lawyer. But my understanding is that rights are what government is required to guarantee equally to all, to protect, and to supply if wanting.

Some argue that rights do not emanate from government, but from human nature, nature, or God: universal or inalienable rights. Such rights are few in number. Some governments deny their people liberty, the pursuit of happiness, and sometimes even life. Do their citizens still have these rights; do they exist in name only, nonexistent in reality?

Here at home, other, derivative rights, including those to privacy, to quiet enjoyment, and to safety, all seem reasonable. Their definitions are determined and legitimized by courts – that is, by government. Once anything is deemed a right, it is incumbent upon government to supply it to those who do not have it in adequate supply. Since government becomes the source, the individual no longer needs to strive to secure it. In fact, it is appropriate to demand that government give you your rights and, further, to give you more if you have less than someone else: equality of rights. Politically, as well as through the courts, government decides what is the proper amount of a given right for individuals or groups.

Recently those who are differently-abled have been guaranteed rights, including access to transportation, public spaces, and mainstream education. Since these are higher on Maslow’s famous hierarchy of human needs than health care, shouldn’t health care be a right as well?

Consider food, clothing, and shelter. These are necessities, more fundamental even than health care. Governments provide food (food stamps, school lunches, surplus give-aways) and shelter (public and Section 8 housing, FHA loans) to those who are otherwise without. Charities help immeasurably (food banks, food pantries, Habitat for Humanity) and also help with clothing (Goodwill, Salvation Army, churches and hospitals).

Yet food, clothing, and shelter are not broadly accepted as rights. They are considered responsibilities. This is not just a difference of semantics. It is a difference of attitude.

Individuals are still expected to feed, clothe, and shelter themselves. The government can help in time of need, but this provision is not generally expected for a lifetime. Most on food stamps strive for the day when they no longer need them. Many I have known in public housing scrimp against difficult odds to afford a place of their own. Even though the government provides, they maintain parallel efforts to provide for themselves.

If government – or private charity – supplies something they are not required to give, the response is gratitude, not entitlement. Responsibility remains with the individual. If the government provides free cheddar and not a properly aged Gorgonzola, there is little impulse to complain. This would not be true if free cheese were considered an American right and if a vast government bureaucracy existed to supply it.

I want everyone to have health care. As necessary, I want government to help people have it. [But there are many political, structural, and practical changes that can be made before it is necessary for government to be a direct provider.] I certainly want charities and other benevolent organizations to help too: Church-based free clinics and endowments for the unfunded are examples.

It is the nature of health care that each person’s potential demand for services is essentially limitless. It is not reasonable for people to demand, as a right, that the public – that is, taxpayers – pay more and more without expectation that they contribute themselves. Under such a system, outcomes – both clinical and financial – will be poor.

Finally, if healthcare is considered as a subsidiary right, to be defined and expanded by government, it can also be limited and denied by government, through rationing or arbitrarily.

Healthcare must remain a responsibility.

In the town hall meeting in Portsmouth with President Obama, there was an obese many asking about access to Lipitor, a brand name medicine that in his opinion worked better than the other presumably generic medicine he was prescribed.

Medicine may be a right. But does the patient have a right to Lipitor? What if there is evidence that he is not following a diet? Or he needs Lipitor only because he is not following a diet.

Health care is a right but where is it absolute and where is it conditional? What if this country gets poorer because this country lags behind Asia? Will rights to more expensive care diminish? One of the problems is that our capacity to treat has increased and our treatments are effective or seem to be (not proven). Denying care to people with rights is problematic.

On the other hand, one can also argue that nature should be permitted to take its course and medical intervention should take place only when there is very clear evidence that there is benefit and that benefit is significant.

Bohdan A. Oryshkevich, MD, MPH

Coming from the perspective of an old ICU doc, I have heard this a million times. It sounds great in theory- who could argue with these points? I can (and have) Here is the real problem with these cliches:
1. Ask most physicians and they recognize futility- no they don’t. Of course everyone has the 90 year old with metastatic cancer being ventilated. Yes, that is futile care. But once you get by those examples everyone has a different idea of futility. I have had primary care doctors (and I do some primary care) tell me I should render care that I was fairly certain wouldn’t work and I have had them tell me I shouldn’t do things that I was fairly certain would. Look for specific definitions of futility in the literature -except for some extremely limited examples there are none because it is so hard to define. It’s like obscenity -every knows it when they see it, but defining it (which is essential if you are going to create a policy around it) is not so easy.

2. Don’t you see the problem with commingling health care savings and end of life care counseling? Of course end of life care counseling is important and will save money- in certain circumstances. But the more these two are linked – as they are in HR 3200 and Section 1233, they more they create a potential conflict of interest. Physicians may then be doing things to save the system money rather than doing the right thing by patients. I’m not saying it will happen (actually I am), I’m saying it could happen. Physicians could become unconscious agents of the state. This is why Emanuel says physicians should consider abandoning the Hippocratic Oath -doesn’t that bother doctors at all? End of life care (and chronic care) counseling is important for the patient because it is the right thing to do, not because it saves money. And remember, some patients are good candidates for life support.

3. “Rather than spending money on technology, we should focus on comfort, symptom management and emotional support.”
Another common misconception- these two are mutually incompatible- they are not. Some of the most compassionate care I have seen has been in the ICU (from ICU nurses). Technology and emotional support are not incompatible if we train our caregivers right (we don’t always do that). It is a serious error to believe otherwise.

Unfortunately, it’s beginning to look like these misconceptions appear to be part of the President’s health care team’s plan. Nothing good can come of that.

As government drives down doctors’ salaries do you really think that we’re going to continue to get H1B doctors to fill the gap? Do you really think that american kids won’t shift to higher paying, lower cost career paths? Do you really think that the material bounty of your average US practice will stay the same?

Dream on.

Health care is not a right. Emergency care does not obligate society to a government dominated universal system.

By analogy consider the property right to expel trespassers. Now consider the special case where a car accident causes someone to fly out of a vehicle and land on someone’s property, breaking their back. The owner isn’t allowed to exercise his normal right to evict nor is he allowed to exclude the EMS team from coming on his property and stabilizing the accident victim before taking him away. At the same time, the property owner’s inability to evict in this and other special circumstances does not mean that you can just camp on his property.

Emergency care is one thing. A universal obligation for the public to treat every earache is something quite different.