School of Law, University of Warwick, Coventry, UK.
Health Hum Rights. 2009;11(2):33-45.
This article analyzes the recent and growing phenomenon of right-to-health litigation in Brazil from the perspective of health equity. It argues that the prevailing model of litigation is likely worsening the country's already pronounced health inequities. The model is characterized by a prevalence of individualized claims demanding curative medical treatment (most often drugs) and by a high success rate for the litigant. Both elements are largely a consequence of the way Brazilian judges have interpreted the scope of the right to health recognized in Article 6 and Article 196 of the Brazilian constitution, that is, as an entitlement of individuals to the satiSfaction of all their health needs with the most advanced treatment available, irrespective of its costs. Given that resources are always scarce in relation to the health needs of the population as a whole, this interpretation can only be sustained at the expense of universality, that is, so long as only a part of the population is granted this unlimited right at any given time. The individuals and (less often) groups who manage to access the judiciary and realize this right are therefore privileged over the rest of the population. This is potentially detrimental to health equity because the criterion for privileging litigants over the rest of the population is not based on any conception of need or justice but purely on their ability to access the judiciary, something that only a minority of citizens possess. This paper examines studies that are beginning to confirm that a majority of right-to-health litigants come from social groups that are already considerably advantaged in terms of all socioeconomic indicators, including health conditions. It is a plausible assumption that the model of right-to-health litigation currently prevalent in Brazil is likely worsening health inequities.
本文从卫生公平的角度分析了巴西最近日益增多的健康权诉讼现象。文章认为，占主导地位的诉讼模式可能使该国本已明显的卫生不公平现象更加恶化。这种模式的特点是，个人要求获得治疗性医疗（通常是药物）的主张占主导地位，而且诉讼当事人胜诉率很高。这两个因素在很大程度上是由于巴西法官对巴西宪法第 6 条和第 196 条所承认的健康权范围的解释造成的，即健康权是个人有权获得满足其所有健康需求的最先进治疗，而不论其成本如何。鉴于资源相对于整个人口的健康需求总是稀缺的，这种解释只能以普遍性为代价，也就是说，只要只有一部分人口在任何时候都享有这种无限的权利。因此，能够设法诉诸司法机关并实现这一权利的个人和（较少情况下）群体比其他人享有特权。这可能对卫生公平造成不利影响，因为赋予诉讼当事人比其他人更优先的标准不是基于任何需要或正义概念，而纯粹是基于他们诉诸司法的能力，而只有少数公民拥有这种能力。本文审查了一些研究，这些研究开始证实，大多数健康权诉讼当事人来自于在包括健康状况在内的所有社会经济指标方面已经处于相当有利地位的社会群体。可以合理地假设，目前在巴西占主导地位的健康权诉讼模式可能会加剧卫生不公平现象。
