Sibley Angus
Institute and Faculty of Actuaries, London, UK.
Linacre Q. 2016 Nov;83(4):402-422. doi: 10.1080/00243639.2016.1249264.
Catholic teaching is emphatic on the need to "guarantee adequate [health] care to all," as Pope Benedict XVI has stated. America has been slower than other advanced countries in progressing towards this goal. Reasons for this delay can be found in certain attitudes that have long been present in American culture, and have been reinforced by the wave of libertarianism (free-market ideology) that swept the world in the late twentieth century. Catholic theology and social/economic teaching can help us understand the flaws in these attitudes, which involve fundamental philosophical and theological principles, but which are far from academic, since they have serious and very practical consequences. In the light of Catholic teaching, we can look towards a sounder understanding of healthcare needs and effective ways of meeting them. This article argues that access to healthcare, at least up to the level of basic necessity, falls under the heading of distributive justice. It is a human right owed by the community to each of its citizens. And since rights entail obligations, this right entails an obligation upon each citizen to contribute, as circumstances permit, to the costs, which need to be shared equitably; they cannot be met simply by each individual providing solely for oneself. Also discussed are the problems of excessive costs in healthcare administration and in pharmacological research, as well as harmful tendencies in private-sector firms to over-reward top management and to target maximum (rather than adequate) profits.
天主教教义强调“保障所有人获得足够的(医疗)护理”的必要性,正如教皇本笃十六世所说。美国在朝着这一目标前进的过程中比其他发达国家进展缓慢。这种延迟的原因可以在美国文化中长期存在的某些态度中找到,并且在20世纪后期席卷全球的自由主义浪潮(自由市场意识形态)中得到了强化。天主教神学以及社会/经济教义可以帮助我们理解这些态度中的缺陷,这些缺陷涉及基本的哲学和神学原则,但远非学术性问题,因为它们会产生严重且非常实际的后果。根据天主教教义,我们可以更合理地理解医疗保健需求以及满足这些需求的有效方式。本文认为,获得医疗保健,至少达到基本需求的水平,属于分配正义的范畴。这是社区对其每个公民应尽的一项人权。而且由于权利意味着义务,这项权利意味着每个公民有义务在情况允许时为需要公平分担的费用做出贡献;这些费用不能仅仅通过每个人只为自己提供来满足。文中还讨论了医疗保健管理和药物研究中成本过高的问题,以及私营企业中过度奖励高层管理人员和追求最大(而非足够)利润的有害倾向。