Davies Ben, Savulescu Julian
Uehiro Centre for Practical Ethics.
Uehiro Chair in Practical Ethics.
Public Health Ethics. 2019 Jul 4;12(2):133-144. doi: 10.1093/phe/phz008. eCollection 2019 Jul.
Some healthcare systems are said to be grounded in solidarity because healthcare is funded as a form of mutual support. This article argues that health care systems that are grounded in solidarity have the right to penalise some users who are responsible for their poor health. This derives from the fact that solidary systems involve both rights and obligations and, in some cases, those who avoidably incur health burdens violate obligations of solidarity. Penalties warranted include direct patient contribution to costs, and lower priority treatment, but not typically full exclusion from the healthcare system. We also note two important restrictions on this argument. First, failures of solidary obligations can only be assumed under conditions that are conducive to sufficiently autonomous choice, which occur when patients are given 'Golden Opportunities' to improve their health. Second, because poor health does not occur in a social vacuum, an insistence on solidarity as part of healthcare is legitimate only if all members of society are held to similar standards of solidarity. We cannot insist upon, and penalise failures of, solidarity only for those who are unwell, and who cannot afford to evade the terms of public health.
一些医疗保健系统据说建立在团结的基础之上，因为医疗保健是作为一种互助形式来提供资金的。本文认为，建立在团结基础上的医疗保健系统有权惩罚一些对自身健康不佳负有责任的使用者。这源于这样一个事实，即团结型系统既包含权利也包含义务，在某些情况下，那些可避免地造成健康负担的人违反了团结义务。合理的惩罚措施包括患者直接承担费用，以及降低治疗优先级，但通常不会将其完全排除在医疗保健系统之外。我们还指出了这一论点的两个重要限制。第一，只有在有利于充分自主选择的条件下，才能认定存在团结义务的缺失，这种情况发生在患者有“黄金机会”改善自身健康的时候。第二，由于健康不佳并非发生在社会真空中，只有当社会所有成员都遵守类似的团结标准时，坚持将团结作为医疗保健的一部分才是合理的。我们不能只对那些身体不适且无力逃避公共卫生条款的人坚持团结原则并惩罚他们违反团结的行为。
