Orzechowski Marcin, Nowak Marianne, Bielińska Katarzyna, Chowaniec Anna, Doričić Robert, Ramšak Mojca, Łuków Paweł, Muzur Amir, Zupanič-Slavec Zvonka, Steger Florian
Institute of the History, Philosophy and Ethics of Medicine, Ulm University, Parkstraße 11, 89073, Ulm, Germany.
Center for Bioethics and Biolaw, Faculty of Philosophy, University of Warsaw, Warsaw, Poland.
BMC Public Health. 2020 Sep 14;20(1):1399. doi: 10.1186/s12889-020-09494-8.
Social diversity can affect healthcare outcomes in situations when access to healthcare is limited for specific groups. Although the principle of equality is one of the central topics on the agenda of the European Union (EU), its scope in the field of healthcare, however, is relatively unexplored. The aim of this study is to identify and systematically analyze primary and secondary legislation of the EU Institutions that concern the issue of access to healthcare for various minority groups. In our research, we have concentrated on three features of diversity: a) gender identity and sexual orientation, b) race and ethnicity, and c) religion or belief.
For the purpose of this analysis, we conducted a search of database Eur-Lex, the official website of European Union law and other public documents of the European Union, based on specific keywords accompanied by review of secondary literature. Relevant documents were examined with regard to the research topic. Our search covered documents that were in force between 13 December 2007 and 31 July 2019.
Generally, the EU legal system prohibits discrimination on grounds of religion or belief, racial or ethnic origin, sex, and sexual orientation. However, with regard to the issue of non-discrimination in access to healthcare EU secondary law provides protection against discrimination only on the grounds of racial or ethnic origin and sex. The issue of discrimination in healthcare on the grounds of religion or belief, gender identity and sexual orientation is not specifically addressed under EU secondary law.
The absence of regulations regarding non-discrimination in the EU secondary law in the area of healthcare may result from the division of competences between the European Union and the Member States. Reluctance of the Member States to adopt comprehensive antidiscrimination regulations leads to a situation, in which protection in access to healthcare primarily depends on national regulations.
Our study shows that EU antidiscriminatory law with regard to access to healthcare is fragmentary. Prohibition of discrimination of the level of European binding law does not fully encompass all aspects of social diversity.
在特定群体获得医疗保健机会有限的情况下，社会多样性会影响医疗保健结果。尽管平等原则是欧盟议程的核心议题之一，但其在医疗保健领域的范围相对未被充分探讨。本研究的目的是识别并系统分析欧盟机构关于不同少数群体获得医疗保健问题的主要和次要立法。在我们的研究中，我们关注了多样性的三个特征：a）性别认同和性取向，b）种族和族裔，c）宗教或信仰。
为了进行本分析，我们基于特定关键词搜索了数据库Eur-Lex（欧盟法律官方网站）及欧盟的其他公共文件，并查阅了二手文献。针对研究主题对相关文件进行了审查。我们的搜索涵盖了2007年12月13日至2019年7月31日期间生效的文件。
总体而言，欧盟法律体系禁止基于宗教或信仰、种族或族裔出身、性别和性取向的歧视。然而，关于在获得医疗保健方面的非歧视问题，欧盟次级法律仅提供针对基于种族或族裔出身以及性别的歧视的保护。欧盟次级法律未具体涉及基于宗教或信仰、性别认同和性取向的医疗保健歧视问题。
欧盟次级法律在医疗保健领域缺乏关于非歧视的规定可能是由于欧盟与成员国之间的权限划分。成员国不愿通过全面的反歧视法规导致了一种情况，即获得医疗保健的保护主要取决于国家法规。
我们的研究表明，欧盟关于获得医疗保健的反歧视法律是不完整的。欧洲具有约束力的法律层面的歧视禁令并未完全涵盖社会多样性的所有方面。
