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Access, Equity and the Role of Rights in Health Care

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Abstract

Modern health care rhetoric promotes choice and individual patient rights as dominant values. Yet we also accept that in any regime constrained by finite resources, difficult choices between patients are inevitable. How can we balance rights to liberty, on the one hand, with equity in the allocation of scarce resources on the other? For example, the duty of health authorities to allocate resources is a duty owed to the community as a whole, rather than to specific individuals. Macro-duties of this nature are founded on the notion of equity and fairness amongst individuals rather than personal liberty. They presume that if hard choices have to be made, they will be resolved according to fair and consistent principles which treat equal cases equally, and unequal cases unequally.

In this paper, we argue for greater clarity and candour in the health care rights debate. With this in mind, we discuss (1) private and public rights, (2) negative and positive rights, (3) procedural and substantive rights, (4) sustainable health care rights and (5) the New Zealand booking system for prioritising access to elective services. This system aims to consider: individual need and ability to benefit alongside the resources made available to elective health services in an attempt to give the principles of equity practical effect. We describe a continuum on which the merits of those, sometimes competing, values—liberty and equity—can be evaluated and assessed.

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Notes

  1. R v Northumbrian Water Ltd, ex p Newcastle and N Tyneside HA. (1998) Divisional Court [1999] Environmental Law Reports 715.

  2. Co-operative Insurance Society v Argyle. [1999] 3 All ER 297.

  3. Section 1(2), National Health Service Act. 1977.

  4. See Re J (a minor) [1992] 4 All ER 614, 625 and R v Cambridge DHA, ex p B [1995] 2 All ER 129.

  5. Re T [1992] 4 All ER 649.

  6. Chapman v United Kingdom (2001) 33 EHRR 399.

  7. Matthews v Ministry of Defence [2003] 1 AC 1163, para 26.

  8. Unreported, Court of Appeal, 1988.

  9. Butterworths Medico-Legal Reports (2000), vol 53, 144.

  10. Such a system operates in Berkshire and Oxfordshire under an Ethical Framework to guide local PCTs.

  11. Secretary of State's Directions of 2003. London, Department of Health. These guidelines are confined to England. NICE guidance remains discretionary in Wales.

  12. Auton v British Columbia (2004) 220 DLR (4th) 411 (British Columbia Court of Appeal).

  13. Auton v British Columbia [2004] 3 SCR 657.

  14. E.g. Smits and Peerbooms (1999) C-157/99.

  15. See: www.berkshire.nhs.uk/priorities/policies/pdf/ab_ethical_framework.pdf.

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Newdick, C., Derrett, S. Access, Equity and the Role of Rights in Health Care. Health Care Anal 14, 157–168 (2006). https://doi.org/10.1007/s10728-006-0023-7

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