Abstract
The principle that everybody should have access to essential health care goods is in conflict with the notion that property rights should be respected. The Kantian doctrine of rights is explored in order to solve this conflict. Kant's notion of a legislative will is explained and used to show the inherent limits of the legal terms “property” and “ownership” (it can refer only to things external to subjects and to possible objects of choice). What is internal to the subject is outside of the realm of the legislative will. A law excluding those unable to pay from access to essential health care would not be just. A law granting that access would be just.
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I do not distinguish here between different kinds of obstacles (actively impeding individuals, impending policies, impeding mentalities etc.). The definition of access used here is broad enough to include inability to pay as an impeding factor.
Engelhardt HT.The Foundations of Bioethics. New York: Oxford University Press 1986: 127ff.
Engelhardt:Foundations: 128.
Engelhardt:Foundations: 135.
Engelhardt:Foundations: 130.
Kant I.Metaphysik der Sitten. Hamburg: Felix Meiner, 1966; Kant I.Grundlegung zur Metaphysik der Sitten. Hamburg: Felix Meiner, 1957.
Doctrine of virtue: 376, translation, Mary Gregor.
The Metaphysics of Morals; Perpetual peace; On the common saying: “This may be true in theory, but it does not apply in practice.”
Compare the excellent overview on the terminological and translation problems of “Willkür” and “Wille” in Allison HE.Kant's Theory of Freedom. Cambridge: Cambridge University Press, 1990: 129ff.
“United will” is the direct translation of the Kantian “vereinigter Wille.” Both John Ladd and Mary Gregor translate that way. But “joint will” may be more adaequate. Compare below. See Ladd J.The Metaphysical Elements of Justice. Part I of theMetaphysics of Morals. New York: Macmillan Publishing Company, 1965; Gregor M.Immanuel Kant. The Metaphysics of Morals. Cambridge: Cambridge University Press, 1991.
Foundations of the Metaphysics of Morals, Akademieausgabe: 394, translation John Ladd. German original: “nicht etwa als ein bloßer Wunsch, sondern als die Aufbietung aller Mittel, soweit sie in unserer Gewalt sind.”
I owe the understanding of the significance of this description to Otfried Höffe. Höffe O.Ethik und Politik. Grundmodelle und -Probleme der praktischen Philosophie. Suhrkamp Taschenbuch 266. Frankfurt/Main: Suhrkamp, 1979.
“To whom who wants (something to be done) no injustice is done.”
This paragraph is a paraphrase of the first lines of §46 of Kant's Doctrine of justice. In German: “Die gesetzgebende Gewalt kann nur dem vereinigten Willen des Volkes zukommen. Denn da von ihr alles Recht ausgehen soll, so muß sie durch ihr Gesetz schlechterdings niemand unrecht tun können. Nun ist es, wenn jemand etwas gegen einen anderen verfügt, immer möglich, daß er ihm dadurch unrecht tue, nie aber in dem, was er über sich selbst beschließt (denn volenti non fit iniuria). Also kann nur der übereinstimmende und vereinigte Wille aller, sofern ein jeder über alle und alle über einen jeden ebendasselbe beschließen, mithin nur der allgemeine vereinigte Volkswille gesetzgebend sein [stress by Kant].” To my view, the translations of both Ladd and Gregor miss the sense of the second phrase, which states an absolute “must,” a supreme condition to be met (“muß ... schlechterdings niemand unrecht tun können”). Ladd: “Because all right and justice is supposed to proceed from this authority, it can do absolutely no injustice to anyone.” Gregor: “For since all Right is to proceed from it, itcannot do anyone wrong by its law [stress by Gregor].” I think the translation of Nisbet is correct: “For since all right is supposed to emanate from this power, the laws it gives must be absolutelyincapable of doing anyone an injustice.” See Reiss H, ed.Kant. Political Writings. Translated by H. B. Nisbet. Cambridge: Cambridge University Press, 1991.
Of course, the procedure of legislation has not only to be public but also representative. But I presume we — unlike Kant's contemporaries — find that not controversial.
This is the difference between Kant on the one hand and Locke with Engelhardt on the other with respect to the notions of property and ownership. Locke and Engelhardt start with the subject's body: My body is the prototype of my property. Kant starts with the moral significance of the term property. Property as a legal term can cover only things external to the subject. Then, it makes no sense to call my body my property: There can be no conflicting juridical claims about living human bodies. But Kant, Locke and even Engelhardt seem to agree that the legal protection of human bodies precedes the legal protection of (other) property.
I skip Kant's justification of “to have something external as one's own.” §§1–10, Doctrine of Right.
This is not to be confused with Kant's claim that it is impossible to will that a natural law prescribes suicide in case of challenges in our lives. Comp.Groundwork, Akademieausgabe: 422.
The following quote which presents a slightly different argument in very contracted form shows that this is Kant's authentic view: “The general will of the people has united itself into a society that is to maintain itself perpetually; and for this end it has submitted itself to the internal authority of the state in order to maintain those members of the society who are unable to maintain themselves. For reasons of state the government is therefore authorized to constrain the wealthy to provide the means of sustenance to those who are unable to provide for even their most necessary natural needs. The wealthy have acquired an obligation to the commonwealth, since they owe their existence to an act of submitting to its protection and care, which they need in order to live; on this obligation the state now bases its right to contribute what is theirs to maintaining their fellow citizens.”Metaphysics of Morals, Doctrine of Right,Akademieausgabe: 326, translation Mary Gregor.
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Heubel, F. A Kantian argument in favor of unimpeded access to health care. Theoretical Medicine 16, 199–213 (1995). https://doi.org/10.1007/BF00998545
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DOI: https://doi.org/10.1007/BF00998545