Universal Healthcare A Moral Perspective

Universal Health Care: A Moral Perspective
By Therese Tisseverasinghe
April 16, 2006
Thesis advisor: Prof. Louis Groarke
First of all, I thank God for all the blessings in my life.
Secondly, thanks Mom, Dad, Annaliese, Marieliese, and Melissa for your continued love,
support, and encouragement in all my endeavors.
Thirdly, thanks Prof. Groarke for being such a wonderful thesis advisor, mentor, and
friend.
Finally, thank-you Prof. Sweet, Prof. Baldner, Prof. L. Byrne, Prof. C. Byrne,
Prof. Mensch, and Prof. Cook
for infusing me with the love of wisdom.
Table of Contents
Argument … 4
Diagram ... 7
Abstract … 8
Introduction … 9
Section I: Value of Health … 11

Part A: Eudaimonia is a fundamental value … 11
Part B: Self-Preservation is a Fundamental Value … 15
St. Thomas Aquinas and Natural Law … 15
Thomas Hobbes and Self-Preservation … 19
Immanuel Kant and the Duty to Oneself … 21
Part C: Pleasure as a Fundamental Value … 25
Conclusion … 27
Section II: Moral Obligation of Society … 29

Part A: Society as an Expression of Human Nature … 30
Empathy and Sympathy … 32
Compassion … 34
Altruism … 39
Conclusion for Part A … 40
Part B: Society Based on Love … 41
Part C: Society based on Happiness for the Greatest Number … 42
Part D: Society Based on Preservation of Human Life … 43
Conclusion … 45
Section III: A Single-Tiered Public Health Care System … 44

Part A: Against For-Profit Private Health Care … 48
Part B: Against a Two-Tiered Health Care System … 52
Conclusion … 55
Bibliography … 58
Argument
Section 1:
Sub argument 1:
P1: Eudamonia is a fundamental value:
Aristotle (Happiness as an end for all humans)
P2: Good health is a means to eudaimonia.
_________________________________________________
SC1: People have a moral obligation to value their health.
Sub argument 2:
P3: Self-preservation is a fundamental value:
Thomas (Natural Law)
Hobbes (Human rationality)
Kant (Duty)
P4: Good health is a means of self-preservation.
_________________________________________________
Sub argument 3:
P5: Pleasure is a fundamental value.
Mill (utilitarianism; hedonism; pain-pleasure principle)
SSC1: Good health is necessary for the enjoyment of one’s life (it increases pleasure and
decreases pain).
P6: If you are sick (as it decreases pleasure and increases pain),
you cannot enjoy life.
_________________________________________________
Section 2:
Sub argument 1:
SSC2: A moral society should be an expression of human nature.
P7: Morality is an expression of a deep human tendency.
Thomas (natural law)
SSC3: Human beings are naturally inclined to be other-regarding.
P8: Human beings have a natural inclination towards empathy and
sympathy.
(Lauren Wispé, Nel Noddings, Kristen Renwick Monroe, and Irene
Switankowsky)
P9: Human beings have a natural inclination towards compassion.
(Hume, Thomas Jefferson, Nicolas Malebranche, Bishop George
Berkeley, George Turnbull, Henry Grove, and the Third Earl of
Shaftesbury)
P10: Altruism is a conspicuous example of how human beings care for
others.
(We admire altruists; they are moral heroes, even if we are not
always altruistic.)
Renwick Munroe
SC1: Health is an important value for all humans. (Reworded from above.)
_______________________________________________________________________
SC2: A moral society should provide comprehensive health care to all members.
Sub argument 2:
P11: Society should be based on love, “charity” (instead of liberal justice).
Jason West
P2: Good health is a means to eudaimonia. .
SSC1: Good health is necessary for the enjoyment of one’s life.
_______________________________________________________________________
Sub argument 3:
P12: The overall aim of society should be to increase pleasure and decrease pain.
(Utilitarianism)
SSC1: Good health increases pleasure and decreases pain. (Reworded from above.)
_______________________________________________________________________
Sub argument 4:
P13: The purpose of society is to preserve human life.
(Thomas Hobbes)
_______________________________________________________________________
Section 3:
SSC4: A two-tiered health care system (where the private sector is for-profit) will not be
able to provide adequate health care to all members of society.
P14: Evidence: empirical, statistical research
Duckkett, Woolhandler and Hammelstein
SC3: A public single-tiered health care is the only way to preserve the health of
everyone.
Section 4:
SC3: Public single-tiered health care is the only way to preserve the health of all human
beings in a society.
MC: A society is morally obliged to provide a public single-tiered health care.

Diagram: Steps in Argument
First, establish sub-conclusion 1:
1. (P1+P2)  SC1
2. (P3+P4)  SC1
3. P6SSC1; (P5+SSC1) SC1
Second, establish sub-conclusion 2:
1. (P7)SSC2
2. (P8+P9+P10) SSC3
3. (SSC2+SSC3+ SC1) SC2
4. (P11+P2+P4+SSC1) SC2
5. (P12+SSC1) SC2
6. (P13+P4)  SC2
Third, establish sub conclusion 3:
1. (P14)  (SSC4) SC3
Fourth, establish main conclusion:
1. (SC3 +SC4)  MC
Abstract
In this thesis, I argue that society has a moral obligation to provide adequate universal
health care to all its members. In the first section, I argue that good health is
instrumentally and intrinsically valuable to all human beings. In the second section, I
argue that society has a moral obligation to value the good health of all human beings,
and as such, to provide universal health care to all. Lastly, in the third section, I use
several studies to demonstrate that a single-tiered public health care system is the best
way to ensure that all members of society receive adequate health care.
Introduction
The purpose of this thesis is to argue that society has a moral obligation to provide
adequate health care to all people. All human beings value good health as a means to
happiness, self-preservation, and enjoyment of a good life. A society of human beings
should respect this intrinsic and instrumental value and therefore provide health care to
all people. A parallel public-private health care system will not be able to provide
comprehensive health care. Therefore, a society should not allow the privatization of
health care.
In the first section, I demonstrate why all human beings value good health. This
section is divided into three parts. In the first part, I use the Aristotelian notion of
eudaimonia to show that health plays an important factor in achieving the ultimate human
end, i.e., happiness. Secondly, I use the moral philosophies of St. Thomas Aquinas,
Thomas Hobbes, and Immanuel Kant to show that all human beings have a moral
obligation to preserve their lives and hence their health. Finally I use John Stuart Mill’s
account of utilitarianism to show that the preservation of health is a fundamental moral
value. Hence, I use five different moral philosophies to demonstrate that all people
should value good health.
In the second section, I present four different arguments to show that society has a
moral obligation to care for its sick. I will not explore the prevailing liberal view in this
thesis. I develop instead an alternative line of reasoning. My first argument is that
human beings are naturally other-regarding, since all human beings have the capacity to
experience sympathy, empathy, compassion, and altruism. If, as St. Thomas Aquinas
argues, morality requires that we ought to act in accordance with our human nature, it
follows that a human society should regard the well being of all who are part of it.
Secondly, if liberalism bases human society on a conception of justice, I use an
argument from Jason West to argue for a society based on love . Love, according to
West, is defined as acting for the good of another. As such, we should care for the health
of others in society. It follows that a good society has a moral obligation to care for the
health of all its members.
Thirdly, I expand on the utilitarian principle that all our actions should aim at
increasing the happiness of greatest number of people in society. Since sickness
decreases pleasure and increases pain, health care should be a service that each individual
is entitled to have.
Finally, I expand on the Hobbesian notion of society. Hobbes believes that
human beings join society for the sake of survival. Since illness leads to a shortened
lifespan, society should provide care for the sick. It follows from these four separate
arguments that we should not only preserve our own health but that of other community
members as well.
In the third section, I argue against a two-tiered health care system. I use
empirical evidence from several studies to demonstrate that private for-profit health care
tends to provide less comprehensive care than its non-profit counterpart. Furthermore, a
two-tiered health care system is detrimental to a public system of care. Therefore, a
society that aims to provide adequate health care for all should not allow a two-tiered
health care system.

Section I: Value of Health
Of all the objects in the world, the human body
has a peculiar status: it is not only possessed by the person who has it,
it also possesses and constitutes him.
—Jonathan Miller 1
The greatest wealth is health.

—Virgil
Health is something that is immensely valued by all people. In this section I argue for
both the instrumental and the intrinsic worth of good health. I start off with the
Aristotelian principle of eudaimonia that the end of human life is to attain happiness.
Certain basic needs must be satisfied in order for human beings to flourish and achieve
their ends. Health, according to Aristotle, is one of the main things that a person must be
provided with if he is to attain a virtuous and flourishing life.
Part A: Eudaimonia is a fundamental value
Born to the court physician of the king of Macedonia, Aristotle (384-322 BC) is perhaps
one of the most well-known philosophers of all time. Following his father’s death,
Aristotle moved to Athens, where he entered Plato’s Academy. He remained at the
Academy, as both a student and a tutor up until Plato’s death, for about twenty years. In
335 BC, Aristotle founded his own school, the Lyceum, which was the centre for both
philosophical thought and empirical research. The surviving works of Aristotle is
believed to be his lecture notes. 2
Aristotle’s writings touch upon various subject matters including that of ethics.
His ethical works are contained in two volumes: Nicomachean Ethics and Eudemian
Ethics. The work that concerns us here is the Nicomachean Ethics, which is believed to
1
Jonathan Miller, The Body in Question, p. 14.
2
Theodore Denise et al., Great Traditions in Ethics, p. 22.
be the first systematic treatment of ethics in Western civilization. In it, Aristotle focuses
on what the fundamental purpose of human life is and the conditions of its attainment. 3
To begin with, we must understand Aristotle’s notion of teleology. What
Aristotle meant by teleology, which comes from the Greek word telos (“end” or
“purpose”), is that everything—natural and man-made—exists, acts, or is made for a
specific reason or purpose. For instance, the telos of a seed is to grow into a specific kind
of plant, that of a heart is to pump blood, that of a bread knife is to cut bread. So every
organism, every artifact, and every action has a telos. A human being who is able to
attain his telos is said to flourish.
Aristotle begins his inquiry of the ultimate human end by first trying to figure out
the end of each of our actions. The Nicomachean Ethics begins with a famous statement:
“Every art and every inquiry, and similarly every action and pursuit, is thought to aim at
some good.” 4 For instance, why does a student want to go to school? So that he may
learn a skill. Why should he learn a skill? In order to find a job. Why should he find a
job? To support himself, and so forth. Now, Aristotle believes that we cannot go ad
infinitum through the reasons why we engage in a certain activity. For then, we would
never reach our final end and human life would be hopeless. There must be an ultimate
end toward which all the other sub-aims are directed at. This end must be sought not as a
means to an end but for its own sake. Aristotle inquires into what this ultimate end is, the
end for the sake of which we all do everything else. 5 He claims that the end to which all
other human activities are geared towards is happiness. He believes that the ultimate
3
Theodore Denise et al., Great Traditions in Ethics, p. 23
4
Aristotle, Nichomachean Ethics, I.1.
5
Aristotle, Nichomachean Ethics, I.12
human end is happiness because it “is the best, noblest, and most pleasant thing in the
world.” 6
The next thing that Aristotle inquires into is how we can achieve happiness. He
concludes that happiness is achieved by living a virtuous life. Aristotle defines happiness
as the activity of the soul in accordance with perfect virtue 7 because “no function of man
has so much permanence as virtuous activity.” 8 The virtues that man must live in accord
with to obtain happiness are not innate but must be developed over time by forming
habits. Virtue or in Greek, arete, refers to the excellence of a thing and hence the
disposition to perform effectively its proper function. 9 For human beings, virtues are
character traits such as courage, prudence, justice, moderation, and so forth
An important aspect of teleology is that a thing may stray from its purpose in
many ways. For instance, a seed that is not given proper nutrients will not be able to
develop into the healthiest plant; a damaged heart will not pump blood as efficiently as
one in perfect condition; a blunt knife cannot cut bread as efficiently as a sharp knife. It
follows, then, that when certain basic conditions are not met or if the object is damaged
the proper functioning of it is also impeded.
If the end of all human endeavors is to achieve happiness, there are many possible
impediments to achieving this end. According to Aristotle, virtues must be explained in
terms of human reason, which he considers to be a distinctive function or activity of
man. 10 Human beings must live a life in accordance with reason to become fully
6
7
8
9
Theodore Denise et al., Great Traditions in Ethics, pp. 23-4.
10
developed persons. Thus, a virtuous person lives according to reason is the way for a
person to realize himself wholly and in turn achieve his end, happiness.
If to achieve happiness is to live virtuously, then we must consider those factors
that may limit one from attaining this end. Aristotle specifies that “some must
necessarily preexist as conditions of happiness, and others are naturally co-operative and
useful as instruments.” 11 According to Aristotle, man needs certain external prosperity
before he can attain the virtues, for he states that “it is impossible, or not easy, to do
noble acts without the proper equipment.” 12 The reason why Aristotle maintains that
external prosperity is a necessity is because “no activity is perfect when it is impeded, …
this is why the happy man needs the goods of the body and external goods … in order
that he may not be impeded in these ways.” 13 In other words any man who is half-naked,
hungry, and diseased will find it difficult to live a life of virtue, such as to be courageous
or generous.
I want to make two important points about external prosperity before concluding.
First, just because one has the basic necessities in life does not entail that one will
become virtuous. In other words, basic needs are a necessary condition but not a
sufficient condition for one to lead a virtuous life. On top of basic needs, one needs
education, proper guidance, example, and so forth, in order to fully flourish. Secondly,
by external prosperity, Aristotle does not mean excessive material goods but things such
as having a healthy body along with the basic necessities of life, such as food, clothing,
11
12
13
Aristotle, Nichomachean Ethics, VII.13.
and shelter. 14 In fact, Aristotle himself cautions us that excessive wealth can be an
impediment.
To conclude, Aristotle argues that the end of human life is to achieve happiness.
Happiness, then, is to be held to be the highest value for all humans. In order to achieve
this end, one must live a life of virtue. However, before one can aim at living a virtuous
life, he ought to have certain important external prosperity. One ingredient of these
external prosperities is good health. Since good health is a means to achieving happiness,
health problems would be an impediment to it. Therefore, good health has instrumental
worth to all human beings since it is a means to achieving the goal of human life.
Part B: Self-Preservation is a Fundamental Value
In this segment, I will discuss self-preservation, the first principle which applies to all
living things. All living things have a natural tendency to protect their own lives.
According to St. Thomas Aquinas, Thomas Hobbes, and Immanuel Kant, this is
especially the case for rational beings such as humans. When we know that something
can potentially harm us, we instinctively avoid it. Such is the case when we immediately
cover our eyes when we think we are about to be hit, or how we automatically pull our
hand away from the surface of a hot stove. Without doubt, human beings instinctively try
to preserve their bodies from impairment. Maintaining good health is a means to
preserving life. Good health, then, is of paramount worth to each and every human being
according to the principle of self-preservation.
St. Thomas Aquinas and Natural Law
14
Aristotle, Nichomachean Ethics, VII.13.
The Medieval philosopher, St. Thomas Aquinas (1225-1274), is perhaps one of the most
influential thinkers in Medieval philosophy. In his most significant work, Summa
Theologia, he attempts to present Christian theology as systematically as possible. It is
apparent that much of his writings on morality are greatly influenced by the works of
Aristotle. For example, he uses the Aristotelian notion of “the good” and “teleology,”
that everything has a purpose or an end, to found his moral principles for a common
human morality. 15
In his Summa Theologia, St. Thomas defines a law as a command that either
induces or restrains individuals for a purposeful reason. The telos (or the purpose) of a
law is to act for the good of the thing it commands. St. Thomas defines a legitimate law
as “nothing else than an ordinance of reason for the common good, made by him who has
care of the community, and promulgated.” 16 So every law must fulfill these four criteria:
first, it is governed by reason; secondly, it is for the sake of the common good; thirdly, it
must be promulgated; finally, it is executed by an authoritative power who cares for the
good of the community.
In the Summa Theologica, St. Thomas discusses law in general as well as the four
types of laws that govern the world; these are eternal, natural, human, and divine law.
The most general law that applies to all created things is the Eternal Law that is inherent
in the order and structure of all reality. Natural law, man’s participation in the divine
reason, is restricted to general precepts. These precepts are then applied to specific and
particular circumstances. St. Thomas calls these specifications of the natural law, human
15
Theodore Denise et al., Great Traditions in Ethics, pp. 77-81.
16
St. Thomas Aquinas, Summa Theologica, Sect. I.II.90.4.
laws. 17 However, St. Thomas believed that natural and human laws alone are insufficient
to direct human affairs. Consequently they must be supplemented by the divine law, the
inspired revelation contained in the Bible. 18
First, we will discuss the Eternal law. The Eternal Law, according to St. Thomas,
“is nothing other than the exemplar of divine wisdom as directing the motions and acts of
everything.” 19 The Eternal Law is the most general law and it is from this that all the
other laws proceed. This law, which comes from the perfect divine reason of God,
dictates the ends of things and applies to both animate and inanimate things along with
rational and irrational beings. The Eternal Law is not directly apparent to humans;
instead, we see traces of it in nature. St. Thomas writes, “Non-rational creatures …
participate in the divine reason by way of obedience.” 20 We can decipher that the Eternal
Law is acting upon all non-rational creatures through the natural order of things in the
universe: such as how the planets circle the sun in a constant fashion and how the seasons
always occur in the same timely manner.
St. Thomas states, “[The] participation of the eternal law in the rational creature is
called the natural law.” 21 Therefore, human beings not only act in ways that are
necessitated by the Eternal Law; we are also able to self-consciously participate in the
Eternal Law through free moral action. St. Thomas explains that the way we discern
natural law from the Eternal Law is through our capacity to reason.
As indicated by St. Thomas, natural law, which applies to the whole of humanity,
is imprinted in the mind of each person. We can know the natural law through our
17
Jack Donnelly, “Natural Law and Right in Aquinas’ Political Thought,” p. 521.
18
19
St. Thomas Aquinas, Summa Theologica, II.I.93.1.
20
21
rationality since “it is something constituted by … reason.” 22 Again, he adds that, “the
light of natural reason, whereby we discern what is good and what is evil, … is the
function of natural law.” 23 So the function of natural law is to direct us towards what is
good for us and away from what is evil. Its function, then, is to direct each person to
their appropriate end and activity.
According to Donnelly, “the telos [of natural law] provides a natural standard of
value and excellence: that which fosters the realization of the telos is good, that which
inhibits it is evil.” 24 In other words, natural law provides us with knowledge of the
proper way to live our lives. We then must use practical reason to act in accord with this
natural inclination. Our rationality, then, helps us to discern those actions that are good
for us and endeavor to live accordingly to attain our ultimate purpose in life.
The basic tenet of natural law is a self-evident truth that is accessible to all human
beings through the faculty of reason. The first command of law is “that good is to be
sought and done, evil to be avoided.” 25 From this single basic principle, pursue good and
avoid evil, all the other primary principles of our moral duties and obligations follow; and
from these primary principles, more specific moral principles can be derived. All the
precepts that flow from the self-evident first principle are revealed to us through the
proper use of human rationality. In other words, the basic principle of natural law is
evident to our minds; however, as we move from general to more and more particular
circumstances, we must use our rationality methodically and carefully in applying this
first principle.
22
23
24
25
The principle that concerns us here is our natural inclination towards self-
preservation. According to the first part of the secondary principles of natural law, the
first moral good for human beings is to preserve their lives. St. Thomas writes, “There is
in man, first, a tendency towards the good of the nature he has in common with all
substances; each has an appetite to preserve its own natural being. Natural law here plays
a corresponding part, and is engaged at this stage to maintain and defend the elementary
requirements of life.” 26 In other words, the foremost inclination for every human, which
we share with all other living things is the principle of self-preservation. Just as all living
things naturally seek to preserve their lives, so too must humans. This natural tendency is
the first moral obligation of all human beings.
There are several ways in which self-preservation can be achieved. For instance,
our rationality tells us to stay away from things that harm us. When we are hurt, we
naturally seek remedies to recover health. It is plainly clear that protecting our health is a
means to protecting our life; this is crucial to all human beings. Health, then, is
instrumental for self-preservation. Therefore, if we are morally obliged to preserve our
lives and good health is a means to achieving this end, we are morally obliged to preserve
our health.
Thomas Hobbes and Self-Preservation
Thomas Hobbes (1588-1679) is an English philosopher who wholly embraced
materialistic ways of thinking. His most famous writing is The Leviathan (1660) in
which he gives a completely mechanistic account of man. His materialistic notion of
man comes down to one thing, “meat in motion.” Hobbes views human beings as
nothing other than sophisticated machines. They are like an engine or a watch, an
26
“artificial life” that moves itself by “springs and wheels.” Hobbes compares a heart to a
“spring” and the nerves to many “strings.” 27
In his introduction, he describes life as nothing but the “motion of limbs.” For
Hobbes, “voluntary motion” or “animal motion” is motivated by two kinds of passions,
appetite and aversion. Appetite or desire is when one is attracted toward something. For
example, when someone is thirsty he will move toward water or, if he is hungry, he will
move toward food. Aversion, conversely, is when one is dissuaded from something. For
example, men move away from anything that will cause them pain. So, men “love” that
which they desire, while those things that cause them to avert, they “hate.” Furthermore,
according to Hobbes, that which we have an appetite for we call “good” and that which
we are averted from we refer to as being “evil.” 28
For Hobbes, human rationality is analogous to a computing device. He writes,
“When man reasoneth, he does nothing else but conceive a sum total, from addition of
parcels; or conceive a remainder, from subtraction of one sum from another.” 29
Rationality, then, is equated with a sort of a calculating apparatus except that it is made
possible through speech. Benjamin Lopata explains Hobbesian understanding of human
rationality: “man is a creature who is primarily motivated by his passions; reason cannot
tell men what to desire but only how best to gratify their passions.” 30 Therefore,
although we are rational animals, our passions come prior to reason. Human beings
possess the two extreme passions, aversion and appetite, and reason is like a calculating
device whose purpose is to calculate the action that will allow them to follow their
27
Thomas Hobbes, The Leviathan, Introduction.
28
Thomas Hobbes, The Leviathan, Chap. VI.
29
Thomas Hobbes, The Leviathan, Chap. V.
30
Benjamin Lopata, “Property Theory in Hobbes,” p. 205.
appetites while avoiding the source of aversion. The function of reason for Hobbes, then,
is to help us maximize the goods in life and minimize the evils.
Hobbes defines the law of nature as “a precept, or general rule, found out by
reason, by which a man is forbidden to do that which is destructive of his life, or taketh
away the means of preserving the same; and to omit that by which he thinketh it may be
best preserved.” Reason then forbids us to do anything that is harmful to ourselves or to
do anything that will prevent us from preserving our lives. Hobbesian notion of reason
is that of a calculating devise used solely for our survival.
Thomas Nagel explains Hobbes’ position on human nature and self-preservation.
He states, “In Hobbes’s language, it is one’s moral obligation to follow the dictates of
reason toward self-preservation and longer life. Certain acts, self destruction, for
example, can never serve as means to self-preservation. Therefore killing oneself or not
protecting oneself against harm can never be morally obligatory.” 31 In other words, it
would be irrational for a person not to try to protect his life in whatever way possible,
since all rational beings are naturally inclined to preserve their lives. To act irrationally is
equivalent to act immorally, according to Hobbes. Therefore, it would be immoral for a
person to not protect his life or to not safeguard his body from harm.
In short, Hobbes’ argues that ultimately what all living creatures want is to
preserve themselves. Humans, as rational beings, are naturally and rationally inclined to
preserve their lives. It would be irrational for a person to allow harm or damage to occur
to his body without seeking remedy. Yet, all human beings are susceptible to illnesses
which threaten this first principle of human nature. Therefore, according to the
31
Thomas Nagel, “Hobbes’s Concept of Obligation,” p. 70.
Hobbesian notion of human nature, good health would be of chief importance to all
human beings and the instrumental value of a healthy body is immeasurable.
Immanuel Kant and Duty to Oneself
Immanuel Kant (1724-1804) is a German philosopher who lived and died in his birth
place, a small town East of Prussia called Konigsberg. He studied, tutored, and lectured
at University of Konigsberg for more than forty years. 32 His Grounding for the
Metaphysics of Morals (1785) was a very influential work. In it, Kant discusses the role
of duty in morality; he also introduces the concept of the Categorical Imperative, a
heuristic tool to help us determine our moral duties.
Kant splits reason into two traditional categories: theoretical reason, which
focuses on math, logic and metaphysics, and practical reason, which deals with morality.
For Kant, morality meant doing one’s duty rather than following one’s desires.
Furthermore, it is motive rather than the consequence that is decisive for moral actions.
For Kant, the only thing that is good in and of itself is a “good will.” 33
Everything else can be good or bad depending on how they are used. So, even if the
consequences of an action turn out to be evil, if the act is done out of pure good will, then
the act is morally right. However, he does grant that there are some qualities that are
“conducive to this good will” and will “facilitate its work.” What is important for Kant
in terms of morality is not the results of an action but only the good intention of the
acting individual.
Kant, being a deontologist, believes that a person ought to always act out of a
sheer sense of duty. He connects duty to “good will, though with certain subjective
32
33
Immanuel Kant, Grounding for the Metaphysics of Moral, p. 7.
restrictions and hindrances.” 34 An important duty that each man possesses is to “preserve
one’s life,” which Kant admits is also an “immediate inclination” for every man. 35 A
man has a duty to preserve himself even when his situation is miserable and ending his
life seems like a better option for him. This is an example of good will, a will that
chooses what is good despite the consequences.
Kant introduces the concept of the Categorical Imperative that he considers to be
the standard of morality. Categorical Imperative is a formula that allows us to deduce
what sorts of actions are moral. The First Formulation of the Categorical Imperative is
that one should “act only on that maxim by which you can at the same time will that it
should become a universal law.” That is, if I want to do something, before I decide to
carry it out, I must first ask myself if I could will that every single person in the world do
the same thing. If I cannot, then I should not pursue this action. In pursuing this action, I
would be contradicting my own will. As a rational agent, I must act consistently in order
to act in accordance with my own rational nature. Through the use of the Categorical
Imperative a person discovers his duties to himself as well as his duties to others. 36
In defense of Kant’s claim that each person has a duty to himself, Margaret Paton
discusses three aspects of duty to self in terms of self-preservation and the development
of one’s talents. However, I will focus only on self-preservation. First, Paton argues that
Kant’s view of duty to oneself is self-regarding. 37 What she means by self-regarding is
that it is concerned with a person’s regard for his own intrinsic worth rather than an
egoistic understanding like that of Hobbes’. For instance, suppose someone lies. Even if
34
35
36
Margaret Paton, “A Reconsideration of Kant’s Treatment of Duties to Oneself,” p. 223.
37
Margaret Paton, “A Reconsideration of Kant’s Treatment of Duties to Oneself,” p. 227.
that lie does not cause harm to himself or anyone else, it is still wrong because the
individual ignores his own inner worth or dignity as a truth-knowing (i.e., rational) being.
Paton asserts that Kant’s doctrine rests on the mystical value ascribed to treating people
as ends. Thus, duties to oneself are important because one must first value oneself, just
as one should value others; this ensures that one will not do anything that is morally
impermissible.
The second point that Paton makes regarding duties to oneself is that they come
prior to duties to others. 38 For instance, self-preservation takes precedence over promise
keeping or helping another. Kant is not implying that self-sacrifice is not a moral good;
neither is he promoting egoism. According to Paton, the development of a good will, for
Kant, takes precedence over the promotion of happiness in the moral life. She believes
that duties to others are for the sake of “cohesion and smooth-running of society” which
in turn is to enable individuals to “seek their own perfection.” She writes, “the real
business of morality remains the cultivation by an individual of his own worthiness and
ultimate perfection.” According to Paton, then, one has duties towards others for the sake
of helping others, but also in order to be dutiful toward oneself. Thus, the centre of moral
activity is to allow one to value oneself and one’s own moral life.
Finally, Paton has an interesting point regarding preservation of one’s life as
being paradigm case of duty to oneself. 39 She writes, “a person’s duties to himself
highlight the possible existence of a value in an individual’s experience that claims his
allegiance over and above the strong, opposing tendency to self-indulgence which may
either sap the will … or else propel him along the way of pleasure-seeking.” That is, by
38
Margaret Paton, “A Reconsideration of Kant’s Treatment of Duties to Oneself,” pp. 228-30
39
Margaret Paton, “A Reconsideration of Kant’s Treatment of Duties to Oneself,” pp. 230-32.
evaluating one’s duties to oneself, one is able to make the fundamental choice between an
egotistic, self-indulgent life and that of a virtuous life in treating oneself as the end of
worthiness. The Categorical Imperative gives each man a third eye standpoint of his life
so that he may wisely choose “the pursuit of dignity and virtue” over the “satisfaction of
as many desires as possible.” 40 Paton claims that Kant believes that the preservation of
one’s life must be a paramount duty to oneself, because it is the necessary and sufficient
condition of being a moral agent at all. By having a duty to refrain from committing
suicide, one is actually prevented from becoming egoistic.
To summarize, Kant regards self-preservation as not only a natural inclination but
also an essential duty oneself. Kant asserts that the duty to preserve oneself is of utmost
moral importance to all human beings. Self-preservation entails sound health. Since it is
essential for all human beings to preserve themselves, it should also be important to
protect one’s body from injury and disease. Therefore, preserving one’s health is an
important value from the point of view of deontology.
Part C: Pleasure as a Fundamental Value
In this segment, I use the principle of utilitarianism to argue for the intrinsic worth of
human health. Utilitarians endorse a hedonistic principle of morality. They contend that
the basic human good is to avoid pain and seek pleasure. Impairments to the body would
be considered a fundamental evil, because illness is a source of pain and suffering and an
40
Margaret Paton, “A Reconsideration of Kant’s Treatment of Duties to Oneself,” pp. 232.
obstacle to the enjoyment of one’s life. Therefore, a utilitarian intrinsically values good
health.
Jeremy Bentham and John Stuart Mill (1806-1873) are influential utilitarian authors.
Mill’s Utilitarianism was completed in 1861. In it, he introduces the concept of utility,
which has its roots in the British empiricism of David Hume, George Berkeley, and John
Locke. However, the notion of utility or the “Greatest Happiness Principle” is most
closely derived from the works of Jeremy Bentham.
According to the principle of utility, happiness is the only thing that is good in
and of itself. The basic tenet of utility is that an action is right if it produces happiness or
pleasure and it is wrong if it produces unhappiness or pain. Basically, then, for a
utilitarian, happiness or pleasure is “the good” that should be pursued while pain and
suffering is an evil and so it should be avoided. On this account, society must always try
to maximize happiness and minimize pain.
Utilitarianism is opposed to two important moral stances: deontology and egoism. The
underlying principle of deontology is that one’s intentions are the sole determinants of
morality, whereas utilitarianism is only concerned with the consequences of the act. The
basic doctrine of egoism is that one ought to always act in such a way that only increases
one’s own happiness, even at the expense of others. Utilitarianism, on the other hand,
asserts that one ought to impartially take into account both one’s own happiness as well
as that of others who will be affected by the action and choose the act that increases the
overall happiness.
Leslie Mulholland argues that, although utilitarianism promotes the greatest
happiness for the greatest number of persons, it both recognizes and treats each individual
as a separate being rather than just as a part of a whole. As she asserts, “enjoyments and
pains are felt only by the living individual.” Once we are able to recognize the
importance of the individual as a living subject, the justification of each individual’s
basic rights to life, property, and basic freedoms follows; these provide the fundamental
protection of each person’s future enjoyment. Utilitarianism, in this way, recognizes the
importance of the individual.
In the case of health, the happiness of an individual is to avoid sickness as it
causes pain and to pursue actions that promote good health. According to Mulholland the
“security of life, limb, and property is probably the most general human interest.” 41
Mulholland asserts, that “the fundamental rights are to protect the course of life of the
living individual.” 42 Therefore, a society that is based on utilitarianism, cannot, in
anyway, ignore or shun the importance of the pleasure and pains and therefore the health
of each individual who participates in that society. The human body is susceptible to
damage, harm, malfunctions, and imperfections. Any sort of malfunction of or injury to
the body causes pain and suffering. If one is suffering from an ailment, then he cannot
enjoy life. Therefore, according to the basic principles of utilitarianism, we are morally
obliged to value good health as a fundamental to all persons.
Conclusion
In this section, I first discussed the notion of eudaimonia by Aristotle. According to
Aristotle, the purpose of human life is happiness. A happy life consists of living
virtuously. However, in order for human beings to flourish and reach their highest
potential, certain basic conditions must be met, such as having good health, adequate
41
Leslie Mulholland, “Rights, Utilitarianism, and the Conflation of Persons,” p. 325
42
Leslie Mulholland, “Rights, Utilitarianism, and the Conflation of Persons,” pp. 325-6
nourishment, a shelter, and sufficient funds to live a modest life. Therefore, using
Aristotelian conception of eudaimonia, I argued why human health is immensely valued
by all humans.
Next, through the moral philosophies of St. Thomas, Hobbes, and Kant, I
demonstrated that as rational beings, our first inclination is to preserve our lives. I also
discussed how good health is intrinsically related to self-preservation as it is a means to
human survival. It follows that good health is inherently valuable to all human beings.
Finally, using Mill’s theory of utilitarianism, I demonstrated why good health is
fundamentally valued by all humans. From the moral point of view of a utilitarian, all
human beings naturally seek pleasure and avoid pain. Sickness causes suffering, which is
something that must be avoided, while good health allows for the enjoyment of one’s life.
Therefore, a utilitarian, just like the other four moral philosophers discussed, also values
good health as it increases one enjoyment of life.
I borrowed from five different philosophers with five separate accounts of human
nature and five different moral philosophies. However, they all seem to converge at one
point: health is a moral good. Good health is something that should be valued by every
single person. In the following section, I argue for the moral obligation of society to
provide adequate health care to all people.

Section II: Moral Obligation of Society
A human being is a part of the whole called by us universe, a part limited in time
and space. He experiences himself, his thoughts and feeling as something separated from
the rest, a kind of optical delusion of his consciousness. This delusion is a kind of prison
for us, restricting us to our personal desires and to affection for a few persons nearest to
us. Our task must be to free ourselves from this prison by widening our circle of
compassion to embrace all living creatures and the whole of nature in its beauty.
–Albert Einstein
Introduction
Although I am aware of the liberal notion of society which holds that amoral individual
freedom should be the primary political value, I will argue in this section for a different
notion of society. My position is that a society should place the values of individual at
the social level. If human beings are moral animals and as such morality plays an
important aspect in our lives, a group of human beings should also reflect those same
values. In this section, I present four separate arguments as to why society should
provide adequate health care to all its members on the basis of four different moral
stances.
First, I argue for a society that is an expression of human nature. If part of being
human is to be other-regarding, then society should also be an expression of this aspect of
humanity. Secondly, I argue for a notion of society based on love. A society whose
primary political value is love rather than justice must place the well-being of all the
individuals in it. Thirdly, I use the utilitarian principle that society should promote the
greatest happiness to the greatest number of people. Finally, I use the Hobbesian
argument that the ultimate reason why an individual enters into a society is to preserve
their well-being. I use these four separate moral stances to argue for the moral obligation
of society to provide adequate health care to all its members.
Part A: Society as an Expression of Human Nature
In the last section we discussed the moral philosophy of St. Thomas Aquinas, particularly
the principles of natural law. According to St. Thomas, we act morally when we act
according to our human nature, which is a natural inclination inside us that is in accord
with reason. St. Thomas states, “all those things to which man has a natural inclination
are naturally apprehended by reason as being good, and consequently as objects of
pursuit, and their contraries as evil, and objects of avoidance ” 43 So, according to St.
Thomas, what is good for man is associated and derived from our natural inclinations. In
other words, that which we are rationally inclined to do is good, whereas that which we
are rationally inclined not to do is evil. St. Thomas emphasizes the connection between
our natural inclinations and the natural law. He writes, “according to the order of
natural inclinations, is the order of the precepts of the natural law.” St. Thomas lists three
different orders or levels of natural inclinations.
The strongest inclination (which we have in common with all life forms) is the
desire to preserve oneself. The second inclination that we have in common with other
animals is to reproduce and care for our offspring. The third inclination, which is unique
to humans, includes the desire to know and love God as well as to live civilly in society.
St. Thomas’ account is a familiar theme in the history of philosophy. To cite only
one more example, Richard Cumberland, a Latitudinarian bishop from the Seventeenth
Century, argues that human nature itself suggests certain rules of life and by studying it
we can derive “what kind of Action Man is fitted by his Inward Frame.” 44 So, according
to Cumberland, our natural inclinations give us the rules that will guide us to perfection
of our humanness. To disobey these natural inclinations which are in accord with reason
would then lead us to imperfection of our human nature. As such, a human society
should endorse those principles that are in accord with these natural inclinations of man.
43
St. Thomas Aquinas, Summa Theologica, 94.2.
44
Quoted by Norman Fiering in “Irresistible Compassion,” p. 200.
Again, Henry More, a Cambridge Platonist, in his Enchiridion Ethicum argues for
the essential goodness of what he calls the human passions. He asserts that passions, our
natural ways of feeling, are in general good in and of themselves and are “singularly
needful to the perfection of human life.” In other words, our passions or natural
tendencies play an important role in helping us become fully human. This is because,
passions, he believes, do not come from our own effort, nor from freethinking or
speculation, nor are they acquired. Instead, he asserts that they are “in us antecedent to
all notion and cogitation whatever” and thus, are “from Nature and from God.” 45 More’s
position is that our passions are not something that is created by man but rather it comes
directly from nature and God. Consequently, they are good in and of themselves.
If morality means acting in accordance with human nature, many great thinkers
argue that human nature is essentially other-regarding. The ability to feel sympathy,
empathy, and compassion as well as to act altruistically is naturally embedded in the
hearts of all human beings. Isaac Barrow, a famous pastor and mathematician, in
reference to benevolence and compassion, says, “the constitution and frame of our nature
disposeth to [natural affection].” That is, the very nature of our being is to feel affection
towards others. One may choose to act in ways that clash with this innate ability, but this
does not mean that it is non-existent.
This natural tendency to feel for others is an experience that is universally understood.
When we see someone trip over or about to trip over, our automatic reaction is to warn
them or to try to stop their fall. These experiences are natural and other- regarding. The
famous English philosopher of Eighteenth Century, David Hume, in a footnote, remarks:
“it is needless to push our researches so far as to ask, Why we have humanity or a fellow-
45
feeling with others? It is sufficient that this is experienced to be a principle of human
nature. We must stop somewhere in our examination of causes; and there are, in every
science, some general principles beyond which we cannot hope to find any principle
more general.” 46 In this section, I will not attempt to prove that human beings have a
natural tendency to feel for their fellow human beings, but instead use the testimony of
many great writers and thinkers to present this inclination as a first principle of human
nature. Feelings of sympathy, empathy, and compassion are not limited to those who are
closest to us. It is an undeniable aspect of humanity that we have a natural and innate
tendency to act in a way that fosters the interest of even strangers. In the following
discussion I argue for the central role that empathy, sympathy, compassion, and altruism,
play in human nature.
Empathy and Sympathy
In this segment, I refer to the definitions and descriptions that Lauren Wispé, Nel
Noddings, Kristen Renwick Monroe, and Irene Switankowsky present in their
philosophical work on sympathy and empathy. Although each has their own
interpretation, all argue that both sympathy and empathy are natural and universal human
experiences that are selfless, emotional states.
Lauren Wispé, a professor at University of Oklahoma discusses the difference
between “sympathy” and “empathy” in her book, The Psychology of Sympathy. She
believes that in empathy, “one person reaches out for the other person,” whereas in
sympathy “the sympathizer is moved by the other person.” Suppose someone is hurt in a
car accident. When we empathize with them, we put ourselves in that situation and
consider the event as if we were the person who is hurt. When we sympathize with them,
46
we look at the event as a concerned bystander. We do not become the accident victim;
we become the onlooker who is troubled by the situation. In empathy, one shares a sense
of self with the victim, whereas sympathy is concerned with communion and self-
awareness is reduced rather than enhanced. 47
Nel Noddings, who is well known for her works on the ethics of caring, describes
empathy as follows: “I receive the other person into myself, and I see and feel with the
other. I become a duality. … The seeing and feeling are mine, but only partly and
temporarily mine, as on loan to me.” 48 In other words, Noddings describes empathy as a
spiritual communion of two people, where neither is the owner of the feeling, but both
own it together; in so doing, they become one.
Kristen Renwick Monroe, in The Heart of Altruism, defines empathy as both a
cognitive process and an affective response. By cognitive process, she means that “it
provides the ability to understand what another person is feeling and to discriminate
among various behavioral cues in order to assess the other person’s emotional state.” 49
She adds as an example that one who empathizes would assume the perspective of the
needy person in an attempt to understand their thoughts and intentions. Empathy is also
an affective response, according to Monroe, because one “is emotionally aroused by the
feelings of others in a way that is favorable to the satisfaction of their needs.” 50
Therefore, for Monroe, one who feels empathy both understands and a feels for another
individual.
47
Lauren Wispé, The Psychology of Sympathy, p. 79.
48
Nel Noddings, Caring, p.30.
49
Kristen Renwick Monroe, The Heart of Altruism, p. 12.
50
Irene Switankowsky distinguishes sympathy and empathy: the former is
passive—we are caused by someone else to reach that emotional state; the latter is
active—because we come to understand the state of the other person, this stirs within us
certain emotions. Switankowsky describes sympathy as “feeling another individual’s
predicament, whether it is his/her sadness or joy, leading … to a type of emotional
identification between two individuals.” 51 She defines empathy as consisting of
understanding another person’s situation. 52 An empathizer changes state from being a
passive to an active agent, where she becomes “intensely conscious of the other person’s
situation.” 53 Switankowsky asserts that empathy is a distinct and different kind of
conscious experience. 54 One who is sympathetic feels something for another person,
whereas one who is empathetic, constructs or creates a feeling for another. 55
Despite these various definitions, sympathy and empathy both have one thing in
common: they are emotional states that are provoked by another person. Our ability to
sense the pains or joys of other human beings through sympathy and empathy is direct
evidence that human beings are not always self-centered egotists. We, in fact, have
innate inclinations to be able to feel and understand the experiences undergone by our
fellow human beings. As such, all human beings have the capacity to place the concerns
of others before themselves. It follows that human beings are other-regarding.
Compassion
The virtue of “compassion” provides another window on the other-regarding nature of
humanity. One dictionary defines compassion as “the humane quality of understanding
51
Irene Switankowsky, “Sympathy and Empathy,” p. 86.
52
53
54
55
the suffering of others and wanting to do something about it.” 56 Another dictionary
defines it as “pity inclining one to help or be merciful.” 57 In other words, compassion is
equated with empathy; although it is believed to be more active since a compassionate
person does not only feel the suffering of another, but also desires to aid those they feel
compassionate for.
Norman Fiering, discusses the doctrine of “irresistible compassion,” 58 a term that
was concocted in the eighteenth century. Irresistible compassion is the idea that feelings
of compassion and sympathy are a natural and intrinsic part of human nature. In this
article, Fiering discusses various philosophers and writers, such as David Hume, Thomas
Jefferson, Nicolas Malebranche, Bishop George Berkeley, George Turnbull, Henry
Grove, and the Third Earl of Shaftesbury, who argue that human beings are naturally
predisposed to show compassion. He equates “irresistible compassion” with feelings of
“sympathy” and “humanity.” 59 In the following section, I review the thoughts of several
great thinkers who accept that these feeling are innate.
According to David Hume, “No man is absolutely indifferent to the happiness and
misery of others. The first has a natural tendency to give pleasure, the second pain. This
everyone may find in himself.” In another of his works, he writes, “absolute,
unprovoked, disinterested malice has never, perhaps, a place in any human breast.” In
other words, it is inhuman to not regard the suffering and joy of another.
In a famous letter, Thomas Jefferson writes, “Nature hath implanted in our breasts
a love of others, a sense of duty to them, a moral instinct, in short, which prompts us
56
WordNet
57
Canadian Oxford Dictionary.
58
Although the following quotes were taken from Fiering’s article, I shall give the original sources.
59
Norman Fiering, “Irresistible Compassion: An Aspect of Eighteenth-Century Sympathy and
Humanitarianism,” p195.
irresistibly to feel and to succor their distresses.” 60 Thomas Jefferson describes
compassion, the love of others, as a “moral instinct” which is embedded in the hearts of
all mankind. According to Fiering, individuals such as Jefferson argued that men have an
interest in “the sufferings of others and are equally irresistibly moved to alleviate that
suffering.” 61 Fiering concurs. He claims that this undeniable experience of mankind,
Fiering is “an automatic mechanism for social good” 62 and that those who lack this
ability to feel empathy are “by definition, something less than human.” 63
According to Nicolas Malebranche, a French Augustinian monk, our desire to act
altruistically is like invisible bonds that “bind and oblige us.” 64 He calls it a “secret
Chain-work.” For instance, if each of us acted according to our own self-interest, while
ignoring the interest of others, then the sense of community and the sense of belonging to
a community are lost. The love we feel for others, which in turn causes us to act
altruistically, is what “chains” us together to form a coherent, wholesome society. So
altruism can be understood as the glue that keeps society together.
The famous philosopher, Bishop George Berkeley, compares our human desire to
unite with our fellow men to the law of gravitation. According to the law of gravity,
there exists an attractive force between every particle such that they have a tendency to
coalace. Berkeley uses this concept as a analogy to how human beings have an innate
tendency to be attracted to one another. In forming a society, we naturally desire the
well-being of all our fellow mankind. He writes, “As the attractive power in bodies is the
60
Jefferson to Thomas Law, June 13, 1814, in Lipscomb and Bergh, The Writings of Thomas Jefferson, p.
141.
61
Norman Fiering, “Irresistible Compassion,” p. 195.
62
Norman Fiering, “Irresistible Compassion,” p195.
63
Norman Fiering, “Irresistible Compassion,” p196.
64
Father Malebranche, Treatise concerning the Search After Truth, p. 165-66.
most universal principle which produceth innumerable effects, and is the key to explain
the various phenomena of nature; so the corresponding social appetite in human souls is
the great spring and source of moral actions. This it is that inclines each individual to an
intercourse with his species, and models everyone to that behavior which best suits with
common well-being.” 65 Berkeley considers anyone who does not experience this to
be a sort of monster or anomaly.
Even Thomas Hobbes, who is known to promote egoism as a moral principle
believes that the one who acts out of love for his neighbor possesses far greater power
than anyone who acts out of self-love. He writes “There is yet another passion
sometimes called, love, but more properly good will or charity. There can be no greater
argument to a man, of his own power, than to find himself able to not only to accomplish
his own desires, but also to assist other men in theirs: and this is that conception wherein
cosisteth charity.” 66
Joseph Butler, the Bishop of Durham, published Fifteen Sermons which were
preached at the Rolls Chapel in London in 1726. Butler believed that passions are an
important part of human nature. In order to attain happiness, man must learn to balance
all his passions. In particular he discusses two important passions: love-for-self and love-
for-others. He maintained that both these passions are equally good and both must be
kept in check. Love-for-self seeks for each his own good, while love-for-others is what
causes man to act benevolently. In an ideal world when man has total love for other the
love for self dies out. 67
65
A. Luce and T. E. Jessop, The Works of George Berkeley. (Guardian, No. 49, May 7, 1713).
66
Thomas, Hobbes. The Elements of Law Natural and Politic. Chap. IX. 17
67
Bishop Butler, Fifteen Sermons.
According to Butler’s view, “the psyche is populated by multiple passions.” He
explains that a passion is satisfied when the object of its desire is obtained, such as when
hunger is relieved by the consumption of food. He believes that all people naturally
possess benevolence, whose object is the happiness of others. Self-love is another
passion possessed by all and its object is one’s own happiness.
David Estlund discusses Butler’s conception of benevolence and well-being.
According to Estlund, Butler’s notion of happiness does not require the full satisfaction
of the passions. It is the balance of all of the satisfaction of the passions that produces
happiness. 68 Estlund suggests that one of Butler’s recurrent themes is that “attention to
one’s benevolent passions is integral to one’s own happiness; it is an ineliminable part of
the balanced pattern of satisfaction, which is, according to nature, human happiness.” 69
Estlund concludes that it is precisely the neglect of one’s own benevolent passions which
results in the failing of one’s own self-love, and this, in turn, results in selfishness and
lost happiness.
According to Estlund, benevolence aims at the good or happiness of another. On
Butler’s account, a person’s good or happiness necessarily includes some degree of
satisfaction of their own benevolent passions. This necessitates then, that each person’s
good depends on someone else’s good, which gives “rise to an infinite chain of
dependence with either infinitely many individuals as links, or (more likely) a loop.” 70
So, what binds society together is this benevolent passion which is also necessary for one
to achieve his own happiness.
68
David Estlund, “Mutual Benevolence and The Theory of Happiness,” pp. 191-2.
69
David Estlund, “Mutual Benevolence and The Theory of Happiness,” p. 192.
70
David Estlund, “Mutual Benevolence and The Theory of Happiness,” p. 195.
I have now shown that sympathy, empathy, and compassion are common human
experiences that are universally understood and experienced. The preceding authors are
just a handful of individuals who testify to this fact. These human emotional states have
one thing in common: they are all other-regarding. I will next discuss altruism. Altruism
is a further example of the other-regarding nature of humans. Unlike the emotional states
of sympathy, empathy, and compassion, altruism is an act that is done out of a selfless
reason. Although not every one engages in altruistic behavior, the existence of such
behavior is a clear example of the selfless nature of humans. Furthermore, we admire
altruists; they are moral heroes, even if we ourselves are not always altruistic. As such,
altruism is a human attribute that is highly valued by people in general.
Altruism
Kristen Renwick Monroe, a professor of political science and philosophy at University of
California, presents an insightful explanation of altruism. Although the idea of altruism
has a long history, it was Auguste Compte, a French Philosopher, the founder of
Positivism, who first coined the term in the 1830s. By altruism, he meant the moral
obligations individuals have to serve others and place others’ interests above one’s own.
Monroe defines altruism as a “behavior intended to benefit another, even when
doing so may risk or entail some sacrifice to the welfare of the actor.” 71 She gives four
important criteria for altruism. First, altruism entails action. If one intends to do
something, but actually does not act on that intention, we cannot qualify the resulting
behavior as altruistic. Secondly, the purpose of an altruistic action is purely for the
71
Kristen Renwick Monroe, “A Fat Lady in a Corset: Altruism and Social Theory,” p. 862.
benefit of another. When an individual does something to benefit another, there cannot
be an ulterior motive that benefits himself, such as the expectation of praise or reward.
Thirdly, altruism necessitates that the intention is more important than the consequences
of the action. If I see someone drowning and I leap into the water to save them, but my
actions accidentally lead to their death, it does not negate the act as being altruistic.
Finally, Monroe believes that the altruistic act must have some possibility of costing the
acting individual. For example, if I act in such a way that it benefits both myself and
others, this is not altruism but rather “collective welfare.”
According to Monroe, the world is not divided into altruists and nonaltruists. She
believes that the potential for altruism exists in all people. 72 Those who act altruistically
are able to see the world in a different way. They have a sense of a shared humanity.
They see that all mankind is connected through a common humanity. 73 Each person is
linked to all other living things and this linkage is what entitles all creatures to a certain
humane treatment merely by virtue of being alive. This way of seeing the other life
forms is not based on any mystical blending of the self with another, but rather on the
recognition that we all share certain characteristics and are entitled to certain rights,
merely by virtue of our status as living organisms.
Conclusion for Part A
I have already shown, in the first section of this thesis, that health should be valued by all
human beings. In this second section I have demonstrated that we human beings are not
absolute egotists. In fact, human beings have the full capacity to feel and be moved to act
in a way that is not self-centered. We human beings can feel the pains and joy of our
72
73
fellow human beings, and furthermore act in a way that may bring suffering upon
ourselves for the sake of another. In other words, we can feel empathy, sympathy and
compassion, and we can act altruistically with respect to others. Thus, human beings are
basically other-regarding creatures.
As St. Thomas and others argue, natural inclinations are intrinsically good when
in accord with human reason. One such natural inclination is that we are innately other-
regarding. If we are beings who morally value good health and if we are also beings who
have a capacity to put aside our egoistic needs for the sake of our fellow human beings,
then it seems plainly clear that we should value the health of all other human beings. A
society of humans, who have an innate tendency to care for others, should reflect these
values. Illness and disease can cause much pain and suffering to individuals. As human
beings who have a natural inclination to feel empathy, sympathy, compassion, and to act
altruistically, it is our moral obligation to consider and promote the health of all our
fellow humanity. A human society should endorse policies that will ensure the sound
health of all. A compassionate, altruistic society, i.e. a society that truly expresses the
best in human nature, is morally obliged to provide adequate health care to all its
members.
Part B: Society Based on Love
Jason West, who is a philosophy professor at Newman Theological College, argues for a
theory of state based on love. His definition of love is that of the Christian virtue of
charity, which concerns the good of others. He uses the understanding of love as
presented by St. Thomas Aquinas to explain the meaning of charity. According to St.
Thomas, “An act of love always tends towards two things; to the good that one wills, and
to the person for whom one wills it: since to love a person is to wish that person good.
Hence in so far as we love ourselves [or another], we wish ourselves good; and, so far as
possible, union with the good.” 74
West emphasizes that he is not advocating love at the expense of justice. Love
and justice are fully compatible because love is the basis of all the other virtues, justice
included. 75 In other words, justice is a subset of love and so they must be compatible.
He argues that if both love and justice is to act for the good of others, there should be no
friction between the two. Consequently, a society based on love, he asserts, is not at the
expense of justice, but in fact is very much attuned with the notion of justice. In fact, his
position is that when love is given priority over justice, “it will be respected all the more
precisely because of this concern for others.” 76 Both love and justice, then, are “an
important part of human life, experience and flourishing.” 77
For St. Thomas, West admits, justice is the first virtue of the political order.
However, he points out that moral order comes prior to the political order. As such, it
follows that the moral virtues are prior to the political ones. He writes, “although justice
is only a concern where there is a lack of love, its purpose is to ensure that each receives
the goods due to him.” 78 Since, both justice and love regard the goods of the other, “the
purpose of justice is to foster a concern for the good of other people and, as a result, it
provides the closest approximation to love which can be demanded of those who enter
into relations with one another.” 79 Therefore he concludes, “Justice, properly practiced,
74
St. Thomas Aquinas, Compendium Theologica, 1. In Jason West’s “Justice in a Context of Love,” s. II.
75
Jason West, “Justice in a Context of Love,” Intro.
76
Jason West, “Justice in a Context of Love,” s. II
77
78
79
fosters love.” Furthermore, “justice, strictly applied, is generally insufficient to fulfil the
needs of those in a community.” 80
A society that is based on love is a society that would be concerned with all its
member’s well being. It would ensure that all the needs of its members are adequately
taken care of. As I have already shown in the first section of the thesis, health plays a
vital role in human achievement (Aristotle) and is greatly valued by all human beings (St.
Thomas, Hobbes, Kant, Mill). Consequently, a society based on love would be
concerned with the good health of all members. (We could even argue that health is a
necessary pre-requisite for love, or at least love in action. In order to act out in love
towards others, we need a minimum of good health. If we want to foster a loving society,
then we have a moral obligation to preserve the health of everyone who is part of that
society.)
Part C: Society based on Happiness for the Greatest Number
In the first section of this paper, I presented the theory of utilitarianism. To reiterate,
utilitarianism is based on a very simple notion that one ought to always act in a way to
increase pleasure and decrease pain. For utilitarians, happiness is the only thing that is
intrinsically good. 81 According to Robin Barrow, the author of Utilitarianism: A
Contemporary Statement, “we ought to perform those acts that are as a matter of fact,
taken together, necessary and sufficient for the happiness of the whole community,
provided that all abide by them.” 82 If morality is the promotion of goodness, then one
should act in a way that it produces greatest happiness to the greatest number of people.
80
81
Robin Barrow, Utilitarianism: A Contemporary Statement, p. 65.
82
Robin Barrow, Utilitarianism: A Contemporary Statement, p. 65.
The basic principle of utilitarianism is that we are morally obliged to increase the
overall happiness of all individuals. In the first section we discussed why human
sickness is a form of suffering. It could also be said that good health is form of
enjoyment. If it follows that, on the utilitarian model, we should fight against sickness
and promote good health for the whole community. According to the principles of
utilitarianism a society is morally obliged to provide adequate universal health care.
Part D: Society Based on Preservation of Human Life
Thomas Hobbes, as we discussed in the first section, places self-preservation as the first
preoccupation of human life. Hobbes argues that the main reason why people join
society is to preserve their lives. As such, if society fails to promote the survival of its
members, a rational person would not remain in that society. Human beings use reason
to preserve their welfare. We do so by moving towards what is good for us and avoiding
what is evil. A rational human being would leave a society without adequate health care.
Benjamin Lopata, in his article “Property Theory in Hobbes,” discusses Hobbes’
notion of society in relation to man’s first inclination to preserve himself. According to
Lopata, Hobbes sees “self-preservation, the protection of one’s life, as the basic aim—
the summum bonum.” Hobbes’ political philosophy is an “attempt to indicate the
optimum conditions which lead to there preservation of life.” 83 So “what is good” for
Hobbes are those things that will enable us to survive, while “what is evil” would be
those things that will cause death (especially violent death).
When man enters society, he is to give up his rights to the sovereign. However,
Hobbes’ asserts that certain basic rights are inalienable and therefore cannot be deserted.
83
The first and foremost of these rights is self-preservation, for it is for the sake of self-
preservation that man enters the social order in the first place. According to Lopata,
“self-preservation is, in the final analysis, the very motivation which impels men to form
a commonwealth and cannot, therefore, be alienated.” 84 Lopata contends that although
Hobbes’s argues for a sovereign who is absolute, men retain the right to disobey the
sovereign under one condition, if the sovereign “threatens their self-preservation.” 85 In
fact, one cannot deny in a civil society the rights to things necessary for preservation of
life such as: “one’s own body, its defense, fire, water, air, and ‘place to live in.’” 86
In general then, society’s goal should be to preserve the well-being of all in it. A
society that does not accommodate the basic needs for survival of its members is an
immoral society. It follows that since good health is an important aspect of survival, a
society must guarantee for each individual the necessary care for his survival. We could
argue that if man is denied care when he is sick, his right to self-preservation is ignored.
Therefore, according to the Hobbesian view, a society may be morally obliged to provide
adequate health care to all its members.
Conclusion
In place of the liberal view that society should increase the freedom of its people and
decrease the amount of government intervention in their lives, I presented four different
arguments that society is morally obliged to provide health care to all its members. First,
I demonstrated that all natural inclinations that are in accordance with rationality are
84
85
86
morally good. As such, we should follow our moral inclinations. We have, however, an
inclination to not only feel the pains and joys of our fellow human beings, but also to act
in such a manner that sets aside our own self-interest. It follows then, that we are morally
obliged to help other human beings when they are suffering. Illness is a form of suffering
and it is something we are all susceptible to. Since good health is valued by all human
beings, we have a moral obligation not only to protect our own health but others’ health
as well. A human society should reflect the (other-regarding) values of those who are
part of it. A society of humans, then, should endorse the well-being of all people who are
in it and therefore is morally obliged to provide adequate health care to all its members.
Secondly, I presented Jason West’s theory of a society based on love. West
argues that love comes prior to justice, so although justice is important to the social order,
it is because justice is a subset of love. Ultimately it is love that sustains the proper
functioning of society. To love another is to put their concern above one’s own. As I
have already argued for in the first section, health is important to all people. As such, a
loving society is one which regards the health of all its members. It must provide
adequate health care for all.
Next, I invoked the utilitarian principle that the objective of society is to increase
the amount of happiness for the greatest number. Providing adequate health care to all
members of society is a necessary means to achieving this end. Therefore, in terms of
utilitarianism, a society is morally obliged to provide care for all its sick.
Finally, my last argument was based on the Hobbesian view that human beings
enter society solely to protect their well-being. As such, one of the obligations of this
society should be to provide the care needed to preserve the life of the individuals who
are part of it. It will follow that adequate public health care is a necessary aspect of such
a society, since we already established how sickness threatens the principle of self-
preservation.
Although I have presented four very different notions of human society in this
section, they all place human well-being as a priority. Whether society is an expression
of human nature, is based on love, or utilitarian principles, or Hobbesian rationality, it
should be concerned to promote the human health of everyone. The best way to ensure
that all human beings receive adequate health care is though a universal health care
system. In the next section I argue against the privatization of heath care system.
Section III: A Single-Tiered Public Health Care System
“Few trends could so thoroughly undermine the very foundations of our free society as
the acceptance by corporate officials of a social responsibility other than to make as much
money for their stockholders as possible.”
–Nobel Prize Winner in Economics, Milton Friedman
“Some aspects of life are too precious, intimate or corruptible to entrust to the market.”
–Woolhandler and Himmelstein
Introduction
According to the World Health Organization (WHO), even about a hundred years ago, an
organized health care system in the modern sense was non-existent. Most people were
born into large families and had to face many infancy and childhood diseases. Those
who managed to survive past this pre-adult stage were prone to a host of potentially fatal
diseases such as measles, smallpox, malaria and poliomyelitis. Infant and child mortality
rates, along with maternal mortality rates were very high. Life expectancy was short –
even half a century ago, life expectancy was about 48 years. 87
The evolution of health care over the past ten decades has greatly changed the
way human health and diseases are managed. Thanks to amazing technological and
pharmaceutical advancements, people who are able to access good quality health care are
able to lead longer lives without many diseases they could have succumbed to a hundred
years ago. Of course, the sad fact today is that, although we have the technological
advancement and the medicine that will ensure the well being of person, for most people
this is not an option; the main reason being that it is not something affordable.
In today’s world, there are two financial aspects of health care that we must
consider. First, there is the payment that must be made to the health institution that
87
World Health Organization, The World Health Report 2002, p. 20.
provides the services; second, there is health-care insurance which is the usual means of
paying medical institutions. Health insurance is a type of insurance whereby the insurer
pays the medical costs of the insured if the insured becomes sick due to covered causes,
or due to accidents. 88 Both the health institutions as well as the health insurance may be
either public or private. The difference between a public and private health insurance is
that tax payers’ money is used to pay for most or all of the costs of public insurance,
whereas either individuals or private companies they work for pay the premiums of
private insurance.
Public health care is a system of health care that is financed entirely or mostly by
citizens’ tax payments instead of through private payments made to insurance companies
or directly to health care providers. In the second section of this thesis, I demonstrated
why a society is morally obliged to provide adequate universal health care. There are two
possible means of providing public health care: it could be publicly or privately funded.
A two-tiered health care system is a system in which a guaranteed public health care
system exists, but where a private system operates in parallel. In the following segment I
will use empirical evidence to argue against allowing private health care. I ultimately
want to demonstrate that private health care provides inadequate care for the sick.
Furthermore, it is damaging to the public system of health care. Therefore, the best way
to ensure that all citizens receive adequate health care is through a single-tired public
health care system.
Against For-Profit Private Health Care
A private for-profit health care system operates to make profit from the sale of service,
health care. One reason why people favour for-profit health care is that they believe that
88
Wikipedia. http://en.wikipedia.org/wiki/Health_insurance
it will optimize care and minimize costs. That is, it is based on the capitalistic notion that
if health care is treated the same as any other product, the company that produces it will
be forced to lower cost yet offer good quality products due to market competition.
Woolhandler and Himmelstein, however, have demonstrated that in terms of quality and
cost of health care, the private for-profit greatly lags behind the not-for-profit care. 89
They refer to many studies that prove that for-profit health care is much lower quality and
more expensive than their non-profit counterpart.
In a meta-analysis done by Dr. Devereaux, a cardiologist of McMaster University,
it was discovered that there is a pattern of higher payments for care in private, investor
owned hospitals as compared with private not-for-profit hospitals. In fact, the for-profit
institutions were19% more expensive. 90 This figure indicates that in 2001, Americans
paid an excess of $6 billion for private investor-owned acute care. 91
In two other studies done by Dr. Devereaux and colleagues, the results indicate
that for-profit hospitals and dialysis clinics have higher death rates. In fact, those who
received their care in for–profit dialysis clinics had 8% higher death rate that those who
got their care at non-profit clinics. 92 This number translates into 2,000 premature deaths
every year among people on dialysis in the U.S. 93 This study also found that for-profit
clinics dialyzed for less time and used lower doses of key medications. In yet another
study by Dr. Devereaux, it was found that adults had 2% higher mortality rate in for-
89
Steffie Woolhandler and David Himmelstein, “The High Costs of For-Profit Care,” p. 1814.
90
American Hospital Association. In “The High Costs of For-Profit Care,” p. 1814.
91
92
P. J. Devereaux et al., “Comparison of mortality between private for-profit and not-for-profit
hemodialysis centeres,” in Michael Rachlis, “Public Solutions to Health Care Wait Lists,” pp. 17-18.
93
P.J. Deveraux et al. “Comparison of mortality between private for-profit and private not-for profit
hemodialysis centers” in Michael Rachlis, “Public Solutions to Health Care Wait Lists,” p. 17.
profit hospitals, while the newborn mortality rate was 10% higher. 94 In his studies, Dr.
Devereaux demonstrates that for-profit health care does not deliver better service than
not-for-profit care.
Investor-owned nursing homes are more frequently cited for being deficient
quality-wise as well as for providing nursing care. According to L.H. Aiken, for-profit
hospitals tended to have fewer staff and these staff were also found to have less
training. 95 As a result, private investor-owned hospice care tends to provide a much
reduced amount of care to the dying than their not-for profit counterpart. According to E.
M. Silverman and his group, health spending was higher and increasing faster in
communities where all the beds were for-profit than in communities where all beds were
non-profit. 96 Thus, despite its higher costs, for-profit health care not only fails to provide
superior quality of care, but, in fact, its care is even inferior to its not-for-profit, less
costly, counterpart.
According to Dr. Devereaux, the reason why for-profit health care facilities are
higher cost with lower quality than the non-profit facilities is that “Private for-profit
facilities typically have to generate 10-to-15% profits to satisfy shareholders. Not-for-
profit facilities can spend that money on patient care.” 97 As Woolhandler and
Himmelstein suggest, private investor-owned hospitals are profit maximizers rather than
94
P.J. Devereaux et al. “A systematic review and meta-analysis of studies comparing mortality rates of
private for-profit and private not-for-profit hospitals” in Michael Rachlis, “Public Solutions to Health Care
Wait Lists,” pp. 17-18.
95
“Hospital nurse staffing and patient mortality, nurse burnout, and job dissatisfaction,” in Michael
Rachlis, “Public Solutions to Health Care Wait Lists” p. 18.
96
“The Association Between For-Profit Hospital Ownership and Increased Medicare Spending” in Michael
Rachlis, “Public Solutions to Health Care Wait Lists.”
97
McMaster University Department of Clinical Epidemiology and Biostatistics press release. Nov. 19,
2002. in “Public Solutions to Health Care Wait Lists,” Dec. 2005.
cost minimizers. So in fact, they use strategies that will bolster profitability which results
in inefficient care and higher costs.
According to Woolhandler and Himmelstein, another reason for higher charge yet
lesser quality in for-profit health institutions is that often these institutions end up paying
billions of dollars in settlements. For instance, the largest hospital firm in the U.S.,
Columbia/HCA, paid the U.S. government US$1.7 billion in fraud settlements dealing
with payments of kickbacks to physicians and over billing Medicare. 98 According to
New York Times, Tenet, the second largest hospital firm in the U.S., had to pay
settlement charges of more than half a billion dollars for giving kickbacks for referrals
and for inappropriately detaining psychiatric patients to fill beds during the 1980s. More
recently, allegations against Tenet includes “performing cardiac procedures on healthy
patients, offering kickbacks for referrals and exploiting Medicare loopholes to claim
hundreds of millions in undeserved payments.” 99
Another negative aspect of for-profit care is that “executives reap princely
rewards” which drains money from the funds available for actual medical care. 100 For
example, according to USA Today, when the CEO of Columbia/HCA resigned in the face
of fraud investigation, he left with $10 million severance package and $324 million in
company stock. 101 Aside from the enormous salaries paid to executives, for-profit
institutions also have high administrative costs. In fact, these for-profit firms spend much
less on nursing care while their administrative costs are 6% higher than the not-for-profit
98
Department of Justice. In “The High Costs of For-Profit Care,” p. 1814.
99
Steffie Woolhandler and David Himmelstein “The High Costs of For-Profit Care,” p. 1814.
100
101
Steffie Woolhandler and David Himmelstein, “The High Costs of For-Profit Care.”
counterpart. 102 For instance, for-private insurance plans take 19% for operating costs
whereas non-profit plans, it is13%, for US Medicare program it is 3% , and for Canadian
medicare it is 1%. 103
In their article, Woolhandler and Himmelstein discuss why these for-profit
companies survive if their product is so much more inferior. 104 One important reason is
that a lot of these for-profit firms have a monopoly on the service. For instance, usually
it is the case that these for-profit firms are the only hospitals available in the town, so
people do not have any real choice. Secondly, many of these firms, in order to make a
profit, are often underhanded in how they label patient diagnosis. An example would be
labeling minor chest discomfort as “angina” rather than “chest pain” so that they are able
to attain higher Medicare payments. Another way these for-profit firms survive in the
market is by selecting lucrative patients and providing services that would cost them the
least amount to care for. An example would be to undertake the “business” of cardiac or
orthopedic care, which does not require as much staffing and medical expenses. These
firms also duplicate the services provided by nearby not-for profit firms, but avoid money
losing programs such as geriatric care.
Woolhandler and Himmelstein conclude that privatization results in a large net
loss to society in terms of higher costs and lower quality. In fact, privatization takes
money from the pockets of low-waged, health workers and gives it to investors and
highly paid managers. Ultimately, allowing for-profit health care makes those who care
for the sick instruments for investors to profit from and views patients as commodities
102
In “Costs of Care and Administration at For-Profit and Other Hospitals in the United States” quoted in
Steffie Woolhandler and David Himmelstein, “The High Costs of For-Profit Care.”
103
Steffie Woolhandler and David Himmelstein, The High Costs of For-Profit Care.”
104
(which violates Kant’s second formulation of his Categorical Imperative that people
should be treated as ends not means). 105 Unfortunately, this leads to inferior care at much
higher price.
Against A Two-Tiered Health Care System
One of the commonly held beliefs for supporting two-tiered health care is that
introducing a private system will decrease overall patient waiting time. In some
countries, governments to varying degrees, subsidize the private sector in hope of
relieving some of the waiting time in the public sector. However, many studies
demonstrate that this strategy is doomed to failure. According to the European region of
the World Health Organization, “Evidence shows that private sources of healthcare
funding are often regressive and present financial barriers to access. They contribute
little to efforts to contain costs, and may actually encourage cost inflation.” 106
According to T. Besley and colleagues, a household survey from the United
Kingdom found that there are longer public waiting lists in areas where there is more
private insurance. 107 In yet another study done by Besley, analysis of regional patterns in
Britain showed, once again, that regions with higher a level of private health insurance
have longer waiting lists. 108
According to Stephen Duckett, the payment per hour for fee-for-medical-service
activity in the private health sector is overall greater than for the payments for the same
operations in the public sector. Doctors are paid more in the private sector. Sadly,
Duckett concluded that “this gives surgeons a perverse incentive to maintain high waiting
105
This is another important line of argument which we will not explore here.
106
World Health Organization, The World Health Report 2002.
107
T. Besley et al. “The Demand for Private Health Insurance: Do Waiting Lists Matter?” in “Private Care
and Public Waiting.”
108
T. Besley et al. “Private and Public Health Insurance in the UK” in “Private Care and Public Waiting.”
times in the public sector to encourage prospective patients to seek private care.” 109
Duckett derives evidence for this general trend from a Canadian study of
ophthalmologists’ practice. It was found that surgeons who practiced only in the public
sector had a median waiting list for cataract surgery of 7 to 8 weeks, as opposed to those
who practiced in both public and private sector where the public waiting time was 15 to
20 weeks. 110 Duckett’s own study confirms that increased private sector activity is
directly associated with increased public sector waiting times. 111 Expanding private care
as a solution to public waiting lists may reduce the support needed for ensuring that
public care is available when required.
To conclude, the mounting evidence makes it clear that private health care sector
diminishes the quality of care of the public sector. To what extent or degree the private
sector negatively affects the public one varies. However, if quality of health care is
diminished that means that many people are prevented from having access to needed care
that will ensures their health and wellness to the highest degree. Therefore, a two-tiered
health care system will be unable to provide adequate health care to all members of
society.
109
Stephen Duckett, in “Private Care and Public Waiting,” p. 88.
110
C. DeCoster, “Waiting Times for Surgical Procedures” in “Private Care and Public Waiting.”
111
Stephen Duckett, in “Private Care and Public Waiting,” p. 88.
Conclusion
In this thesis, I have argued that society has a moral obligation to provide adequate health
care to all people. In section one, I first demonstrated using the Aristotelian notion of
eudaimonia that health is fundamental to achieving happiness. Before an individual can
lead a virtuous life, he needs good health. Therefore, all human beings should value good
health as it will allow them to flourish and enable them to achieve their fullest moral
potential.
The second argument I have presented is that self-preservation is a fundamental
value to all humans. St. Thomas Aquinas, Thomas Hobbes, and Immanuel Kant all argue
that self-preservation is a fundamental human good. According to St. Thomas Aquinas,
natural law dictates to us that we must pursue good and avoid evil. From this primary
principle, we can derive the first general principle of morality that one should preserve
one’s life. For Hobbes, the only good that motivates man to act morally is to preserve
himself. Therefore, self-preservation is fundamental to all humans. According to
Immanuel Kant, self-preservation is not only a natural inclination but also a duty one has
to himself. A means to preserving oneself is by ensuring that one is in good health, since
illness threatens one’s survival. Thus, good health is a fundamental value to all humans.
My third argument in the first section derives from John Stuart Mill’s
utilitarianism. Utilitarianism follows the basic principle that we should do what
increases happiness and decreases pain. It is clear that illness is a source of pain and
suffering. As such, human beings naturally avoid bad health and value good health. I
concluded the first section by showing that good health is something that is valued both
intrinsically and instrumentally by all humans.

In the second section I demonstrated why society should provide universal health
care to all humans. I presented four arguments that demonstrate that a moral society
should provide public health care to all its members. Although I am aware of the liberal
position that the political and moral order are independent, my position is that since a
society is a human community it should nourish the needs and values of the individuals
that compose it.
First, I argued that a human society is an expression of human nature. One aspect
of human nature is that we are not completely egoistical creatures. In fact, human beings
have the capacity to regard and act for the sake of others. This is not just limited to our
closest friends or kin. In fact, even if two people are strangers, they have the capacity to
feel and act for the good of the other person. As such, a society of human beings should
promote a concern for all other people. In the first section we have already established
that good health is valued by all humans. Therefore, if illness is a fundamentally bad and
causes human suffering, a human society should provide health care to alleviate the
suffering of the individuals that compose it.
My second argument is from Jason West’s notion of society based on love.
Although West does not reject the fact that justice is an important aspect of society, his
argument is that love, in the sense that one acts for the good of another, comes prior to it.
Therefore, a society should be based on love more so than justice. A society that
promotes the value of love, would aim to reduce the suffering of individuals in it. Since
we have already established the value of health to human beings in the first section, a
society of love should also value the good health of all its members by providing
adequate health care.

My third argument expands on the principle of utilitarian society. A society that
embraces the utilitarian principles should promote the greatest happiness for the greatest
number. In Section One, it was already established that good health promotes the
happiness of individuals. Promoting the good health of all members is a means to
promoting the greatest happiness for greatest number. Therefore, according to the
principles of utilitarianism, one way to increase happiness and reduce suffering is by
providing adequate health care to all members of society.
Finally, I described the Hobbesian notion of society. According to Hobbes, the
fundamental reason why anyone joins society is to preserve their own life. If so, society,
in order to fulfill its side of the bargain, has a moral obligation to provide adequate health
care to all its members as good health positively correlates with longevity.
To summarize: in Section Two, I provided four important reasons why society
should provide adequate health care to all members. The best way to ensure that all
people receive health care is through public funding. That is, a moral society would use
tax dollars to pay for the care of all of its sick, so that health care does not discriminate
against the poor or underprivileged.
In the third section of this thesis, I have demonstrated that a two-tiered health care
system will not be able to provide adequate health care for all its members. Firstly, a
private for-profit health care delivers inferior quality care for much higher costs.
Secondly, allowing a private for-profit health care system will be detrimental to the
public system, increasing waiting times and patient lists. If then, as demonstrated in
Section Two, society has a moral obligation to provide adequate health to all community
members without discrimination, it must institute and maintain a single-tired universal
system of health care that is funded through tax money of all individuals in that society.
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Universal Healthcare A Moral Perspective

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Universal Health Care: A Moral Perspective

Section I: Value of Health … 11

Section II: Moral Obligation of Society … 29

Section III: A Single-Tiered Public Health Care System … 44

SC1: People have a moral obligation to value their health.

MC: A society is morally obliged to provide a public single-tiered health care.

First, establish sub-conclusion 1:

3. P6SSC1; (P5+SSC1) SC1

Second, establish sub-conclusion 2:

3. (SSC2+SSC3+ SC1) SC2

Third, establish sub conclusion 3:

1. (P14)  (SSC4) SC3

Fourth, establish main conclusion:

happiness, self-preservation, and enjoyment of a good life. A society of human beings

account of utilitarianism to show that the preservation of health is a fundamental moral

should value good health.

thesis. I develop instead an alternative line of reasoning. My first argument is that

Secondly, if liberalism bases human society on a conception of justice, I use an

health of all its members.

increasing the happiness of greatest number of people in society. Since sickness

Finally, I expand on the Hobbesian notion of society. Hobbes believes that

two-tiered health care system is detrimental to a public system of care. Therefore, a

health care system.

The greatest wealth is health.

provided with if he is to attain a virtuous and flourishing life.

Part A: Eudaimonia is a fundamental value

Aristotle moved to Athens, where he entered Plato’s Academy. He remained at the

philosophical thought and empirical research. The surviving works of Aristotle is

believed to be his lecture notes. 2

To begin with, we must understand Aristotle’s notion of teleology. What

“purpose”), is that everything—natural and man-made—exists, acts, or is made for a

attain his telos is said to flourish.

character traits such as courage, prudence, justice, moderation, and so forth

the proper functioning of it is also impeded.

impediments to achieving this end. According to Aristotle, virtues must be explained in

terms of human reason, which he considers to be a distinctive function or activity of

If to achieve happiness is to live virtuously, then we must consider those factors

useful as instruments.” 11 According to Aristotle, man needs certain external prosperity

external prosperity is a necessity is because “no activity is perfect when it is impeded, …

Part B: Self-Preservation is a Fundamental Value

to preserve their bodies from impairment. Maintaining good health is a means to

according to the principle of self-preservation.

St. Thomas Aquinas and Natural Law

influential thinkers in Medieval philosophy. In his most significant work, Summa

Theologia, he attempts to present Christian theology as systematically as possible. It is

good of the community.

inspired revelation contained in the Bible. 18

instead, we see traces of it in nature. St. Thomas writes, “Non-rational creatures …

always occur in the same timely manner.

their appropriate end and activity.

the first moral obligation of all human beings.

instrumental for self-preservation. Therefore, if we are morally obliged to preserve our

Thomas Hobbes and Self-Preservation

Thomas Hobbes (1588-1679) is an English philosopher who wholly embraced

which he gives a completely mechanistic account of man. His materialistic notion of

“spring” and the nerves to many “strings.” 27

Hobbes, “voluntary motion” or “animal motion” is motivated by two kinds of passions,

we are averted from we refer to as being “evil.” 28

For Hobbes, human rationality is analogous to a computing device. He writes,

parcels; or conceive a remainder, from subtraction of one sum from another.” 29

possible through speech. Benjamin Lopata explains Hobbesian understanding of human

is to help us maximize the goods in life and minimize the evils.

best preserved.” Reason then forbids us to do anything that is harmful to ourselves or to