Sunteți pe pagina 1din 62

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

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

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

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. .
P4: Good health is a means of self-preservation.
SSC1: Good health is necessary for the enjoyment of one’s life.
_______________________________________________________________________
SC2: A moral society should provide comprehensive health care to all members.

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.)
_______________________________________________________________________
SC2: A moral society should provide comprehensive health care to all members.

Sub argument 4:
P13: The purpose of society is to preserve human life.
(Thomas Hobbes)
P4: Good health is a means of self-preservation.
_______________________________________________________________________
SC2: A moral society should provide comprehensive health care to all members.
SC2: A moral society should provide comprehensive health care to all members.
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:

SC2: A moral society should provide comprehensive health care to all members.
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
Aristotle, Nichomachean Ethics, I.9.
7
Aristotle, Nichomachean Ethics, I.13.
8
Aristotle, Nichomachean Ethics, I.10.
9
Theodore Denise et al., Great Traditions in Ethics, pp. 23-4.
10
Theodore Denise et al., Great Traditions in Ethics, p. 23.
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
Aristotle, Nichomachean Ethics, I.9.
12
Aristotle, Nichomachean Ethics, I.8.
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
Jack Donnelly, “Natural Law and Right in Aquinas’ Political Thought,” p. 522.
19
St. Thomas Aquinas, Summa Theologica, II.I.93.1.
20
St. Thomas Aquinas, Summa Theologica, II.I.93.5.
21
St. Thomas Aquinas, Summa Theologica, II.I.91.2.
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
St. Thomas Aquinas, Summa Theologica, II.I.94.2.
23
St. Thomas Aquinas, Summa Theologica, II.I.91.2.
24
Jack Donnelly, “Natural Law and Right in Aquinas’ Political Thought,” p. 521.
25
St. Thomas Aquinas, Summa Theologica, II.I.94.2.
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
St. Thomas Aquinas, Summa Theologica, II.I.94.2.
“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
Theodore Denise et al., Great Traditions in Ethics, p. 145.
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
Immanuel Kant, Grounding for the Metaphysics of Moral, p. 9.
35
Immanuel Kant, Grounding for the Metaphysics of Moral, p. 10.
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
Quoted by Norman Fiering in “Irresistible Compassion,” p. 199.
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
Quoted by Norman Fiering in “Irresistible Compassion,” p. 210.
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
Kristen Renwick Monroe, The Heart of Altruism, p. 13.
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
Irene Switankowsky, “Sympathy and Empathy,” p. 86.
53
Irene Switankowsky, “Sympathy and Empathy,” p. 86.
54
Irene Switankowsky, “Sympathy and Empathy,” p. 88.
55
Irene Switankowsky, “Sympathy and Empathy,” p. 88.
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
Kristen Renwick Monroe, The Heart of Altruism, p. 233.
73
Kristen Renwick Monroe, The Heart of Altruism, p. 206.
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
Jason West, “Justice in a Context of Love,” s. II
78
Jason West, “Justice in a Context of Love,” s. II
79
Jason West, “Justice in a Context of Love,” s. II
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
Jason West, “Justice in a Context of Love,” s. II
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
Benjamin Lopata, “Property Theory in Hobbes,” p. 204.
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
Benjamin Lopata, “Property Theory in Hobbes,” p. 206.
85
Benjamin Lopata, “Property Theory in Hobbes,” p. 206.
86
Benjamin Lopata, “Property Theory in Hobbes,” p. 208.
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
Steffie Woolhandler and David Himmelstein, “The High Costs of For-Profit Care,” p. 1814.
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
Steffie Woolhandler and David Himmelstein, “The High Costs of For-Profit Care,” p. 1814.
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
Steffie Woolhandler and David Himmelstein, “The High Costs of For-Profit Care,” p. 1815.
(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.

Selected Bibliography

Aristotle. Nicomachean Ethics. New York: Arno Press, 1973.

Butler, Bishop Joseph. Fifteen Sermons.


http://web.mit.edu/holton/www/courses/moralpsych/ SermonXI.pdf

Canadian Oxford Dictionary. 2nd Ed. Edited by Katherine Barber. Oxford: Oxford
University Press, 2004.

Denise, Theodore, Nicholas White, Sheldon P. Peterfreund. Great Traditions in Ethics.


11th Ed. Wadsworth: Toronto, 2005.

Donnelly, Jack. “Natural Law and Right in Aquinas’ Political Thought,” The Western
Political Quarterly, Vol. 33, No. 4. (Dec., 1980), pp. 520-535.

Duckett, Stephen. “Private Care and Public Waiting,” Australia Health Review; Feb
2005; Vol. 29, 1; pp. 87-93.

Estlund, David. “Mutual Benevolence and The Theory of Happiness,” The Journal of
Philosophy, Apr., 1990; 87, 4; pp. 187-204.

Fiering, Norman. “Irresistible Compassion: An Aspect of Eighteenth-Century Sympathy


and Humanitarianism,” Journal of the History of Ideas, Apr. – Jun., 1976; Vol. 37, 2; pp.
195-218.
(Includes citations by David Hume, Thomas Jefferson, Nicolas Malebranche, Bishop
George Berkeley, George Turnbull, Henry Grove, and the Third Earl of Shaftesbury)

Groarke, Louis. The Good Rebel. Fairleigh Dickinson University Press: Madison, N.J.,
2002.

Harman, Gilbert. “Human Flourishing, Ethics, and Liberty,” Philosophy and Public
Affairs, Autumn, 1983; Vol. 12,4; pp. 307-322.
Hobbes, Thomas. The Elements of Law Natural and Politic. 1640. http://www.thomas-
hobbes.com/works/elements/10.html
──The Leviathan, 1660. http://oregonstate.edu/instruct/phl302/texts/hobbes/leviathan-
contents.html

Kant, Immanuel. Grounding for the Metaphysics of Moral. 3rd ed. Hackett Publishing
Company: New York, 1993.

Lopata, Benjamin. “Property Theory in Hobbes,” Political Theory, May, 1973; Vol.1, 2;
pp. 203-218.

Mellone, S. H. “Some of the Leading Ideas of Compte’s Positivism,” International


Journal of Ethics, Oct., 1897; 8, 1; pp. 73-86.

Mill, John Stuart. Utilitarianism. Bobbs-Merrill: New York, 1957.

Monroe, Kristen Renwick. “A Fat Lady in a Corset: Altruism and Social Theory,”
American Journal of Political Science, Nov., 1994; Vol. 38, 4; pp. 861-893.
──The Heart of Altruism. Princeton University Press: Princeton, 1996.

Mulholland, Leslie. “Rights, Utilitarianism, and the Conflation of Persons” The Journal
of Philosophy, Jun., 1986; Vol. 83, 6; pp. 323-340.

Nagel, Thomas. “Hobbes’s Concept of Obligation.” The Philosophical Review, Jan.,


1959; Vol. 68, 1; pp. 68-83.

Paton, Margaret. “A Reconsideration of Kant’s Treatment of Duties to Oneself,” The


Philosophical Quarterly, Apr., 1990; Vol. 40, 159; pp. 222-233.

Rachlis, Michael. “Public Solutions to Health Care Wait Lists,” access online at:
www.policyalternatives.ca.

Switankowsky, Irene. “Sympathy and Empathy,” Philosophy Today; Spring 2000; 44, 1;
pp. 82-86. (Includes citations by Lauren and Wispé, Nel Noddings.)

Thomas Aquinas, Summa Theologica, Trans. by Fathers of the English Dominican


Province Benziger Bros. edition, 1947.
http://www.ccel.org/a/aquinas/summa/FS.html#TOC09

West, Jason. “Justice in a Context of Love: A Response to Rawls and Dworkin on


Redistribution of Wealth.” (Draft Version) Newman Theological College. (Personal
communication from author.)

Wikipedia. http://en.wikipedia.org/
Woolhandler, Steffie and David Himmelstein. “The High Costs of For-Profit Care,”
Canadian Medical Association. Journal; Jun, 2004; Vol. 170, 12; pp. 1814-1815.

WordNet: A Lexical Database for the English Language.


wordnet.princeton.edu/perl/webwn.

World Health Organization, The World Health Report 2002. http://www.who.int/whr/


2000/en/whr00_en.pdf