The allocation of affordable healthcare resources across the United States has been a topic under the spotlight of scrutiny for almost three decades. In his lecture, Dr. Brown highlights disparate distributions of healthcare to communities of color, and the tensions which have arisen as a result of the COVID-19 pandemic. As stated in the lecture, Black, Hispanic, and American Indian populations were shown to be 3x as likely to contract COVID-19 than white populations. These inequities seen in healthcare data can be attributed to factors which are dynamic. Societal factors influence and interact with each other, making a single underlying reason out of the question. According to the CDC [1], such tensions arise from occupational, educational, economic, and discriminatory factors, with a key interaction of health taking place across this spectrum. Already amid discussions of how healthcare should be classified on a social distributive level, the exacerbation of community risk factors due to COVID beg for an examination of how inequitable medicine can be.

Now that all Americans have been made to confront the reality of a healthcare crisis, our system has become stressed to a breaking point, perhaps requiring the formation of a new system of medical ethic. Dr. Brown presents ideas of distributive justice by John Rawls here, questioning the definition of healthcare as a primary good, and its allocation as a natural, necessary resource, or a social resource constrained by societal bounds. The critique of Rawls’ theory hinged on this definition, as well as who comprises the groups who make distributive judgements. John Rawls was an ethicist who championed theories of equal societal distribution. His ideas hinged on the fact that, as humans, we possess natural rights. But, as citizens, we have given up some of these rights through a social contract with a government, which in return should grant protection from societal harm [2]. If seen as a social good, healthcare falls victim to inequities that inevitably befall society, and there is no obligated subsidization. If health is seen as a natural good however, extensions of this theory would state that many societal harms are simply out of the hands of the individual, and that the role of the government should be to provide an equal playing field for all. These two viewpoints seem to mirror the debate on socialized v. private medicine. One considers all citizens to be entitled to health outcomes as distributed by the government, while the other relies on the exchange of capital and use of insurance proxies in attempts to outgrow what a government system could do. A distinction in ethics and values can be made between the two, with of course the greatest influence coming from economics. Putting the government in control of healthcare systems works to admit that they must be standardized for all, but to keep them private and subject to fluctuation is to accept natural inequity to come.

 

Socialized healthcare systems seem to be the side that aligns better with Rawlsian distribution. Connections have been made between Rawls’ principles and the guiding philosophies of the UK’s National Health Service (NHS) [3]. In a paper analyzing such philosophies, Rawls’ idealistic “veil of identity” is hedged against the reality of complex injustices we see and can be viewed only as an acceptable starting point. This veil refers to the blindness towards identity that comes with equal distribution. Factors of race, ethnicity, or even personal choice must be ignored in favor of the underlying principle of justice. Evidence of these values can even be seen in the American system, in regulation of the Affordable Care Act which restrict insurance companies’ ability to discriminate based on pre-existing conditions or identity characteristics. While this does a small part in reducing malpractice on the caregiver end, what Rawls’ veil does not recognize are the interactions between health and community risk factors which may cause individuals to have different baseline needs. With a completely blind view, it is easy to confuse equality and equity. An equal distribution might give all individuals the same care, while an equitable distribution attempts to create a fair playing field, bringing all up to the same level. While some advantages may exist in blind treatment, there are inequities which must be accounted for to be able to fully treat a patient.

 

As we are on a path to further global interaction in business, politics, and media, so do our problems grow on a global scale. As Dr. Brown stated, there are determinants for health which come from environmental issues, dangerous utilities, workplace incidents, interactions with authority figures, and the worldwide transmission of disease with no defined boundary. These factors place the burden on individuals, but stem from systems which transcend their control. It can be seen from the higher rates of contraction and death from COVID in communities of color that our current system lacks a key element in equitable distribution. Whether this stems from the core philosophy of private healthcare, or a disregard for the enhanced risk posed to densely populated working communities, a shift in resource allocation, as well as effective education on preventative measures are necessary. Pieces of equal distribution from John Rawls’ can be useful in defining healthcare, but only as a starting point in systems which wish to provide care to all. Private healthcare hinges on accepting inequities, but the COVID-19 pandemic has amplified its key flaws to a point which require deep revision as not to repeat history. It must be accepted that all, especially those which face risks out of their control, are entitled to prosperous health.

 

[1] “Health Equity Considerations and Racial and Ethnic Minority Groups.” Centers for Disease Control and Prevention. Centers for Disease Control and Prevention, July 24, 2020. https://www.cdc.gov/coronavirus/2019-ncov/community/health-equity/race-ethnicity.html.

[2] Papadimos, T.J. Healthcare access as a right, not a privilege: a construct of Western thought. Philos Ethics Humanit Med 2, 2 (2007). https://doi.org/10.1186/1747-5341-2-2

[3] Fritz, Zoë, and Caitríona Cox. "Conflicting demands on a modern healthcare service: Can Rawlsian justice provide a guiding philosophy for the NHS and other socialized health services?." Bioethics 33, no. 5 (2019): 609-616.

Facing Disaster: The Ethics of Pandemic 

This article was written by Bioethics Minor student Brennan Sandor

Brennan Sandor is a fourth year undergraduate student at Loyola Marymount University, pursuing his Bachelors in Psychology with a Minor in a Bioethics.

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