The human right to health has been established in international law since 1976. However, philosophers have often regarded human rights doctrine as a marginal contribution to political philosophy, or have attempted to distinguish ‘human rights proper’ from ‘aspirations’, with the human right to health often considered as falling into the latter category. Here the human right to health is defended as an attractive approach to global health, and responses are offered to a series of criticisms concerning its demandingness.

The twentieth century saw a vigorous debate over the nature of rights. Will theorists argued that the function of rights is to allocate domains of freedom. Interest theorists portrayed rights as defenders of well-being. Each side declared its conceptual analysis to be closer to an ordinary understanding of what rights there are, and to an ordinary understand- ing of what rights do for rightholders. Neither side could win a decisive victory, and the debate ended in a standoff.

This article offers an integrated account of two strands of global health justice: health-related human rights and health-related common goods. After sketching a general understanding of the nature of human rights, it proceeds to explain both how individual human rights are to be individuated and the content of their associated obligations specified. With respect to both issues, the human right to health is taken as the primary illustration. It is argued that the individuation of the right to health is fixed (...) by reference to the subject matter of its corresponding obligations, and not by the interests it serves, and the specification of the content of that right must be properly responsive to thresholds of possibility and burden. The article concludes by insisting that human rights cannot constitute the whole of global health justice and that, in addition, other considerations—including the promotion of health-related global public goods—should also shape such policy. Moreover, the relationship between human rights and common goods should not be conceived as mutually exclusive. On the contrary, there sometimes exists an individual right to some aspect of a common good, including a right to benefit from health-related common goods such as programmes for securing herd immunity from diphtheria. (shrink)

There are various grounds on which one may wish to distinguish a right to health care from a right to health. In this article, I review some old grounds before introducing some new grounds. But my central task is to argue that separating a right to health care from a right to health has objectionable consequences. I offer two main objections. The domestic objection is that separating the two rights prevents the state from fulfilling its duty to maximise the health (...) it provides each citizen from its fixed health budget. The international objection is that separating a human right to health care fails the moral requirement that, for any given moral human right, the substance to which any two right-holders are entitled be of an equal standard. (shrink)

This paper offers four arguments against a moral human right to health, two denying that the right exists and two denying that it would be very useful (even if it did exist). One of my sceptical arguments is familiar, while the other is not.The unfamiliar argument is an argument from the nature of health. Given a realistic view of health production, a dilemma arises for the human right to health. Either a state's moral duty to preserve the health of its (...) citizens is not justifiably aligned in relation to the causes of health or it does not correlate with the human right to health. It follows that no one holds a justified moral human right to health against the state.Education and herd immunity against infectious disease both illustrate this dilemma. In the former case, the state's moral duty correlates with the human right to health only if it demands too much from a cause of health; and in the latter, only if it demands nothing from a cause of health (that is, too little). (shrink)

The publication of the Report of the International Bioethics Committee of Unesco on Social responsibility and health provides an opportunity to reshape the conceptual framework of the right to health care and its practical implications. The traditional distinctions between negative and positive, civil-political and economic-social, legal and moral rights are to be questioned and probably overcome if the goal is to pursue ‘the highest attainable standard of health’ as a fundamental human right, that should as such be guaranteed to every (...) human being. What we are called upon to, is the commitment not to exclude now and forever anyone from having access to the ‘excellence’ of scientific and medical progress. Therefore, the addressees of this ‘responsibility’ cannot be just the governments and the states within the limits of their ‘jurisdiction’. The challenge is to tackle at the same time the social and global determinants of health. (shrink)

Against a backdrop of non-ideal political and legal conditions, this article examines the health capability paradigm and how its principles can help determine what aspects of health care might legitimately constitute positive health care rights—and if indeed human rights are even the best approach to equitable health care provision. This article addresses the long American preoccupation with negative rights rather than positive rights in health care. Positive health care rights are an exception to the overall moral range and general thrust (...) of U.S. legal doctrine. Some positive rights to health care have arisen from U.S. Constitutional Eighth Amendment cases and federal and state laws like Medicare, Medicaid, the State Children’s Health Insurance Program, the Emergency Medical Treatment and Active Labor Act, and the Patient Protection and Affordable Care Act. Finally, this article discusses some of the difficulties inherent in implementing a positive right to health care in the U.S. (shrink)

This article begins by clarifying and noting various limitations on the universal reach of the human right to health care under positive international law. It then argues that irrespective of the human right to health care established by positive international law, any system of positive international law capable of generating legal duties with prima facie moral force necessarily presupposes a universal moral human right to health care. But the language used in contemporary human rights documents or human rights advocacy is (...) not a good guide to the content of this rather more modest universal moral human right to health care. The conclusion reached is that when addressing issues of justice as they inevitably arise with respect to health policy and health care, both within and between states, there is typically little to gain and much to risk by framing deliberation in terms of the human right to health care. (shrink)

Despite a high and growing global average income, billions of human beings are still condemned to lifelong severe poverty, with all its attendant evils of low life expectancy, social exclusion, ill health, illiteracy, dependency, and effective enslavement. This problem is solvable, despite its magnitude.

In December 2007 it was revealed that the British government is considering the exclusion of certain groups of migrants—those considered to be present “illegally”—from primary health care provided by the National Health Service. At present, practitioners have discretion to accept any individual for NHS treatment regardless of their status. A joint Home Office and Department of Health review is examining this access for foreign nationals, and the likely outcome is the restriction of access to irregular migrants, which would, according to (...) the Institute of Public Policy Research, affect around 390,000 people. In 2004 such groups were excluded from NHS secondary care, most controversially from treatment for HIV, and so the present proposal would bar them from all but emergency health treatment. (shrink)

I defend economic and social rights as human rights, and as a feasible approach to addressing world poverty. I propose a modest conception of economic and social rights that includes rights to subsistence, basic health care and basic education. The second part of the paper defends these three rights. I begin by sketching a pluralistic justificatory framework that starts with abstract norms pertaining to life, leading a life, avoiding severely cruel treatment, and avoiding severe unfairness. I argue that economic and (...) social rights are not excessively burdensome on their addressees and that they are feasible worldwide in the appropriate sense. Severe poverty violates economic and social rights, and accordingly generates high-priority duties of many parties to work towards its elimination. (shrink)

I defend economic and social rights as human rights, and as a feasible approach to addressing world poverty. I propose a modest conception of economic and social rights that includes rights to subsistence, basic health care and basic education. The second part of the paper defends these three rights. I begin by sketching a pluralistic justificatory framework that starts with abstract norms pertaining to life, leading a life, avoiding severely cruel treatment, and avoiding severe unfairness. I argue that economic and (...) social rights are not excessively burdensome on their addressees and that they are feasible worldwide in the appropriate sense. Severe poverty violates economic and social rights, and accordingly generates high-priority duties of many parties to work towards its elimination. (shrink)

Linkage arguments, which defend a controversial right by showing that it is indispensable or highly useful to an uncontroversial right, are sometimes used to defend the right to health care. This article evaluates such arguments when used to defend RHC. Three common errors in using linkage arguments are neglecting levels of implementation, expanding the scope of the supported right beyond its uncontroversial domain, and giving too much credit to the supporting right for outcomes in its area. A familiar linkage argument (...) for RHC focuses on its contributions to the right to life. Among the problems with this argument are that it requires a positive conception of the right to life that is not uncontroversial and that it only justifies the subset of RHC that seeks to prevent loss of life. A linkage argument for RHC with better prospects claims that a well-realized right to health care enhances the realization of a number of uncontroversial rights. (shrink)

On 10 December 1948, the General Assembly ofthe United Nations adopted and proclaimed the Universal Declaration of Human Rights, a truly historic document, the full text of which is reproduced here. Following this historic act, the Assembly called upon all Member countries to publicize the text of the Declaration and "to cause it to be disseminated, displayed, read and expounded principally in schools and other educational institutions, without distinction based on the political status of countries or territories." Jacques Maritain was (...) actively involved in the drafting of the Declaration, especially its clauses regarding freedom of conscience and religious expression. (shrink)

Many international declarations state that human beings have a human right to health care. However, is there a human right to health care? What grounds this right, and who has the corresponding duties to promote this right? Elsewhere, I have argued that human beings have human rights to the fundamental conditions for pursuing a good life. Drawing on this fundamental conditions approach of human rights, I offer a novel way of grounding a human right to health care.

Although access to medicines is a vital feature of the right to the highest attainable standard of health (“right to health”), almost two billion people lack access to essential medicines, leading to immense avoidable suffering. While the human rights responsibility to provide access to medicines lies mainly with States, pharmaceutical companies also have human rights responsibilities in relation to access to medicines. This article provides an introduction to these responsibilities. It briefly outlines the new UN Guiding Principles on Business and (...) Human Rights and places the human rights responsibilities of pharmaceutical companies in this context. The authors draw from the work of the first UN Special Rapporteur on the right to the highest attainable standard of health, in particular the Human Rights Guidelines for Pharmaceutical Companies in Relation to Access to Medicines that he presented to the UN General Assembly in 2008, and his UN report on GlaxoSmithKline (GSK). While the Guiding Principles on Business and Human Rights are general human rights standards applicable to all business entities, the Human Rights Guidelines for Pharmaceutical Companies consider the specific human rights responsibilities of one sector (pharmaceutical companies) in relation to one area of activity (access to medicines). The article signals the human rights responsibilities of all pharmaceutical companies, with particular attention to patent-holding pharmaceutical companies. Adopting a right-to-health “lens,” the article discusses GSK and accountability. The authors argue that human rights should shape pharmaceutical companies' policies, and provide standards in relation to which pharmaceutical companies could, and should, be held accountable. They conclude that it is now crucial to devise independent, accessible, transparent, and effective mechanisms to monitor pharmaceutical companies and hold them publicly accountable for their human rights responsibilities. (shrink)

The Constitution of the World Health Organization affirms that “the enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being.” The Universal Declaration of Human Rights lays the foundations for the international framework for the right to health. This human right is now codified in numerous national constitutions, as well as legally binding international human rights treaties, such as the International Covenant on Economic, Social and Cultural Rights.Although medical care and access to (...) medicines are vital features of the right to health, almost two billion people lack access to essential medicines, leading to immense avoidable suffering. Improving access to essential medicines could save 10 million lives each year, four million of them in Africa and South-East Asia alone. Gross inequity is a shocking feature of the world pharmaceutical situation. (shrink)

At first blush, debt‐for‐nature swaps seem to provide win‐win solutions to the looming problems of environmental degradation and extreme poverty. So, one might naturally assume that they are morally permissible, if not obligatory. This article will argue, however, that debt‐for‐nature swaps are sometimes morally questionable, if not morally impermissible. It suggests that some criticisms of traditional (economic) conditions placed on loans to poor countries also apply to the (environmental) conditionality implicit in such swaps. The article's main theoretical contribution is to (...) suggest a general argumentative strategy for posing a challenge to the moral acceptability of many seemingly innocuous, or even apparently good, policies in the real world. Its discussion of how we should respond to seemingly tragic dilemmas (e.g. between protecting nature and respecting human rights) may also be of general interest. (shrink)

Is there a human right to health? If so, what are its grounds? Can a legal or moral human right to health provide any practical guidance when it comes to making decisions about, for instance, the allocation of scarce health resources? There are many possible answers to these questions in the literature. This article surveys some of these replies. First, however, it examines the distinctions between legal and moral human rights and rights to health vs. health care. It then surveys (...) the literature on potential grounds for a moral human right to health. It concludes by considering replies to several common objections to the existence of a human right to health. (shrink)

: In The Morality of Freedom, Joseph Raz argues against a right to autonomy. This argument helps to distinguish his theory from his competitors'. For, many liberal theories ground such a right. Some even defend entirely autonomy-based accounts of rights. This paper suggests that Raz's argument against a right to autonomy raises an important dilemma for his larger theory. Unless his account of rights is limited in some way, Raz's argument applies against almost all (purported) rights, not just a right (...) to autonomy. But, on the traditional way of limiting accounts like his, Raz's account actually supports the conclusion that people have a right to autonomy. So, unless there is another way of limiting his account that does not have this consequence, Raz's argument against a right to autonomy does not go through. (shrink)

ABSTRACT Most of the world's health problems afflict poor countries and their poorest inhabitants. There are many reasons why so many people die of poverty‐related causes. One reason is that the poor cannot access many of the existing drugs and technologies they need. Another, is that little of the research and development (R&D) done on new drugs and technologies benefits the poor. There are several proposals on the table that might incentivize pharmaceutical companies to extend access to essential drugs and (...) technologies to the global poor.1 Still, the problem remains – the poor are suffering and dying from lack of access to essential medicines. So, it is worth considering a new alternative. This paper suggests rating pharmaceutical and biotechnology companies based on how some of their policies impact poor people's health. It argues that it might be possible to leverage a rating system to encourage companies to extend access to essential drugs and technologies to the poor. (shrink)

Most of the world's health problems afflict poor countries and their poorest inhabitants. There are many reasons why so many people die of poverty-related causes. One reason is that the poor cannot access many of the existing drugs and technologies they need. Another, is that little of the research and development (R&D) done on new drugs and technologies benefits the poor. There are several proposals on the table that might incentivize pharmaceutical companies to extend access to essential drugs and technologies (...) to the global poor.1 Still, the problem remains – the poor are suffering and dying from lack of access to essential medicines. So, it is worth considering a new alternative. This paper suggests rating pharmaceutical and biotechnology companies based on how some of their policies impact poor people's health. It argues that it might be possible to leverage a rating system to encourage companies to extend access to essential drugs and technologies to the poor. (shrink)

All people have human rights and, intuitively, there is a close connection between human rights, needs, and autonomy. The two main theories about the natureand value of human rights often fail to account for this connection. Interest theories, on which rights protect individuals’ important interests, usually fail to capturethe close relationship between human rights and autonomy; autonomy is not constitutive of the interests human rights protect. Will theories, on which human rights protect individuals’ autonomy, cannot explain why the nonautonomous have (...) a human right to meet their needs. This paper argues that it is possible to account for the close connection between human rights, needs, and autonomy if human rights at least protect individuals’ ability to live minimally good lives. It argues that people need whatever will enable them to live such lives and autonomy is partly constitutive of such a life. This argument also has importantimplications for some other key debates in the human rights literature. (shrink)

The human right to health is crucial in the fight against global poverty. Health and an adequate standard of living are intimately connected. Poor health can make it difficult to overcome poverty, and poverty can make it difficult to attain good health. For the human right to health to be effective, however, it must have sufficient content to do the important normative work of rights. In the first part of this paper I give plausible arguments against the very existence of (...) a human right to health based on its lack of content and extend this to other social rights such as the right to adequate income, housing and education. In the second part of the paper I provide a defense of human social rights, including the human right to health, by arguing that these human rights, though abstract, have enough content to function as rights. (shrink)

To be justifiable, the demands of a conception of human rights and global justice must be such that (a) they focus on the protection of important human interests, and (b) their fulfilment is feasible. I discuss the feasibility condition. I present a general account of the relation between moral desirability, feasibility and obligation within a conception of justice. I analyse feasibility, a complex idea including different types, domains and degrees. It is possible to respond in various ways if the fulfilment (...) of basic socioeconomic human rights against severe poverty seems at first to be infeasible. (shrink)

The American Journal of Bioethics, Volume 12, Issue 6, Page 35-37, June 2012.

The right to health care is a right to care that is not too costly to the provider, considering the benefits it conveys, and is effective in bringing about the level of health needed for a good human life, not necessarily the best health possible. These considerations suggest that, where possible, society has an obligation to provide preventive health care, which is both low cost and effective, and that health care regulations should promote citizens’ engagement in reasonable preventive health care (...) practices. (shrink)

In this stimulating work of political philosophy, acclaimed philosopher G. A. Cohen sets out to rescue the egalitarian thesis that in a society in which distributive justice prevails, peopleâes material prospects are roughly equal. Arguing against the Rawlsian version of a just society, Cohen demonstrates that distributive justice does not tolerate deep inequality. In the course of providing a deep and sophisticated critique of Rawlsâes theory of justice, Cohen demonstrates that questions of distributive justice arise not only for the state (...) but also for people in their daily lives. The right rules for the macro scale of public institutions and policies also apply, with suitable adjustments, to the micro level of individual decision-making. Cohen also charges Rawlsâes constructivism with systematically conflating the concept of justice with other concepts. Within the Rawlsian architectonic, justice is not distinguished either from other values or from optimal rules of social regulation. The elimination of those conflations brings justice closer to equality. (shrink)

Globalization, a process characterized by the growing interdependence of the world's people, impacts health systems and the social determinants of health in ways that are detrimental to health equity. In a world in which there are few countervailing normative and policy approaches to the dominant neoliberal regime underpinning globalization, the human rights paradigm constitutes a widely shared foundation for challenging globalization's effects. The substantive rights enumerated in human rights instruments include the right to the highest attainable level of physical and (...) mental health and others that are relevant to the determinants of health. The rights stipulated in these documents impose extensive legal obligations on states that have ratified these documents and confer health entitlements on their residents. Human rights norms have also inspired civil society efforts to improve access to essential medicines and medical services, particularly for HIV/AIDS. Nevertheless, many factors reduce the potential counterweight human rights might exert, including and specifically the nature of the human rights approach, weak political commitments to promoting and protecting health rights on the part of some states and their lack of institutional and economic resources to do so. Global economic markets and the relative power of global economic institutions are also shrinking national policy space. This article reviews the potential contributions and limitations of human rights to achieving greater equity in shaping the social determinants of health. (shrink)

Doing the best we can in the world as it is requires that appropriate account be taken of The object of this essay is to examine what amounts to feasibilitydesirability considerations.feasibilitycoming in degrees objects that the advisee controls feasibility ofought-implies-can” principle, a point of departure that frames feasibility considerations in a dismissive or otherwise inadequate way.

Despite the prevalence of human rights discourse, the very idea or concept of a human right remains obscure. In particular, it is unclear what is supposed to be special or distinctive about human rights. In this paper, we consider two recent attempts to answer this challenge, James Griffin’s “personhood account” and Charles Beitz’s “practice-based account”, and argue that neither is entirely satisfactory. We then conclude with a suggestion for what a more adequate account might look like – what we call (...) the “structural pluralist account” of human rights. (shrink)

In “World Poverty and Individual Freedom” (WPIF) I argue that the global order – because it is coercive – is obligated to do what it can to ensure that its subjects are capable of autonomously agreeing to its rule. This requires helping them meet their basic needs. In “World Poverty and Not Respecting Individual Freedom Enough” Jorn Sonderholm asserts that this argument is invalid and unsound, in part, because it is too demanding. This article explains why Sonderholm’s critique is mistaken (...) and misses the main point of WPIF’s argument. It also explains why WPIF is important -- it can address some of those most resistant to significant obligations of global justice - libertarians, actual consent theorists, and statists. (shrink)