Human Dignity and Bioethics

Justice and Access to Health Care
Dignity and Bioethics | 485
Access to health care and the just distribution of health care resources
are pressing questions both within individual nations and between
the nations that constitute our globalized world community. Human
dignity is often invoked in such discussions, but without much clarity
or rigor.
Intrinsic dignity, as elaborated in this essay, can be understood
as the foundation of all human rights. We respect the rights of an
individual because we first recognize his or her intrinsic dignity. We
do not bestow dignity because we first bestow rights. Human beings
have rights that must be respected because of the value they have by
virtue of being the kinds of things that they are.
Intrinsic dignity is at the core of all our beliefs about moral obligation.
Of particular relevance to discussions of access to health care
resources are principles P-I and P-IV.
Absolute rights (also called negative rights or natural rights) are
based on P-I, the duty to respect all members of natural kinds that
bear dignity. These include, for example, the rights not to be killed,
not to be treated disrespectfully, and not to be experimented upon
without one’s consent. These rights can and should be respected by
all persons and all societies regardless of their ecological, historical,
physical, social, or economic circumstances. In Kantian terminology,
these rights entail duties of perfect obligation.
I have argued that health care is not an absolute right or a natural
right in this sense of the word. 31 To assert a right to health care is to
assert a positive right—a right to goods and services that must, of
necessity, vary according to the ecological, historical, physical, social,
and economic circumstances of individual persons and societies. In
Kantian terminology, these rights entail duties of imperfect obligation.
They apply to the degree that they can be instituted in various
circumstances. Such so-called positive rights are based on P-IV, the
duty to build up the inflorescent dignity of individuals belonging to
a natural kind that has, as a kind, intrinsic dignity.
Health is critical for the flourishing of any member of any living
natural kind. This is no less true for members of the human natural
kind. Diseases diminish health. Accordingly, the concept of disease
necessarily includes reference to the adverse effects of the condition