My main concern with granting a right to health care—particularly if my intuition is correct that people understand a right to health care to mean a right to health—is the effect this might have on the patient's individual freedom and liberty. It has become clear to me that as the concept of health and conversely of disease has expanded to encompass a variety of psychological and social problems such as alcoholism, drug addiction, infertility, child abuse, obesity, ugliness, anxiety, unhappiness, even lack of fulfillment, there has been a concomitant decline in a sense of personal accountability for these conditions. As the limits of health expand, and the sense of personal responsibility declines, physician interventionism, perhaps a form of medical paternalism, increases. This is not because physicians deliberately seize this opportunity to be paternalistic but because an expansive vision of physician-related activities sanctions and often requires physician intervention in areas previously treated by social institutions such as courts, churches, schools, and the family. This gradual increase in the scope of medicine has been tempered to some extent by a countervailing increase in consumer activism and legislative and administrative regulation. Indeed, the current claim of a right to health care may have partially resulted from consumer activism, particularly consumer criticism regarding accessibility and quality of medical services.
If a right to health care is granted, irreversible modifications in the original doctor-patient relationship may result, such that both physician and patient become responsible to and dependent upon a societally imposed definition of health and disease, and, in particular, of which health services are appropriate.
The specter that looms is that, as the right to health care and, implicitly, the right to health become established, unanticipated individual duties and obligations may be imposed upon patients and doctors alike. Freedom of choice may be restricted by society in order to defend society's interest in the provision of health care and in the maintenance of health. It could become one's duty to preserve his own health, to the point where . . . one would be prohibited from smoking, drinking alcohol immoderately, and eating between meals, and one might be required to maintain one's weight, sleep approximately seven hours nightly, eat breakfast, and exercise regularly. Individual liberty and freedom may be sacrificed to a societal guarantee of health care and health unless society decrees that resources for health care are unlimited. This Orwellian vision of a coercive state and a decline in human liberty may seem inordinately pessimistic, but I do not think that it is; a right to health care could make this jeremiad a reality. I am fearful that as our notion of expanding limits of medicine coincides with an expanding notion of a right to health care and a right to health this unfortunate situation may become a reality. I recognize I have depicted a system of government in many ways inimical to the basic libertarian tradition of American democracy. But so for that matter is a right to health care and a right to health.
(Mark Siegler, "A Right to Health Care: Ambiguity, Professional Responsibility, and Patient Liberty," The Journal of Medicine and Philosophy 4 [June 1979]: 148-57, at 155-6 [ellipsis added])
Keith Burgess-Jackson, J.D., Ph.D. 