Responsibility, accountability, and distributive justice : a case for discontinuing universally subsidised healthcare in New Zealand.
Degree GrantorUniversity of Canterbury
Degree NameMaster of Arts
Technology has advanced in leaps and bounds over the last few decades, and countries with universal healthcare policies are now beginning to struggle. Health care is more expensive and, with growing populations, governments cannot continue to provide the same level of healthcare as they have in the past. Many have tried to suggest a system for allocating medical resources, which not only preserves the resources, but also ensures they are distributed fairly. In the field of bioethics, there has been much debate regarding whether or not those, who are morally responsible in some way for the development of their illness, should still be able to access medical resources. I will suggest within this thesis that those who are morally responsible for their injuries or illnesses no longer have a right to subsidised healthcare, provided by the State. Instead, those individuals should cover at least some, if not all, the costs of their medical treatment. I will also propose that when in direct competition for resources, that is, organ transplants, those who were instrumental in the cause of their sickness should receive reduced entitlements. The proposal is particularly relevant considering that on 11 October 2009, TVNZ 3 News reported that ACC, New Zealand’s Accident Compensation Corporation, had made the ‘biggest corporate loss in New Zealand history.’ They were over twelve billion dollars in debt with no foreseeable way to resolve the situation.1 ACC is just one of the corporations responsible for ensuring that all New Zealanders receive subsidised healthcare. The two other agencies are local District Health Boards, and PHARMAC, who are responsible for funding pharmaceuticals. The current level of subsidies cannot continue, and ACC are cutting services and raising levies. Motorcyclists were one group targeted by levy increases. In 2007, there were over one thousand motorcyclists injured on New Zealand’s roads.2 Motorcyclists, angry about the increases to levies, staged several protests. The motorcyclists believed that to raise their levies was unfair; this thesis attempts to prove that it is. In this thesis, I plan to show that health resources should be distributed based on moral merit. This ensures that those with preventable, self-caused, sickness do not unfairly deplete health resources. These individuals are a burden on healthcare resources so, in order for government funding to continue to be a sustainable practice, something must be done to ‘block the drain.’ Health resources are distributed justly when based on John Roemer’s ‘Equality of Opportunity’ theory.3 After the initial distribution, additional resources are allocated based on merit. Thus, everyone has a fair share of medical resources. Those that consume more than their allocated fair share, due to moral responsibility, need to restore the resources they have unfairly consumed. To achieve this goal, the ‘guilty’ party will be required to fund some, if not all, the costs of their medical treatment. This thesis hinges on several assumptions: first, that moral responsibility can be determined. The first chapter is devoted to a brief examination of this topic. After examining the theories of Aristotle, Harry Frankfurt, Peter Strawson and Susan Dwyer, it is concluded that Walter Glannon provides the most pertinent account of moral responsibility. The second assumption is that there is no right to healthcare. A positive right to healthcare would indicate that, regardless of how sickness developed, receiving medical treatment is a matter of right. The second chapter discusses this supposed right to healthcare. I aim to determine whether the right to health care is a positive absolute, or positive prima facie. A prima facie right is one that can be ‘trumped’ when in competition with other rights. In this chapter, I will also determine whether the right to health care can be overridden in certain circumstances. The third assumption is that, if such a policy is paternalistic, paternalism is justifiable. The third chapter outlines some objections to the theory and features a discussion of paternalism. Using the neutrality constraint shows that paternalism is justified. After discussing the main assumptions, the thesis focuses on justifying the proposal. One of the main arguments for allocation of resources based on merit is the ‘restoration argument.’ This argument suggests that it is morally permissible to require those who consume more than their fair share of resources to restore the resource pool to its previous state. Stephen Wilkinson attacks the ‘restoration argument’ by using what he calls the ‘reverse restoration argument.’ Chapter Four is not only devoted to outlining the ‘restoration argument’ but also a reply to Wilkinson’s critique. Research into this area has identified one particular point of interest: addicts. Intuitively, addicts are morally responsible for their conditions, as they make a choice to indulge in a known addictive substance. Research into the area of addiction suggests that potential addicts are more likely to underestimate their susceptibility to addiction, and therefore become addicted. Addiction, and the effect on it has on moral responsibility, is discussed in chapter five. The final chapter acknowledges the remaining practical issues, and of particular interest is how moral responsibility could be determined fairly and consistently. The first section discusses the problem of genes and their relationship to moral responsibility. Next, I present Roemer’s ‘Equality of Opportunity’ theory as the most just way of distributing resources. I also outline my ‘Responsibility Continuum’; a tool designed to designate moral responsibility. The final discussion includes some closing recommendations. I have reached my conclusion, that people should be held morally accountable for their health states, by researching the various areas related to the topic. Unfortunately, space constraints have required me to limit my analysis of areas, such as moral responsibility, rights and duties, and addiction, to only a brief examination. There is certainly more scope for discussion on this topic. Saving healthcare dollars is simply a case of holding individuals accountable for their actions. To do so empowers the population to take control of their health states. Everyone must scrutinise their lifestyle choices, and choose between the vice, or subsidised medical treatment. I believe that reasonable people will choose the latter, and sacrifice these unhealthy behaviours. As a result, problems such a smoking, obesity, and self-caused sicknesses will no longer be a problem for the healthcare system.