David T. Ozar

The concept of basic healt.h care has grown steadily in importance in recent years as more and more of those who reflect on the issue of a right to health care conclude that we need to distinguish between kinds of health care to which people do have a right and others to which they do not have a right. There is little consensus on where to draw this line. But there does seem to be general agreement that, if this distinction is valid, it is so because some kinds of health care are less important, less essential, less something than others, and because the right to health care (if there is such a thing) extends only to those kinds of health care that are more important, more essential, more whatever-it-is. A number of authors have used the term 'basic' to represent this something and this is the term which I shall use. In this article, I shall offer a theory of what we mean by basic health care. I shall do this by developing, in Section 1 of the paper, a general theory of kinds of needs. In Section 2 I will give a brief account of the special moral significance of the levels of need which I designate as basic. In Sections 3-4 1 shall try to identify, in the context of the health care resources available in our society, the health care needs which fall into the previously developed categories of basic need.

In this paper I clarify the distinction between actions performed under a social rule and a mere pattern of behavior through an examination of two distinctive features of actions performed under a social rule. Developing an argument proposed by H.L.A. Hart in The Concept of Law, I first argue that, where a social rule exists, there nonconformity/conformity to the pattern of behavior set down in the rule count as good reasons for criticism/commendation of actions covered by the rule. Secondly I argue that, where a social rule exists, nonconformity/conformity to the pattern set down in the rule must be taken account of (at the risk of self-contradiction) in judging actions covered by the rule commendable or subject to criticism. This in turn means that, where a social rule exists, there can be no genuine exceptions to the rule because the notion of a genuine exception to a social rule makes no sense.

The notion of group responsibility has received some very fruitful examination in recent years. But there still remains an important commonsense objection to this notion. Moral responsibility for an action is ordinarily linked to and held to depend upon the action's being the product of an act of choice on the part of the agent. The thrust of the objection here is that it is extremely difficult to understand how intentional acts like acts of choice can be properly attributed to a group. The notion of a group "consciousness" does not seem a very satisfactory resolution of this problem. In this paper I shall propose that there are actually three distinct processes, as well as many hybrid combinations of them there, by which groups "make choices." That is, when we look at the activities of groups, we discover three different kinds of analogues to the act of choice of the individual person. I shall be illustrating each of these models with examples of health care decisions. In addition, I shall also try to illustrate how the level of personal moral responsibility of each of the individuals making up the group, i.e., each one's responsibility for the group's action, can be seen to flow from the particular role that an individual plays within the process of "group choice" that is involved. In this way, I hope to shed light not only on the topics of group choice, group responsibility, and the interplay of personal and group responsibility, but also to show concretely the valuable role that these themes can play in our understanding of the moral elements of the health care setting. CiteULike Connotea Del.icio.us What's this?