GLOBAL HEALTH CARE INJUSTICE: AN ANALYSIS OF THE DEMANDS OF THE BASIC RIGHT TO HEALTH CARE By PETER GEORGE NEGUS WEST-ORAM A thesis submitted to the University of Birmingham for the degree of DOCTOR OF PHILOSOPHY Department of Philosophy School of Philosophy, Theology and Religion College of Arts and Law University of Birmingham September 2014 University of Birmingham Research Archive e-theses repository This unpublished thesis/dissertation is copyright of the author and/or third parties. The intellectual property rights of the author or third parties in respect of this work are as defined by The Copyright Designs and Patents Act 1988 or as modified by any successor legislation. Any use made of information contained in this thesis/dissertation must be in accordance with that legislation and must be properly acknowledged. Further distribution or reproduction in any format is prohibited without the permission of the copyright holder. ABSTRACT Henry Shue’s model of basic rights and their correlative duties provides an excellent framework for analysing the requirements of global distributive justice, and for theorising about the minimum acceptable standards of human entitlement and wellbeing. Shue bases his model on the claim that certain ‘basic’ rights are of universal instrumental value, and are necessary for the enjoyment of any other rights, and of any ‘decent life’. Shue’s model provides a comprehensive argument about the importance of certain fundamental goods for all human lives, though he does not consider health or health care in any significant detail. Adopting Shue’s model, I argue that access to health care is of sufficient importance to the enjoyment of any other rights that it qualifies as what Shue describes as a ‘basic’ right. I also argue that the basic right to health care is compatible with the basic rights model, and is required by it in order to for it to achieve its goal of enabling right holders to enjoy any decent life. In making this claim I also explore the requirements of the basic right to health care in terms of Shue’s triumvirate of duties and with reference to several key examples. Acknowledgements While it is not possible to thank everyone for their support who deserves it here, I would like to take this opportunity to note certain people whose support, advice, and friendship have made this thesis possible. First , I am deeply grateful to my supervisor, Professor Heather Widdows, whose support, encouragement, advice and expertise have all been vital to the completion of this thesis. Any quality that is in the following pages is the result of her guidance, knowledge, and skill as a supervisor. I am also very grateful for the friendship and support of my friends and colleagues in the Department of Philosophy at the University of Birmingham. Thanks must especially go to my mum and dad, Lotte and Peter, and to my brother, Patrick, and sister, Kate, whose love and support has been constant and invaluable. Finally, immense thanks to Jamie for her constant support, advice, and love. This thesis was made possible through generous funding from the Arts and Humanities Research Council (AHRC) ‘Block Grant Partnerships’ scheme, to which I am very grateful. Contents PREFACE .............................................................................................. 1 CHAPTER ONE ...................................................................................... 5 GLOBAL JUSTICE AND THE BASIC RIGHT TO HEALTH CARE .............. 5 1.1 – The Purpose of Moral Rights ......................................................... 6 1.2 – Defining Moral Rights .................................................................. 8 1.3 – Defining Basic Rights ................................................................ 13 1.4 – Defining Standard T hreats .......................................................... 19 1.5 – Shue’s Three Basic Rights .......................................................... 22 1.5a – The Basic Right to Security .................................................... 22 1.5b – The Basic Right to Subsistence ............................................... 25 1.5c – The Basic Right to Liberty ..................................................... 29 1.5d – Summarising Shue’s Three Basic Rights .................................. 32 1.6 – The Basic Right to Health Care ................................................... 34 1.7 – Health or Health Care? Establishing Accurate Terminology ............ 39 1.8 – Rejecting the Positive/Negative Rights Distinction ........................ 46 1.9 – Shue’s Triumvirate of Duties ...................................................... 50 1.9a – The Duty to Avoid Depriving .................................................. 54 1.9b – The Duty to Protect From Deprivation ..................................... 54 1.9c – The Duty to Aid the Deprived ................................................. 56 1.9d – Summarising Shue’s Triumvirate of Duty ................................. 57 1.10 – The Advantages of the Basic Rights Model For Analysing Questions of Global Justice ................................................................................ 59 1.10a – Clarity of Justification ......................................................... 61 1.10b – Clarity of Obligation ........................................................... 64 1.10c –Clarity of Objective .............................................................. 71 1.10d – Summarising the Benefits of the Basic Rights Model ............... 78 1.11 – Summary ................................................................................. 81 CHAPTER TWO ................................................................................... 84 THE DUTY TO AVOID DEPRIVING: ‘NEUTRAL’ BE HAVIOUR AND THE BASIC RIGHT TO HEALTH CARE ........................................................ 84 2.1 – Different Types of Depriving Behaviour and How They May be Avoided ............................................................................................ 86 2.1a – Non-Malevolence .................................................................. 89 2.1b – Conscientiousness ................................................................. 90 2.1c – Impartiality .......................................................................... 92 2.1d – Non-malevolence, Conscient iousness, and Impartiality .............. 96 2.2 - The TRIPS Regime ..................................................................... 99 2.3 – Deprivations of Basic Essential Medicines Caused by TRIPS ........ 101 2.4 – Rejecting Deontological Defences of TRIPS ............................... 107 2.4a – Novel Products, Patents, and the Type/Token Distinction ......... 108 2.4b – Prioritising Important Rights: Intellectual Property Vs. Healt h Care ............................................................................................ 114 2.4c – TRIPS and Rights ................................................................ 122 2.5 – Consequences of TRIPS: Challenging Consequentialist Justifications ...................................................................................................... 123 2.6 – Partial Behaviour and TRIPS: How TRIPS Violates the Duty to Avoid Depriving ........................................................................................ 130 2.7 – Expanding the Argument – Two Additional Examples .................. 134 2.8 – Alternative Approaches ............................................................ 138 2.9 - Summary ................................................................................. 140 CHAPTER THREE .............................................................................. 142 INFECTIOUS DISEASE AND THE DUTY TO PROT ECT FROM DEPRIVATION .................................................................................. 142 3.1 – Shue’s Original Formulation of the Duty to Protect From Deprivation ...................................................................................................... 145 3.2 – The Significance of Agent Independent Deprivation Hazards ........ 148 3.3 – Expanding the Duty to Protect From Deprivation ......................... 152 3.4 - Fulfilling the Duty to Protect From Deprivations of Health ........... 156 3.4a – Protective Social Infrastructures ........................................... 158 3.4b –Medical Interventions: Treating Victims to Protect Third Parties 163 3.4c - Protecting by Participating in Public Health Measures ............. 170 3.5 – The Practical Requirements of the Duty to Protect ....................... 180 3.6 – Summary................................................................................. 184 CHAPTER FOUR ................................................................................ 186 CONSTRUCTING THE DUTY TO AID THE DEPRIVED ........................ 186 4.1 – Aid and the Triumvirate of Duty ................................................ 190 4.2 – Three Problematic Examples for the Duty to Aid the Deprived ...... 195 4.3 – Five Criteria for Evaluating Deprivation Scenarios ...................... 206 4.3a – Criterion One: Liability ....................................................... 208 4.3b – Criterion Two: Severity ....................................................... 215 4.3c – Criterion Three: Aggregate Welfare Score (AWS) ................... 221 4.3d – Criterion Four: Contingent Ability ........................................ 231 4.3e – Criterion Five: Opportunity Cost ..........................................