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I'm leaving the old question text below, because it's not fair to change it after others have commented. But I'd like to ask a simplified question since it seems the original was misunderstood. I want to know the objectivist stance on obligation of medical professionals to treat in emergency circumstances.

The simplified question: There are circumstances where in current American society people expect a hospital to treat (for example, unconscious victims with life-threatening injuries and no insurance card in his/her pocket) regardless of ability to demonstrate payment intention (may or may not be able to pay, won't know until the victim wakes up or family shows up). My question is, is there ANY such circumstance that an Objectivist would consider significant enough for the government to force treatment. Or is it the Objectivist position that a government has no right to obligate a medical facility to provide emergency triage services.

OLD QUESTION: I have read the other posts on here about Healthcare (such as http://objectivistanswers.com/questions/709/if-healthcare-is-not-a-right-and-you-were-a-homeless-guy-with-appendicitis-what-would-you-do), and the objectivist view around all of these answers seems to be summed up with "there is no right to healthcare, it is a privilege you can pay for." I believe there are some scenarios that the prior answers do not address and I would like to understand the objectivist stance around healthcare.

As a hospital operating under these circumstances, there is little incentive to treat unconscious patients brought to me in an emergency basis, particularly ones that may appear poor and unable to pay. Is it the objectivist stance that hospitals allowed an insured unconscious patient die because they guessed (possibly incorrectly) that he/she was not insured or able to pay cash for his bill?

All of the answers around other healthcare questions assume personal capacity and responsibility to pay for your own healthcare. What about infants, children and mentally handicapped individuals that are typically not recognized as being capable of being responsible for themselves? Is the objectivist stance that an infant's access to medical care, basic immunizations, etc are determined by the financial status and success of their parents / caretakers?

Finally, some medical conditions are a cause of the violation of a person's rights, and there is precedent for a communal approach to addressing justice of those issues. As I understand it, basic police protection and civil restitution via the courts for a violation of rights are acceptable policy to objectivists. If a person breaks into my home, the police will attempt to stop that person from violating my rights, or pursue them after the fact to administrate justice. I would also have the right to seek restitution in the courts, so if the person stole $500 from me, I could bring a lawsuit against them for $500. This system seems ill-equipped to address violent crime. If someone poisons or shoots me, I may need immediate medical care that I am not sufficiently prepared to pay for. And the traditional means of restitution via the courts is not speedy enough to provide payment for my medical needs. Is it the objectivist stance that a victim of violent crime may be denied treatment and allowed to die because they did not for-see and financially plan for the assault?

I'd like to be clear that I am not attempting to argue or debate the morals or values of the objectivist stance. I am not attempting to change or critique the stance. I am just trying to clarify and understand the objectivist viewpoint. As I understand it the objectivist viewpoint is that healthcare is not a right. If that is the case, then it is acceptable objectivist policy that in the above scenarios an unconscious car wreck victim, a baby with poor parents and a treatable disease, and a gunshot victim without money to pay a surgeon have no right to healthcare and will either receive charity or die. And that the government should defend a health institution / doctor's right to deny those medical services without payment at the barrel of a gun. Is that a correct understanding of the viewpoint?

asked Jul 23 '12 at 14:42

thoolihan's gravatar image

thoolihan
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edited Nov 09 '13 at 11:07

Greg%20Perkins's gravatar image

Greg Perkins ♦♦
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I think if you honestly look at the situation you will conclude that there are other options besides charity, death, payment in full before services are rendered, and government force, for a person needing healthcare (or his/her parents in the case of a minor).

To answer your question, no, that is not a correct understanding of the viewpoint.

(Jul 23 '12 at 16:20) anthony anthony's gravatar image

I disagree with that statement anthony. Someone is going to pay for that immunization / treatment. If it's the patient or their family, it's called a purchase. If it's the taxpayers, it's called a tax. And if it's the hospital, a pharmaceutical company, a church, a neighbor, or anyone else, then it's called a charity. Is there another option?

(Jul 23 '12 at 16:25) thoolihan thoolihan's gravatar image

To clarify, I didn't say payment in full prior to services would be necessary in an objectivist health care system. However, if the obligation to treat were removed, then market forces would drive out the charitable treatment as a hospital that refused patients without insurance or some demonstration intent to pay would be far cheaper. And treatment would likely require some demonstration of ability to pay like insurance or credit rating info.

(Jul 23 '12 at 16:41) thoolihan thoolihan's gravatar image

Yes, there are other options. Can you provide a more specific scenario? Or at least pick one of the above scenarios to discuss?

(Jul 23 '12 at 16:43) anthony anthony's gravatar image

Okay, so we have insurance and credit ratings to add to the list of options. Can you think of any others?

(Jul 23 '12 at 16:55) anthony anthony's gravatar image

anthony: specific scenario = the baby of an poor person who has no money to pay for any treatment will live with the treatment of a basic antibiotic and die otherwise. The parent is not present, or has no money to pay or ability to work off the payment, or is simply a delinquent with no interest in the child. The child patient cannot pay, and the government won't pay because health care is not a right, then any other option would fall under the category of charity, would it not?

(Jul 23 '12 at 16:55) thoolihan thoolihan's gravatar image

I wouldn't classify adoption or reassignment of custody as charity. In the latter case, as would occur with regard to an abandoned child ("simply a delinquent with no interest in the child"), the new guardian could even sue for child support (although, good luck collecting).

Also, you should consider that the number of deadbeat parents will likely go down dramatically when the government stops paying people for having children that they can't afford.

(Jul 23 '12 at 16:57) anthony anthony's gravatar image

1) adoption is a form of charity (even if the motivation is because you want to be a parent) 2) it's unrealistic to think you could line up an adoption in time for urgent medical needs 3) if you want to revoke parental rights in order to pay for an antibiotic, I don't think you're an objectivist

(Jul 23 '12 at 17:05) thoolihan thoolihan's gravatar image

1) that's a strange definition of charity; 2) no, but you could assign temporary custody in a jiffy, in a case of urgent need; 3) failure to provide your child with a basic antibiotic, which is necessary for survival, is child neglect, and there's nothing in Objectivism which says otherwise.

(Jul 23 '12 at 17:18) anthony anthony's gravatar image

Ok, as I said in the question, I'm looking for the objectivist viewpoint, not arguing with it. I would only say that I'd be surprised if that is the universal objectivist viewpoint, specifically reassigning parental rights because I'm unable to pay for medicine. It's one thing to say that if the parent can't pay for a $5 antibiotic, it's another to say you're going to take away custody of a parent who can't pay for surgery to save a child who has been a car accident. That seems against objectivist philosophy.

(Jul 23 '12 at 17:44) thoolihan thoolihan's gravatar image

Your specific scenario which I was responding to wasn't about a parent who couldn't pay for surgery for a child who has been in a car accident. It was about a parent who was "not present", "has no money to pay or ability to work off the payment" (for "a basic antibotic"), "or is simply a delinquent with no interest in the child".

(Jul 23 '12 at 19:08) anthony anthony's gravatar image

Also, my response wasn't that the government should step in an forcibly take the child away. In two of the cases, the parent has already relinquished custody. In the middle one, we're talking about a parent who is either criminally negligent or mentally incompetent, either of which are grounds for forcibly removing a child if the parent will not relinquish custody voluntarily, but it probably would rarely get to that point.

(Jul 23 '12 at 19:14) anthony anthony's gravatar image

I'll answer one question:

"Is it the objectivist stance that hospitals allowed an insured unconscious patient die because they guessed (possibly incorrectly) that he/she was not insured or able to pay cash for his bill?"

Yes it is. In fact, I would state that the Objectivist stance is that hospitals has the right to refuse service to anyone, even if that person HAS money but is black and the hospital takes the position of not treating black people.

(Jul 23 '12 at 20:52) Humbug Humbug's gravatar image

I know that there is an emotional response to this statement by non-Objectivist. The question I ask you then: Does the owner of such hospital have an obligation to setup a hospital to treat people that he doesn't want to treat (e.g., non-paying, black people, etc.)? Why? If he doesn't have an obligation to set one up, then why does he have an obligation to treat them after one is setup?

(Jul 23 '12 at 20:52) Humbug Humbug's gravatar image

anthony - you misunderstand my question. There are circumstances where in current American society people expect a hospital to treat (for example, unconscious victims with life-threatening injuries and no insurance card in his/her pocket) regardless of ability to demonstrate payment intention (may or may not be able to pay). My question is, is there ANY such circumstance that an Objectivist would consider significant enough for the government to force treatment. Is there a circumstance that justifies obligation or not. I take your answers as no.

(Jul 23 '12 at 21:02) thoolihan thoolihan's gravatar image

Humbug - thank you for answering the question clearly. Please post as an answer, not a comment.

(Jul 23 '12 at 21:03) thoolihan thoolihan's gravatar image

I believe you are referring to the Emergency Medical Treatment and Active Labor Act. That applies to almost all, but not quite all hospitals (those that accept government payments). (http://en.wikipedia.org/wiki/Emergency_Medical_Treatment_and_Active_Labor_Act) As it is a chosen obligation, I'm not sure that Objectivism has a problem with the Act per se, but rather with the funding of Medicare/Medicaid through taxation.

In any case, Objectivism holds that a doctor/nurse/hospital-owner does not have an obligation to treat a patient simply because s/he is a doctor/nurse/hospital-owner.

(Jul 23 '12 at 21:25) anthony anthony's gravatar image

@thoolihan: I do not have the ability to post answers at the moment. I'm certain someone else will come by and post a more clear answer within the next 24 hrs anyway.

(Jul 23 '12 at 21:34) Humbug Humbug's gravatar image

One cannot stop tragic events from happening. The objectivist viewpoint does not deny the tragedy in these cases; however, it is morally wrong to punish those who can afford it (taxpayers) simply because other people cannot; charity is voluntary. Also, the effects of a socialized healthcare system would ensure that NO ONE would be able to afford it in these situations. These accidents will not stop, this is true, but government intervention will only make everything worse.

(Jul 30 '12 at 03:44) I am John Galt I%20am%20John%20Galt's gravatar image
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"My question is, is there ANY such circumstance that an Objectivist would consider significant enough for the government to force treatment. Or is it the Objectivist position that a government has no right to obligate a medical facility to provide emergency triage services."

My answer is that it is not either-or. It IS the Objectivist position that the government has no right to obligate a medical facility to provide emergency triage services, BUT, in, say, a time of war, where winning that war requires medical treatment of a militarily important person, the government might rightfully compel treatment from a civilian doctor.

Rights apply in a context, generally relatively normal life. Doctors are not slaves to the emergencies of others. The normal life of an ER doctor involves dealing with patients who sometimes desperately need help. But their need is not a claim on his effort. Under normal circumstances (for an ER doctor), he has, according to Objectivism, the moral right not to treat.

I'll emphasize, here: it doesn't matter whether the patient appears to be able to pay. What matters here is simply whether the doctor wishes to treat the patient. The doctor has a right to be a totally abhorrent physician and to destroy his own reputation by doing so.

That said, it's possible to imagine an unusual context where it's moral to compel the doctor. Yes, such is abhorrent to what I'd call Objectivist sensibilities, but in such case we're talking about the ethics of a war. A war is something beyond the mere fact that some individual requires medical attention for the sake of his own survival. The autonomy of the doctor cannot rightfully be sacrificed for the life of a patient, unless perhaps, the patient is of great military significance.

In times of war, there is collateral damage -- in this case, the damage would be to the doctor.

The important fact here is that the notion of rights must be understood by reference to normal conditions. The principle is that is is wrong for the government to compel a person to do work.

Once that principle is firmly grasped, then special circumstances might be considered, such as wars.

But the fundamentals of ethics and politics must not be derived from reference to emergencies or wars.

Ayn Rand wrote a great essay about this called "The Ethics of Emergencies."

answered Jul 24 '12 at 12:20

John%20Paquette's gravatar image

John Paquette ♦
1002956310

edited Jul 25 '12 at 14:02

There are no circumstances in which healthcare is a right (unless self-provided). Healthcare service, provided by person's with the knowledge and capability to provide it, is only justifiably accessed by mutual agreement. Using force to compel knowledgable, skilled people to provide the service, when they are unwilling to do so, is completely contrary to Objectivist principles, in any context. There is no circumstance in which Objectivsts would force another person to do something. Fortunately, healthcare professionals actually want to provide care to people - in exchange for the benefits they desire and aquire from it. That is why they entered the profession. It would nearly be irrational for them to refuse to treat someone. But if they did refuse, no Objectivist principle would justify forcing them to provide it.

answered Nov 21 '13 at 11:10

MarcMercier's gravatar image

MarcMercier ♦
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edited Nov 21 '13 at 11:13

Actually, I did just think of a circumstance in which providing health care, or at least the cost of it, should be compelled. If A causes B harm, and B requires healthcare as a result of that harm, a court could find A liable and compel A to pay B restitution to cover the cost of care. Under that set of circumstances, it is just/proper to compel someone uwilling to pay, to do so. However, the circumstance is a bit removed from having an absolute right to healthcare. The right B had was be free from harm of A's actions. Now that A harmed B, B is entitled to be compensated for A's act.

(Nov 21 '13 at 12:00) MarcMercier ♦ MarcMercier's gravatar image

I disagree, as soon as you say "in any context".

Yes, people have a right not to be forced by others. But in a war, or emergency, those rights don't apply.

Rights are derived in a context, and apply in that context.

(Nov 21 '13 at 13:00) John Paquette ♦ John%20Paquette's gravatar image
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Nothing is a right unless self-provided. That is to say, the very meaning of "right" implies the sanction of some sort of action on the part of the right-holder.

(Nov 21 '13 at 13:24) anthony anthony's gravatar image

Yes. I conceded in my follow-up that in a context in which A caused the harm to B, A would can justly be compelled to compensate for the cost of healthcare.

I do not understand, or imagine, any circumstances under which 'war' would justify compelling a healthcare provider to provide it. Participation in war, more so than most things, is only just when voluntarily participated in.

(Nov 22 '13 at 15:35) MarcMercier ♦ MarcMercier's gravatar image
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Asked: Jul 23 '12 at 14:42

Seen: 1,689 times

Last updated: Nov 22 '13 at 15:35