Beyond forbearance as the moral foundation for a health care system
analysis of Engelhardt's principles of bioethics
pp. 113-138
in: Reading Engelhardt, Berlin, Springer, 1997Abstract
H. Tristram Engelhardt, Jr., in his The Foundations of Bioethics, constructs what he calls the foundations of a "general secular morality"1 of bioethics. "This account," he explains, "can be regarded as a transcendental argument to justify a principle of freedom as a side constraint, as a source of [moral] authority" (70).2 This principle, which he calls the principle of permission (or forbearance), justifies a basic moral right against the use of unconsented-to force against the innocent (15). But it does not justify a basic moral right to assistance, including access to basic health care. "A basic human secular moral right to health care," Engelhardt explains, "does not exist-not even to a decent minimum of health care" (375). However, he argues, if a moral community chooses to do so, it may create a right to basic health care by establishing at least a two-tiered health care system: an upper tier where personsuse private funds to purchase whatever medical care they wish, and a bottom tier where persons have access regardless of their ability to pay. The principle of permission and its derivative principle of private ownership justify the upper tier, which is universally required as a basic right, while a principle of beneficence justifies a bottom tier, which is always optional.
