Health as a value, health as a right

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A saying in Italian goes like this: “Quando c’è la salute, c’è tutto” (When there is health, there is everything). That is, everything that matters is there, as long as you are healthy.

Arguably, and strange as it may sound given the coronavirus pandemic, most people may have actually been (at least physically) very healthy in the last few weeks, and probably healthier than they would have been without the pandemic. The reason is clear: the lockdown measures either strongly recommended or enforced in most countries have kept most people physically distant from other people. As a result, the chances to catch any virus have dramatically dropped for most people.

But it has also become clear that the Italian saying is false, at least if understood literally. Most people’s health may have been secured, but at the price of missing out, at least for some time, on many of the things that matter.

No, when there is (physical) health, not everything that matters is there. It’s not easy to articulate the goods that have been totally sacrificed or drastically set back by the enforced or voluntary confinement, let alone compose a complete list, but I’ll try:

1) The freedom to move around, both in one’s surroundings and between cities or countries, whenever one wants and for whatever reason;

2) Face-to-face social interaction (with schoolmates, teachers, professors, colleagues, friends, relatives, lovers…) and the benefits (including, e.g. mental health) that usually come with face-to-face as opposed to virtual interactions (an important debate to be had here, by psychologists and philosophers, is precisely what the face-to-face benefit differential is);

3) The personal freedom usually afforded to parents by being able to rely on kindergartens and schools (as well as children’s freedom from parents!);

4) Any kind of work that cannot be done (or cannot be done well) from home, not to mention the very fact that many people have become unemployed;

5) Related to this, the overall economic wealth in many countries;

6) The possibility of many leisure activities, again including their many benefits;

7) Not least, a balanced relationship between the state and its citizens, where the state does not systematically present itself to law-abiding citizens in the sinister guise of policemen controlling their behavior.

But could sacrifices to all these values have been made in the name of the value of one’s own or others’ health? After all, the vast majority of ethical theorists (from Plato and Aristotle to our days) have never thought of health as an ultimate value or an end in itself, but rather as instrumental to other, more basic values, like happiness, virtue, freedom, and self-realization.

So it would be surprising if all those sacrifices were justified in the name of a value that is merely instrumental. Nor does it seem that, for example, people’s happiness has been especially promoted thanks to protecting their health – if anything, the sacrifices required by the lockdowns seem to have made many people rather miserable, making negligible whatever health-based gain in happiness there might have been.

It should be clear that the sacrifices have not been made in order to preserve everyone’s health from the threat of coronavirus. That would have been unreasonable: despite the virus being still largely unknown and without a cure or vaccine, the vast majority of those who get sick from coronavirus do not suffer much and do recover within a relatively short time.

From this angle, coronavirus does not seem to be much worse than the seasonal flu, and it’s certainly very far from any “black plague” scenario. But reducing the dangers of the seasonal flu has never been a good enough reason to shut down schools or avoid physical interaction during the flu season, so that cannot be the issue in the case of coronavirus either.

Of course there are many people (elderly, with immunodeficiency, etc.) to whom coronavirus does pose a higher danger to health and life than the flu. However, it is important to realize that – harsh as it sounds – the point of extensive lockdowns cannot exactly be the preservation of the health or life of people in at-risk groups. Let’s not forget that in normal times people go out, kids go to school, etc., and as a result people in at-risk groups may well (and do) catch some viruses which may turn out to be fatal to them, but this is a risk that societies deem worth taking.

So what’s the point of the current lockdowns? Of course, it does have to do with the health of at least some people, but what is crucial is not preserving their health per se, but rather making sure that their right to health, hence their right to receive adequate treatment, is guaranteed, in a situation where, given the easy spread of the virus, healthcare resources would not be sufficient to take proper care of all those patients who need hospital treatment.

So the point of the lockdowns is to ensure the continued provision of a moral right, as well as of a legal right, at least in those countries that recognize a right to universal healthcare services (this distinction is important for those countries, like the US, which only recognize a limited right to healthcare).

If we now reconsider the sacrifices listed above under the lens of rights, it should be clear that many of them involve the suspension (at least to some degree) of a (moral or legal) right for all people, most obviously the rights to free movement and free association, in the name of protecting the right to health for some people.

I will not take a stand as to whether this is an acceptable trade-off between some people’s and other people’s rights, though I’m inclined to think so, assuming the lockdown is only a temporary solution. Also, it can be argued that, after all, it’s everyone’s right to healthcare at stake here: without the lockdowns entire healthcare systems would have collapsed, thus making them for a long time unable to properly address the health needs of the whole population, not just of coronavirus patients.

Ethical reflection on the coronavirus crisis thus brings to light a perhaps surprising point: even if health as a value may not enjoy a particularly high status (given that it’s an instrumental value), and so may not as such justify important sacrifices to other values; on the other hand, health as a right can have the status of a fundamental right, and can therefore justifiably trump other fundamental rights, at least in times like these.

Francesco Orsi is a Senior Research Fellow in Practical Philosophy at the University of Tartu. This story was originally published in the Estonian science portal Novaator.

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