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  • From Conception to Realization:A Human Right to Health

On The Web

Bioethics Forum

www.bioethicsforum.org

President Obama’s Groundbreaking Order on Hospital Visitation and Decision-Making
BY Carol Levine
The changes President Obama calls for in his April 15 memorandum are ground-breaking, but anyone who might be vulnerable to being excluded as a hospital visitor or substitute decision-maker should be prepared to be a forceful advocate. Culture change takes a long time.

Overturning Health Reform: A Cautionary Tale
BY Wendy E. Parmet
A judicial defeat of health care reform, especially by the Supreme Court, would require reversing or at least questioning much of the settled precedent on which our post–New Deal jurisprudence stands.

Also: Susan Hawthorne analyzes the newly proposed options for changing ADHD’s diagnostic criteria for DSM-V; Dhruv Khullar explains why you can’t trust Vitaminwater; Ann E. Mills and Patti M. Tereskerz look at the uncertain future of gene patents; and Ross White wonders why so many Republicans are all of a sudden opposed to individual mandates.

The Health Care Cost Monitor
www.healthcarecostmonitor.org

Small Steps Toward Cost Control
BY RICHARD B. SALTER

It is hard to overstate how fiscally irresponsible health care reform is. One finds many admirable goals that come with unaf-fordable price tags. No reasonable person would consider the act’s small, tentative, and horizon-focused steps toward reining in medical spending to balance its massive new entitlements. This gap between rhetoric and reality makes Obama, Pelosi, and Reid sound like demented Peronists every time they open their mouths.

  • To the Editor
  • Sofia Gruskin

John Arras and Elizabeth Fenton are, it seems, trying to write a provocative piece (“Bioethics and Human Rights: Access to Health-Related Goods,” Sept–Oct 2009). Sharp digs at the United Nations generally and the World Health Organization specifically, quick observations about commentators that lend support to their positions with inadequate attention to more nuanced writings, and sweeping generalizations about the nature of human rights and about those academics and practitioners working in the area all make for lively reading. Reaching beyond the rhetoric, however, one is left to conclude, after many pages of reflection and at times inchoate attack, that human rights may offer something important to bioethics, as long as it does not take away from what bioethics has to offer. But is this really a contentious position?

To build on what is proposed in this article, a few points about human rights would seem to require attention. While certainly the authors’ emphasis on the right to health is well placed, determining the value of rights for bioethical discourse requires explicit attention to the indivisibility and interdependence of rights as concerns both the underlying determinants of health and the delivery of health services. We must try to assess the value of such rights as privacy, education, information, participation, and freedom from discrimination as they interact with the right to health and with one another. To consider the right to health in isolation is to miss a key contribution of rights to health and well-being and an important area for reflection and debate.

With respect to the authors’ specific focus on the right to health—or, more accurately, on the component of the right to health concerned with access to health care and the allocation of health-related goods—several points are worth emphasizing. As I have noted in earlier writings, a rights-based approach sets out a process, contributes legal accountability and established criteria to be debated within the process itself, but was never intended to determine “who should receive which resources here and now in resource-poor settings.” Its distinct contribution is requiring analysis of which rights and which populations would be impacted by each intervention, with specific attention to the availability, accessibility, acceptability, and quality of the proposed intervention and the establishment of accountability mechanisms in relation to meeting goals. While it seems the authors would be willing to engage with these points given their attention to so-called institutional conceptions of human rights, explicit attention to these criteria and their implications for health would do much to clarify the specifics of the...

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