Of Marginalized Populations and Public Health Care

Solomon Benatar has written, "Modern communication, transport, methods of money exchange, the creation of nuclear and other potential weapons of mass destruction and the emergence of new infectious diseases have shrunk distances and differences, and created common global risks. In this context, and with a deeper understanding of the impact of adverse forces shaping the wealth and health of nations, we need to appreciate how we are all deeply implicated in the lives of others, and cannot hide with moral credibility behind the barrier of physical distance while billions of people live impoverished lives."

Benatar's quote comes amidst a larger call on his part for a more robust discourse concerning public health ethics. That is, beyond talk about the rights of individual patients in a medical setting and the various ethical dilemmas that might arise for an individual (i.e. issues relating to in vitro fertilization, use of stem cells, euthanasia, refusal of care, etc.) which have been at the center of much of the current discussion in the domain of bioethics, there is an earnest need for consideration of how the health of populations is structured and maintained, even sometimes in conflict with the uncompromising autonomy of individuals.

In America we are immersed in a debate about the reform of our health care/health insurance system. It is a temptation, I think, in the midst of such a debate to lose sight of the broader implications of our decisions about the management of health in the United States. Benatar put it wonderfully, in this present world of fluid currencies, economies, pathogens, nuclear weapons, and Internet technologies, "...we are all deeply implicated in the lives of others..."The way in which we choose to manage the delivery of health care here in the United States will have global implications, whether we acknowledge that or not.

The threat of viral sickness that ravages populations across the globe affords an example of the importance of providing for effective care in our own country. The failure to provide the necessary medical care to a single individual, or groups of individuals represents a direct threat to the overall health of the population in the country, but also the world given the ease with which people can travel now.

Thus, when various state legislatures or the national legislature consider the question of whether various not for profit health clinics should provide medical services to illegal immigrants, they would be wise to remember that "...we are all deeply implicated in the lives of others..." A failure to take care of these individuals represents a failure to take care of the national population as a whole, and even the global population. To be sure, we live in a world of limited resources, and we simply cannot provide for everyone. But in a world where we are all so deeply connected to one another we should be sensitive to steep divides that provide some with enormous benefits and power and others with virtually no benefits or significant power. It may be true that a strictly egalitarian society is impossible, and perhaps is not even desirable, but this need not mean that we cannot provide a basic level of care for each and everyone in an effective manner that keeps an eye to the larger good of a population or society and not merely individuals alone.

Perhaps by coming to terms with our own marginalized populations here in the United States we can finally recognize the need to recognize and address the profound lack of health care resources in other marginalized populations throughout the world.