Table 13.1.
Individual and Community Rights and Responsibility in Health: Ethical/Legal Issues
| Ethical/Legal Issues | Individual Rights and Responsibilities | Community Rights and Responsibilities |
|---|---|---|
| Sanctity of human life | Individuals responsible to avoid behavior damaging their own health and that of others | Responsible for providing a feasible basket of service; equitable access for all |
| Individual vs. community rights | Immunization for individual protection | Immunization for herd immunity and community protection; education; community may mandate immunization |
| Right to health care | All are entitled to needed emergency, preventive, and curative care | Community right to care regardless of location, age, gender, ethnicity, medical condition, and economic status |
| Personal responsibility | Individual responsible for health behavior, diet, exercise, and nonsmoking | Community education for health-promoting lifestyles; avoid “blame the victim” |
| Corporate responsibility | Management accountability to criminal and civil action | Producer, purveyor of health hazard accountablity for individual and community damage |
| Provider responsibility | Professional, ethical care, and communication with patient | Ensure access to well-organized health care, accredited to accepted standards |
| Personal safety | Protection from individual, family, and community violence | Public safety, law enforcement, protection of women, children, vulnerable groups and elderly, safety from terrorism |
| Freedom of choice | Choice of health provider, limitations of gatekeeper functions, control costs function, right to second opinion, and right of appeal | Confidentiality, informed consent, birth control ensuring individual rights, limitations of self-referrals to specialist |
| Euthanasia | Individual’s right to assisted death within limitations by societal, ethical, and legal standards | Assure individual and community interests; prevention of abuse by family or others with conflict of interest |
| Confidentiality | Individual’s right to privacy, limitation of information | Mandatory reporting of specified diseases; data for epidemiological analysis |
| Informed consent | Right to know, risks vs. benefits; agree or disagree to treatment or participation in experiments | Helsinki Committee approval of research; regulate fair practice in right to know; Patient’s Bill of Rights |
| Birth control | Right to information and access to birth control and fertility treatment; woman’s rights over her body | Political, religious limited promotion of fertility; alternatives to abortion; legal protection of women’s right to choose |
| Access to health care | Universal access, prepayment; individual contribution through workplace or taxes | Solidarity principle and adequate funding; right to cost containment, limitations on service benefits |
| Regulation and incentives to promote preventive care | Social security for hospital delivery, attendance for prenatal care; primary care, ambulatory care; home care | Incentive grants to assist communities for programs of national interest; limit institutional facilities |
| Global health | Human rights and aspirations; economic development, health, education, and jobs | Reduction of health risks; occupational hazards and environmental damage |
| Rights of migrants and minorities | Equality in universal access | Pro-active outreach for high-needs groups |
| Prisoners’ health | Human rights | Security and human rights; reduce inequalities in sentencing convicts, harsh dangerous conditions in prisons; prohibition of torture and execution |
| Allocation of resource | Lobbying, advocacy for equity and innovation | Adequate resources for health; equitable distribution, targeting high-risk groups; cost containment |
Source: Adapted from Tulchinsky TH, Varavikova EA. The new public health, 3rd edition, San Diego, CA; Academic Press/Elsevier, 2014.Chapter 15, page 807.