Is Public Health a Public Good?

Often, the struggle to do what we believe is right can make us take on some actions that may be considered wrong. Certainly this is the case with Peter Gonzalez, a inner city doctor who works at Uphams Corner Neighborhood Health Center. In order to combat the spread of AIDS in the area, Dr. Gonzalez, slips in AIDS testing forms into the packet of information that patients flip through and sign without reading. However, the Massachusetts law requires informed consent in order to test patients. So, the first question that should be addressed is whether or not Dr. Gonzalez's approach is legal or ethical in it's nature.

Of course, it takes only a look at Massachusetts Policy on HIV Testing (Exhibit One) to realize that Dr. Gonzalez's methods, as described in the case study, are definitely illegal. The law states that he must give informed consent, and by simply slipping the papers in for them to sign, he is not doing that, thereby making his actions illegal. However, perhaps the greater question here is whether or not this method is ethical. To answer this, we should look at the actions for consequentiality and from a deontological approach.

Consequentialist ethics, which are based on the outcome, which specify that the actions themselves are not what the situation should be judged by, but rather the outcome of those actions. When we follow consequentialist ethics, we must ask ourselves if the ends justify the means. In this case, the end goal is a good one, as Dr. Gonzalez is saving lives and fighting against the spread of AIDS in his community. Even though his actions may not be by the books, his intended goals are positive, and his actions, though they may sidestep the law, are ethical. However, when we look at the situation under deontological ethics, we get a different picture entirely. This type of ethics is focused on how the goals are achieved, and not what the outcome is. Deontological ethics are based upon following the rules and an obligation to do what is legally right. Under these standards, Dr. Gonzalez's methods would not be ethical. No matter how good his intentions or his intended outcome may be, he has still broken the rules, and he has disobeyed the law, this means that he has acted in a manner which is squarely unethical.

However, is it right for the government to allow us to choose whether or not we get AIDS testing. To answer this, let us look to the three pronged test of government action. The first prong states that it depends on the gravity of the public concern. In this case, public concern is very high, and if patients know they have AIDS, it could greatly reduce the spread of the disease. Whether we like it or not, AIDS can effect anyone, and thus the gravity of the public concern is definitely high enough to call for government intervention. The second test, which is the degree to how the action will advance public concern also comes out positive. This testing could greatly reduce the spread of AIDS, and thus it would be helping to fight the disease in a number of ways. Testing for AIDS is perhaps one of the most important things that can be done to fight it. However, the third prong, which deals with how the action limits freedom, is where mandatory testing hits a problem. Testing for AIDS will greatly limit the freedom of all, even those who do not have AIDS will be forced to undergo testing and the results may become common knowledge. This would be an invasion and would greatly limit rights. It is for these reasons that the three pronged test of government action would state AIDS testing cannot be mandatory.

However, there are alternatives to total government financing and control of the Uphams Health Center. There could be a voucher system created, in which the center would be given money in order to improve their abilities and equipment. This would prevent total control, but would also give the center more power to help patients. A system of partial ownership may also be imposed, in which the government will own shares of the business without completely controlling it. Allowing the center some freedom, but still placing them under the support of larger private industries, it would be a meeting in the middle. Another method would be contracting, in which certain functions would be given private control. In this case, the center may lose some freedom with regards to certain aspects, but they would get the help they need and further support, and still retain some control. Perhaps the larger question here is whether or not public health is a public good. A public good is available for all, and will not be reduced when others consume or use that good. Public health, of course, is available to all. But, if too many take part in the health care system, than it is possible that it would mean reduced chances for others to get the same quality care. However, all in all, the argument can be made that public health is a public good, as it is available to all, and should be guaranteed that everyone has the right to good health.