Love and Justice in Health Care and Public Health
Part 1 of this article outlined a Christian moral perspective that helps us see how private individuals and institutions as well as public servants and governments are loving us in the midst of this pandemic. I argued that love and justice form the core of the moral life for Christians and non-Christians, and we observed that love and justice are intertwined, that love incorporates seeking justice, but that love calls us to go beyond justice (that is, beyond what is due another person). We also saw that love and justice are properly ordered from the bottom up, from the particularity of close relationships up to the universality of all including those remote from us.
Part 2 builds on this discussion of the duties of love and justice, sketching an analytical framework for thinking about health care and public health during this emergency.
1. Building up from Particular Loves
This discussion of love and justice counsels us to start with our particular loves of self, spouses, children, parents, siblings, near neighbors in our communities, and Christian brothers and sisters in our faith communities and then build up to universal love. Our particular loves, loyalties, and obligations are fundamental aspects of our creaturely condition as personal beings created in God’s image and situated providentially in time and place. Because justice is included in love, this discussion also counsels us to similarly prioritize our pursuit of justice by starting with closer relationships and then building up to justice concerns more broadly.
During this health emergency, our focus is understandably on our particular loves, and keeping ourselves and our families at home protects us, our families, and our near neighbors. Likewise, health care is provided within the context of particular loves and justice, as individual patients receive diagnostic and therapeutic services from individual and institutional providers within their local communities. Likewise, with public health, which involves government efforts to control and prevent diseases and to promote the health of populations, efforts begin with local populations and build up to broader populations. The local character of health care and public health becomes evident when a member of a community contracts the coronavirus. The patient receives care from local individual and institutional health care providers who report the case of infectious disease through the surveillance system to local and state public health authorities who are monitoring cases in particular populations.
2. Ensuring Justice in Love
This discussion of love and justice invites us to see how individuals, organizations, and civil governments promote neighbor love by ensuring justice in interpersonal relations. The laws that governments make help to define justice in relationships among individuals and organizations and secure justice by prohibiting and penalizing wrongful conduct and defining rights and obligations, and we can see this in both health care law and public health law. Health care law concerns the financing, organization, and delivery of medical services to patients, and it is composed of state contract law, tort law, health insurance law, organizational law, and antidiscrimination law as well as some federal laws such as the Medicare and Medicaid laws, the Emergency Medical Treatment and Active Labor Act, and antidiscrimination laws. Public health law is composed of a wide range of state and federal laws that are aimed at preserving the public’s health by controlling and preventing infectious diseases, ensuring safe food and water, and safely disposing of waste. These laws structure relationships between providers and patients, between employers and employees, and among citizens, and they define the duties that are owed.
Health care providers, public health authorities, and government officials at every level are responding to a pandemic, which is the highest level of global health emergency.[1] As our local, state, and government officials take legally authorized action to limit the spread of infection by restricting travel, ordering businesses and schools to temporarily close and churches to temporarily abstain from meeting in large numbers, and directing people to stay at home, civil government is loving us and our neighbors by prohibiting harmful conduct, protecting individuals and communities, and thereby ensuring justice. The federal government is also taking unprecedented action to safeguard the stability of American health care institutions by ensuring that the poor and the uninsured as well as the insured can receive medical care at hospitals. Even while taking these actions, government must act justly by treating citizens and organizations equally and observing their rightful claims, being mindful that justice requires all (including governments) to respect and give to each his due. Likewise, businesses and other organizations must carefully consider what justice requires of them in their contractual relationships with employees and other businesses, and individual and institutional health care providers must consider what justice requires as they care for patients.
3. Showing Love Beyond Justice
This discussion of love and justice also invites us to see how individuals and organizations are loving others in close relationships and in more remote relationships in ways that go beyond justice. Even as the coronavirus spreads and communities experience severe outbreaks, individuals and organizations are responding with love that exceeds the requirements of justice. Grocery stores are staying open, and workers are stocking shelves and checking out customers. Trucking companies and truckers are delivering food and other necessary goods to stores. Churches are meeting food and other needs within their communities. Individuals and organizations are scrambling to produce gowns, masks, face shields, and ventilators, hurrying to identify effective therapies, and providing meals and lodging to health care workers. Health care providers are leaving their home communities and travelling to hotspots to provide care. Samaritan’s Purse has set up and is running emergency medical facilities in Italy and New York City. In these instance, people individually and through organizations are lovingly serving neighbors and even imperiling their own health and lives while serving.
Although ensuring justice is the primary concern of civil government, our local, state, and federal governments are also loving us in ways that exceed the demands of justice. For instance, public school administrators, staff, and teachers are helping to distribute food to students and families in need, and they are creatively conveying messages of hope and encouragement within their communities. Police officers are helping to deliver food and other necessities to homes and even buying groceries for needy families. Local governments in Florida agreed to cruise ships docking and sick passengers disembarking, even though that decision created health risks. Additionally, the United States government is giving financial aid to needy countries and leading the international humanitarian and health response to the pandemic.
Come back next week for part 3 of this series.
[1] The term “pandemic” indicates a scale of infectious disease spread that is wider than an outbreak and an epidemic. It is an epidemic of infectious disease that has spread over several countries or continents that is affecting a large number of people and causing significant economic, social, and political disruption. An “outbreak” is a small but noticeable increase in the number of cases of illness over the expected number during a defined period of time in a particular place in a particular population. An “epidemic” is an infectious disease outbreak over a larger area, and it represents a greater increase in the number of cases above what is normally expected in a population in a geographical area.
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