Access To Public Health and Morality - Mayo Center for Innovation

Explaining Access to Care in the Context of Evolving Morals

Post Written By Elliott Wortham

We often explain our newly born enthusiasm for increased access to care with terms such as “new payment structures”, “consumerism,” and the “ACA.” However, it appears that our emphasis on access to care in the U.S. is nothing but a reaction to a change in how we make moral decisions. As one of my favorite theorists, Donald Black, argues, our morals change over time due to fluctuations in social relationships, both of which have and will continue to shift.

In the United States, we have traditionally demanded the moral right to privacy and the right to opportunity. This means that we often avoid questioning our right to accumulate and enjoy more than others, including examining people’s ability to have better access to care than those less fortunate. One reason for our proficiency in perpetuating inequality is the existence of emotional barriers between ourselves and those who may not be like us, limiting our capacity to care for all.

As time passes, we are gaining more exposure, predominantly through the facilitation of technology, to the suffering of others no matter their location or social distance from us. We have created what media theorist Marshall McLuhan calls a “global village” and developed new types of closeness, which Donald Black terms “self-closeness” and “global closeness.” We all know self-closeness well because most of us ask questions like “I don’t know who I am” or “I worry too much.” Subsequently, Black claims this brings about a "right" for everyone to deserve a feeling of well-being, and a duty to pursue and protect their own happiness. As we become more connected to the rest of the world (global closeness), this “right,” among many others, becomes boundless. This surely includes obtaining access to care, such as mental healthcare.

Morality is moving slowly away from a right to privacy (with technology, we seemingly don’t have much of this anymore) and opportunity to a right to happiness and right to rights – think gay rights, global human rights, and animal rights. The healthcare system is trying to grapple with access to care, much like the rest of the society is grappling with an increasingly connected world where people are close to everyone and every conflict is "their" conflict. The healthcare system must, like it is desperately trying to do, determine what access really means and expand how we care for others given a new moral imperative to do so.

Link to Moral Time by Donald Black: Click Here

Link to Marshall McLuhan’s theory of the global village: Click Here