Fourteenth Amendment and Health Care
The Fourteenth Amendment's Equal Protection Clause prohibits states from denying "the equal protection of the laws." Cases like Jacobson v. Massachusetts, Washington v. Harper, and Cruzan v. Director, Missouri Department of Health, demonstrate its application in health care.
Jacobson v. Massachusetts addressed mandatory smallpox vaccinations. The Court emphasized the state's priority in preventing disease spread over individual rights.
Washington v. Harper examined inmates' right to refuse antipsychotic medication. The Court supported the prison's forced medication policy, highlighting the state's duty to maintain safety in correctional facilities.
Cruzan v. Director, Missouri Department of Health involved withdrawing life support from a woman in a vegetative state. The Court upheld Missouri's strict evidence requirement for stopping care, emphasizing the state's interest in preserving life.
These cases showcase the state's ability to prioritize certain public health concerns over individual rights. The Equal Protection Clause provides a framework, but the state's interpretation holds significant power against individual autonomy in health care decisions.
Constitutional Explicit Rights and Health Care
The U.S. Constitution does not explicitly mention or endorse a right to health or medical care. The original Constitution and Bill of Rights mainly protect individual liberties from government interference rather than guaranteeing specific entitlements like health care.
Efforts to incorporate health care rights into constitutional discourse have occurred:
- President Franklin D. Roosevelt's proposed "Second Bill of Rights" in 1944 aimed to expand fundamental protections, including a right to "adequate medical care."
- More recently, Representative Jesse L. Jackson Jr. introduced a proposal for a constitutional amendment ensuring a right to health care.
Both proposals failed to gain necessary support.
The framers created a document focused on limiting government powers rather than mandating government-provided services. This design restricts the direct applicability of constitutional arguments favoring a universal right to health care. Cases and policies must work within the existing framework, often leaving considerable room for state discretion and legislative specificity.
Implied Rights and Access to Health Care
Certain Supreme Court rulings have established nuanced understandings of privacy and bodily integrity that implicitly address health care services. However, these implied rights do not obligate the government to provide financial support for exercising these rights.
In Maher v. Roe, the Court upheld Connecticut's decision not to publicly finance non-therapeutic abortions. Similarly, in Harris v. McRae, the Court upheld restrictions on federal funding for abortions under the Hyde Amendment.
These rulings suggest that while the implied rights doctrine can protect individual choices and privacy in health care, it does not extend to requiring taxpayers to bear the financial burden. The Court distinguishes between protecting rights and upholding government-funded entitlements, reinforcing that the framers' primary goal was to limit government overreach rather than extending its mandatory provision of services.
The landscape of health care access and rights remains a complex interaction of constitutional interpretation, legislative action, and judicial precedent. While personal autonomy in health matters is affirmed, public funding for these choices occupies a distinct and often contentious area.
Health Care Legislation and Congressional Powers
The constitutional basis for Congressional health care legislation stems from the broad authority granted by Article I, Section 8 of the U.S. Constitution. This section empowers Congress to tax and spend for the general welfare and enact necessary and proper laws.
United States v. Doremus affirmed Congressional authority under the taxing power. Steward Machine Co. v. Davis established the constitutional legitimacy of Congress's power to tax and spend for public welfare by upholding the Social Security Act.
The Patient Protection and Affordable Care Act (ACA) brought these powers into focus. In National Federation of Independent Business (NFIB) v. Sebelius, the Supreme Court:
- Upheld the individual mandate as a valid exercise of Congress's taxing authority
- Struck down the ACA's Medicaid expansion provision as unconstitutionally coercive
These cases highlight the Constitutional foundation for Congress's legislative authority in health care, demonstrating the balance between federal imperatives and state prerogatives.
Human Rights and Health Care
International human rights instruments like the International Covenant on Economic, Social and Cultural Rights (ICESCR) and the World Health Organization (WHO) Constitution recognize health as a fundamental right. However, the U.S. has not ratified the ICESCR, and WHO's vision involves voluntary commitments rather than binding legal obligations.
The U.S. federal structure complicates the uniform application of international human rights standards. State-level autonomy often dictates the variability in health care access and quality, leading to significant disparities.
"From its founding the Nation's basic commitment has been to foster the dignity and well-being of all persons within its borders. … Welfare, by meeting the basic demands of subsistence, can help bring within the reach of the poor the same opportunities that are available to others to participate meaningfully in the life of the community."
The U.S.'s approach to health care, intertwined with constitutional interpretations and legislative pragmatism, continually grapples with the broader human rights mandates articulated by international bodies. The challenge remains for the U.S. to reconcile its foundational emphasis on limiting government reach with the expanding global discourse on health as a universal right.
The interplay between individual rights and state interests in health care remains a complex issue. The balance often tilts in favor of state priorities, particularly when public health, safety, and life preservation are at stake.
- U.S. Const. amend. XIV, § 1.
- Jacobson v. Massachusetts, 197 U.S. 11 (1905).
- Washington v. Harper, 494 U.S. 210 (1990).
- Cruzan v. Director, Missouri Department of Health, 497 U.S. 261 (1990).
- Maher v. Roe, 432 U.S. 464 (1977).
- Harris v. McRae, 448 U.S. 297 (1980).
- United States v. Doremus, 249 U.S. 86 (1919).
- Steward Machine Co. v. Davis, 301 U.S. 548 (1937).
- National Federation of Independent Business v. Sebelius, 567 U.S. 519 (2012).
- Goldberg v. Kelly, 397 U.S. 254 (1970).