The Pluralist Right to Health Care

Michael Da Silva is the Alex Trebek Post-Doctoral Fellow in Artificial Intelligence and Healthcare at the University of Ottawa.

Chapter 1: Introduction 
Health Rights: The Phenomenon and the Problem 
The Existing Literature 
The Current Project 

Part I: Conceptualizing and Measuring the Right to Health Care 

Chapter 2: Health Rights: A Taxonomy 
Introduction
Rights and Duties 
A Brief Taxonomy of Health Rights (and Health Rights Projects)
The Present Project’s Place in the Taxonomy
Problems Facing Existing Health Rights 
Conclusion 

Chapter 3: The Case for a Pluralist Conception of the Right to Health Care 
Introduction
A Pluralist Model is Necessary to Account for the Right’s Uncontroversial Features 
(a) The Goods Necessary for a Dignified Existence Jointly Constitute a Necessary Component of the Right to Health Care
(b) The Goods Necessary for a Dignified Existence Alone Do Not Capture All That Should Be Under the Right to Health Care 
(c) Procedural Fairness in Health Care Allocation is a Necessary Component of the Right to Health Care
(d) Procedural Fairness Alone Does Not Capture All That Should Be Under the Right to Health Care 
(e) A Functioning Health Care System is a Necessary Component of the Right to Health Care 
(f) A Functioning Health Care System Alone Does Not Capture All That Should Be Under the Right to Health Care
The Pluralist Model Has Further Advantages
The Pluralist Model Can Withstand (Other) Serious Criticisms One May Raise Against It
(a) Objection 1: The Minimum Floor Remains Subject to Problems Plaguing Any Attempt at Specifying Content 
(b) Objection 2: The Pluralist Model Cannot Identify a Traditional Right 
(c) Objection 3: Dignity Cannot Form the Basis of a Justiciable Right 
(d) Objection 4: Health Outcomes Should Be Primary
(e) Objection 5: Applying Constitutional Standards is Preferable 
Conclusion 

Chapter 4: The Pluralist Right to Health Care and International Human Rights Law 
Introduction 
Methodology 
The Core Components of the International Right to Health Reflect Concerns with Each Element of the Pluralist Right to Health Care and Instantiate the Pluralist Right 
(a) Universal Access to Health Care 
(b) Prioritization of Certain Goods and Peoples 
(c) Progressive Realization of Other Aspects of the Right 
(d) Modes of Domestic Implementation 
(e) Remedies 
(f) Improved Health Outcomes 
Conclusion

Appendix 1: A (Non-Exhaustive) List of Key Sources for Identifying the International Right to Health Care 

Chapter 5: Metrics for Realization of the Right to Health Care
Introduction
International Law and Empirical Metrics 
Metrics for Right to Health Care Realization 
(A) Health Care System/Policy Markers 
(B) Self-Defined Benchmarks and Indicators 
(C) Coverage of and Access to Essential Goods 
(D) Daniels and Sabin’s Fairness Markers 
(E) Rates of Access to the Goods Selected in the Process from (d) 
(F) Progressive Realization 
Dual Application of the Metrics 
Putting the Metrics to Work 
Objections and Replies 
(a) Objection 1: These Metrics Do Not Easily Map onto the Components of the Pluralist Right 
(b) Objection 2: No State Can or Should Be Expected to Score Well on All These Metrics
(c) Objection 3: These Metrics Break with An Important Development in International Law
(d) Objection 4: These Metrics Ignore the Perspective of Rights Holders 
Conclusion

Appendix 2: Metrics for Comparative Analysis of Right to Health Care Implementation

Part II: The Right to Health Care in Canada: A Case Study in Realization

Chapter 6: The Mainstream Canadian Health Care System and the Pluralist Right to Health Care
Introduction
An Introduction to the Canadian Health Care System
The Mainstream Canadian Health Care System Does Not Ensure Access to Many Goods Necessary for a Dignified Existence 
The Mainstream Canadian Health Care System Fulfills Some, But Not All, Aspects of Accountability for Reasonableness 
The Mainstream Canadian Health Care System Does Not Have All the Systemic Elements Demanded by the Pluralist Right to Health Care 
Canada’s Progressive Realization of the Right is Difficult to Assess and Substantive Progress Appears Minimal
Conclusion

Chapter 7: Vulnerable Populations in Canada and the Pluralist Right to Health Care
Introduction 
An Introduction to Two Vulnerable Population-Specific Programs: The IFHP and the NIHBP
The IFHP and NIHBP Fill Some Gaps in Essential Goods Coverage for Some Persons, but Barriers to Access Remain 
The IFHP and NIHBP Do Not Fulfill All Procedural Demands of the Pluralist Right to Health Care 
The IFHP and NIHBP Help Fill in Some Gaps in Canada’s Realization of the Systemic Component of the Pluralist Right to Health Care
The NIHBP is Gradually Progressively Realizing the Right 
The IFHP Required Multiple Interventions to Avoid Serious Deliberate Retrogression in Right to Health Care Realization 
Conclusion 

Chapter 8: Tools for Better Realizing the Pluralist Right to Health Care in Canada
Introduction 
Three Branches of Canadian Public Law
(a) Constitutional Law
(b) Human Rights Law
(c) Non-Human Rights-Based Administrative Law
Possible Legal Paths Forward
(a) Constitutional Law
(b) Human Rights Law
(b) Non-Human Rights-Based Administrative Law
Conclusion
Conclusion: Next Steps

Chapter 9: Concluding Thoughts and the Path(s) Forward
Introduction 
Summary
Directions for Future Research