PubMed · 8554999
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C Potrykus. Workface: downgrading.. https://pubmed.ncbi.nlm.nih.gov/8554999/
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This article is the last in a series on virtues and values in medicine and health care. Its point of departure relates to the heritage of the great French 1789 revolution. Equality in society is hardly attainable, but equity in health care, providing health care according to need rather than according to wealth, has been a highly valued aim for the post-war Norwegian health services. The political ideas of this development came from the socialist labour movement as well as from Christian ideas of charity, merging to form the institutions of the post-war welfare states. Fraternity, brotherhood, or in its modern version solidarity, is based on the very nature of man as a social being, but has also been a tool to create political power necessary to achieve equity. Mounting research evidence on inequality and health shows that what makes a difference to health is more a matter of people's relative income and status in society rather than their absolute material standard of living. The values of equity and solidarity are challenged by recent neo-liberalist and populist movements. Market models in the health services tend to turn health services into commodities and patients into consumers. This has implications for medicine beyond the financial impact. Utilitarian arguments tend to favour more user fees for medical services and drugs, the emergence of private services and health insurance, the result being a drift towards greater inequality in health and access to health services. However, recent research on value preferences suggests that issues related to equality are gaining support in several European countries.
The Americans With Disabilities Act (ADA) was widely hailed at the time of its enactment in 1990 as providing broad protection against disability discrimination, including discrimination against individuals infected with the human immunodeficiency virus (HIV). In the years since its enactment, however, courts frequently interpreted the ADA as providing far less protection than was initially anticipated. The Supreme Court's first case involving HIV and the acquired immunodeficiency syndrome, Bragdon v Abbott, addressed this trend by ruling that a woman with asymptomatic HIV infection is protected from discrimination in accessing dental services. In doing so, the Court endorsed an interpretation of the ADA that is broadly protective for individuals with disabilities. The Court also ruled that health care professionals may legally refuse to treat a patient because of concern that the patient poses a direct threat to safety only if there is an objective, scientific basis for concluding that the threat to safety is significant. In addition to the ADA, state laws frequently prohibit disability discrimination and apply to some employers and others not regulated by federal law. A state-by-state survey of those laws demonstrates that, consistent with Bragdon v Abbott, individuals with asymptomatic HIV have widespread protection on the state level.
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