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Do No Harm: A Defense of Markets in Healthcare

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Abstract

This paper argues that the rules that constitute a market protect autonomy and increase welfare in healthcare. Markets do the former through protecting rights to self-ownership and a cluster of rights that protect its exercise. Markets protect welfare by organizing and protecting trades. In contrast, prohibition destroys legitimate markets, giving rise to so-called black markets that harm both the autonomy and well-being of agents. For example, a fee-for-service medical system is a highly developed and specialized market. It is individuals working together, through the division of labor, to provide mutual insurance. This coordination, and the benefits it makes possible, is not possible without injunctions against harm. Prohibitions on harm are not mere ethical niceties, they are practice rules for both healthcare and markets. Placing the doctor within a healthcare market actually reinforces the doctor’s moral obligation, and the legal enforcement of that obligation, not to harm. Similarly, markets reinforce patient rights to self-determination through legal and institutional enforcement of the harm principle in the form of the protection of certain basic welfare rights to life, bodily integrity, property, trade, and contract. Since the establishment of markets protects agent autonomy and welfare, and prohibition directly harms the same, there are strong reasons for establishing markets to protect trade in precisely those areas where autonomy and well-being are most vulnerable to exploitation, for example, the trade in human kidneys.

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Notes

  1. It should be noted that Taylor (2005, p. 88) seems to refer to black markets as “unregulated” markets. Stefan Grzybowski in The Lancet makes a similar remark: “A black market is an illicit trading system that avoids government regulation” (2004, p. 28). The argument of this paper is that the reason these markets are unregulated is that prohibitions on trading remove all state protections and directly punish normal endogenous protections. For instance, no one is permitted to offer contract services or protections for kidney vendors today. Neither can there be independent rating agencies since it would be foolish to broadcast reputation in a banned market. These so-called markets are not unregulated; they are anti-regulated through prohibition.

  2. There is the very real question of “How much is enough?” However, similar questions seem to permeate all moral rights and duties. Do I always need to keep a promise? Can I do anything with my property? That questions of detail require constant attention does not militate against the existence of a duty. Markets, rather than just a simple trade, require some form of information disclosure, since the underlying purpose of a market is to organize and protect trades.

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Correspondence to William Kline.

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Kline, W. Do No Harm: A Defense of Markets in Healthcare. HEC Forum 22, 241–251 (2010). https://doi.org/10.1007/s10730-010-9140-7

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