Healthcare without Dignity

A year ago one of the world's strictest lockdowns was imposed in India. As the pandemic spread we saw the inadequacy of our healthcare system: the dilapidated infrastructure, underserved medical professionals and the underprovision of accessible, affordable healthcare.

We watched the plight of the poor and disprivileged, of the rich and privileged. Our healthcare system failed most of us. The ambiguity over immunity, the uncertain risk of several variants, and the still unclear rate of infections and deaths in the monsoon season show that this public health crisis is far from over for Indians.

It is apparent now that health and healthcare practices do not merely deal with patients but that which is fundamentally emotional, political, social and human. The relation of health to the society we are in defines our right to health, and lays bare the principle of dignity.

Our right to good health and healthcare exists independent of the market, and possesses an emancipatory connection to our right to life with dignity, guaranteed to every human being.

The pandemic has created conditions for us to ask fundamental questions.

Can our autonomy as individuals remain independent of our health?

If we must constantly worry about buying health, can we practise the freedom and fulfil the dreams we aspire to in the 21st century?

Is the development of this country possible if the primary need of its people’s health is not accounted for?

Healthcare practice needs to be organised around a central principle of value assigned to the health of each individual. Some argue that this central value should be dignity: the inherent self-worth of an individual, and respect of this self-worth by other people. This definition of dignity comes down to us from Immanuel Kant. Dignity also is understood as a status concept, where a person’s dignity is associated to their standing determined by society.

For now we will stick to the former definition of dignity, which is a value based definition that has laid the ground for egalitarianism, and through it understand the current social affairs surrounding health.

With the onset of the pandemic, we discovered new and rediscovered existing states, scales and forms of indignities. We witnessed the social and medical ostracising of people infected with COVID19, or those treating them, the witchhunt of members of the Tablighi Jamaat in April last year, and the ill-treatment of people (especially migrant workers in the cities) on the streets and inside quarantine facilities.

School shutdowns meant the suspension of midday meals for children. For some of our children it was a two-fold deprivation and loss of dignity, of education and of nourishment.

The challenge of seeking dignity both in public and in private brought me to the preamble to the Indian Constitution, which guarantees dignity to each individual. In the absence of care offered by our parliamentary government, recourse to the Constitution for autonomy and dignified existence was also witnessed earlier during the anti-CAA movement of 2019–2020.

In order to understand the apathy of the current healthcare system towards our dignity, we can look at some judgments of the Supreme Court. Indian legal jurisprudence treats dignity as the normative ground for constitutional rights, and in its 1981 judgment in Francis Coralie Mullin it expands the right to life to include the right to life with human dignity.

This reference to jurisprudence to understand the social and material reality of our healthcare system cannot be seen as an outside perspective. Public health and public health crisis are a sociological matter, where the concerns of society as a whole are at stake.

At the same time it brings forth the need to consider the image of an individual carved out by jurisprudence of rights. As in the historic judicial interpretations of 2011 in Aruna Ramchandra Shanbaug, the Supreme Judgment states that the right to health includes the right to good quality of life up to death, and the right to quality and peaceful dying.

Or in 2018, when in Common Cause vs Union of India the court elaborated that the sanctity of life, right of self­-determination, and dignity of an individual are to be maintained, and that our right to health encompasses the right to refuse invasive medical treatment, and the right to a living will.

A public health crisis if not addressed with diligence and care is a crisis of our rights and dignity. This pandemic reminds us of the existing challenges to our health care system. Hence I take this opportunity and treat this space as a public space for bringing back old discussions concerning people.

Health cannot continue to be a privilege bought by a few. Our intrinsic worth as people can only be acknowledged when the state alleviates the distress caused by our current system of healthcare.

Only an egalitarian conception of health, which is to make health a public good and the healthcare system public can achieve this. Universal health coverage, and the integration of preventive care, treatment, rehabilitative and palliative care is necessary for our dignity. Only in achieving this can a new mode of autonomy be found.

Monica Yadav did a masters in development studies from TISS and is currently a PhD scholar of theatre and performance studies at JNU, and a fellow with Pallium India.