Remedying right of the people
Chapter 1 Positioning of Problems
Section 1 Necessity of the theoretical activities over "the right of Patients"
Section 2 Key idea is remedying rights
Chapter 2 The remedying rights
Section 1 Submission of general idea of " remedying"
Section 2 Submission of "the remedying rights"
Section 3 Setting up the idea of remedying rights
Section 4 Impliments of securing of the remedying rights
Section 5 How should we grasp the thought of "freedom of remedying"?
Section 6 Submission of "the rights for receiving medical services"
Chapter 3 The treatment rights
Section 1 treatment authority and the treatment rights
Section 2 "Freedom of treatment"
Section 3 "Freedom of treatment" and the "Medical ethics"
Section 4 Conquest of the medical holiness theory
Section 5 From "freedom of treatment" to the treatment rights
Chapter 1 Positioning the Problems
Section 1 Necessity of the theoretical activities over "the right of Patients"
A sudden change of population structure is progressing along with progress of "the socialization of life". Public opinion on medical care is changing extensively now. Changes are not limited to medical care. It may be said that the should-being of public services, including social welfare or education, is asked fundamentally. It may be said that such an unprecedented social change forms the root of the problem.
However, it was never the sole reason why contradiction around medical care intensifies. Rather, the main reason is due to large-scale reactionary offensive targetting for public service. The logic of market economy has been brought into local governments and public corporations directly. And now, it becomes one of the greatest tasks for the ruling layer, to cut off social security for senior citizen.
Against people hoping for substantiality still more of public service, they would worsen the not enough current security system more. Therefore, this attack cannot but go with ideological deceptions either. Thus the lines of Ad Hoc Commission on Administrative Reform are started as ideology attacks. It will become a focus of confrontation of thought increasingly, whether to deny demands of people as "the Rights".
For us, the fighting medical worker, in order to resist off the reaction offensive, and to develop the movements to keep life and living, there is the reason why the meaning of "keeping right of patients" is asked repeatedly now.
We are necessitated to search thoroughly in the core nature of this rights theoretically under the new situation. Because, when it is argued with traditional view for patients, human rights, medical care, or medical technology, we would be very hard to discover the secret aim hidden in the current ideological offensive.
And because, in the fields of more concrete medical practice, medical care and connection of the welfare, we would be hard to grasp the tasks such as breakthrough of medical management difficulty, or solidarity between medical care and social workers, connecting with the thoughts of "good medicine"
Section 2 The remedying rights is the key general idea
In order to develop the medical exercise theory that balanced with the stage of struggles, I think it is necessary to review from the broader viewpoint that of each citizen's living activities and of social services corresponding to them.
It seems that there is a limit when we argue within the frame of the existing medical insurance system and supply system, even to say, the frame of "medical care" vs "patient".
In this article, I would like to use the word "the sick" instead of "patient", in order to grasp peopleal group of patients with broader category including their living process.
In addition, I want to express the living process of the sick as "remedying", including activities out of the places of medical care.
And I want to regard the attack that is submitted to medical care now, as hostility to "the remedying rights of people" first of all.
Furthermore, I want to grasp various fights as one part of the fight of more positive and richer realization of "the remedying rights of people" instead to cry "keep rights!" merely.
Chapter 2 The remedying rights
Section 1 Submission of idea of " remedying"
The rights to live just as human beings during sickness. The rights to utilize medical services to realize the above rights. They are the rights of people proved in the Article 25 of the Constitution.
I call them "the remedying rights" and "the rights to access" here.
The remedying rights do not remain in the framework of the rights to live. It is the human rights connecting indivisibly with the rights to grow one's ability, to live independently, to realize one's dignity, and to taste one's joy of working (that is proved in Article 26 and 27).
The word "remedying" means the process to reproduct one's every day life, while struggling against illness, regaining one's health, or praying for healthy recovery.
Here, those whom I say the sick are people who are ill either acutely or chronicaly, and are treating theirselves in various manners. If the sick has a checkup with a medical institution, the sick will become a patient. The former is expressed as a disease rate by public welfare statistics. The latter is shown as checkup rate.
In a process of remedying activity, all kinds of public or personal service including medical care are used as the means. However, remedying activity itself does neither confine only to receive benefits of service nor absorbed into process of medical practice.
Once, the process that the sick heals own illness and regain one's health, was thought as a purely personal matter outside social system. The remedying was "quite free practice" within those limits. However, that freedom meant merely enduring or depending on a doubtful folk remedy. The freedom has the same meaning as "freedom for dying" for the person without money.
As the refusal for such a "freedom" and as the demand for social fairness, it is natural that the fight to demand the rights to access spreads.
However, even if it is assumed that the rights to access came true anyhow, as soon as put into the situation of treatment once, it would be discouraged. The sick could not but be put for completely passive existence, when they received treatment at once.
With changes of recent technical development and patient / illness structure, the mode of treatment has changed, and a medical field to premise initiative of a patient became magnify greatly. remedying activity became to be thought as one of social activities developed under one's independent judgment, while receiving instructions and order demanded from the side of medical persons as the premise of activity.
The systematic recognition and secure of such an activity becomes the core idea of the remedying rights.
Section 2 Proposal of "the remedying rights"
(1) A category of the remedying rights
To approve the remedying rights is to approve and support socially that the sick themselves are the free subject of remedying activity.
remedying activity includes multilayal contents. It is the activity that a person intends to cure illness based on one's independent will. It is also an activity to realize return and adaptation to society, and is the activity that a person will realize himself more wealthily in the process.
The process is the living process which had an aim in itself. It is not only a return to a state before illness. The remedying rights are remedying living rights. Even if it takes into account for "freedom of a remedying" in the base, it does not confine the idea of freedom as a general.
If we use the word of "freedom" daringly, it should be understood as the freedom with which each indivisuals make efforts to realize themselves at their best, while they premise the preconditons for their activities.
(2) A premise of the remedying rights
Security of the remedying rights puts together with security of right to being / living rights for healthy people indivisibly. Living rights are compound rights, which should be reexamined in the frame of the basic culture / living right. It is an essential premise for security of the remedying rights of the sick that the being / living rights would be got for all nation.
The right of the sick is to be a right for the social weak. So long as it is recognized and supported by the society general, it cannot become a really effective right.
When we watch it historically, it came true for the first time, after a lot of citizens around the sick fought as their own demand.
Substantial contents of the remedying rights are defined compulsorily, by the standard of social mutual agreement of the time, and by the standard of fight in general of the time in its turn.
The remedying rights can also be explained from "freedom and the happiness pursuiting right" of Article 13 of Constitution. However, from the reason that I have told as above, the remedying rights should be thought as that have been formed as a class / collective right.
Section 3 Time setting of the remedying rights
(1) Changes of society and of illness constitution
In the background where a thought of the remedying rights became important, there is "nationalization" of geriatric diseases. Now, the situation is general that the sick continue his life as a member of society while having any chronic diseases. remedying life strengthen character of life as a member of society while suffering illness, rather than the days of fight against illness separated by society.
Demands relating remedying are not special ones. They become to be feeled hard to separate with a general life demands. The sick is an independent subject in another scene of life. He is prepared his realistic base with which he can demand legitimate relation as an independent person for both the state and medical institutions.
Another big social change in the recent medical care / welfare is characterised as "aging society." Elder people are the social weak alike that the most are the sick. The sick is often lost independence also, and needs the conservation. Thus there are characteristics of senior generation problem in the unifying difficulties of remedying and of living.
Through these cases, it occurs necessity that families as the conservation subject and citizens are united with the sick to demand and realize the true remedying rights. There is the inevitability that the remedying rights are told as one of living rights, and life demands are pushed out in the form of insistence of the remedying rights.
(2) Characteristics of remedying demands
There is one more charasteristic in these movements. It is that the sick / family / citizen demands not only the right to receive treatment generally, but also demand concretely concerned with the remedying rights itself.
Although the exercise itself has still a lot of contradiction in its contents. However, if we watch the movement developmentally, we can see a big change to relate in the essence of a remedying there.
Till now, the patient or the citizen have been only the objects of enlightenment for the state or medical institutions. They appeared as the subject who should bear responsibility in their own remedying now. They play as sovereign for various service and security. And they are going through to institutionalize remedying rights as definitive one of human rights.
We do not only welcome this movement, but should be armored theoretically ahead of it, and orientate the direction of it positively.
Section 4 Contents of securing for the remedying rights
The remedying rights are legal and social approval of the demand of the sick. The approval should not remain to regard the remedying as a radical rights for human being. Because the right is concrete as like the demands are concrete.
Demands of the sick can be devided as follows
1. Demands which is common with citizen in general as a living person
2. Demands of being characteristic as the sick in general
3. Demands of the individual sick owing to the kind and the grade of his illness.
(1) General demands as a human being of the sick.
In other words, it is demands to found a definite aim by daily life, and to spend days fitting as a human being even if during illness, (living / being demands)
(2) Specialistic demands as the sick.
This is divided into two subdemands which bear contradiction in itself.
A) Demands to a condition / environment to be fit for the days of fight against illness (protection demands)
B) Demands to know about illness, to accept it, to become the subject of remedying, and to practice due to his own remedying policy (independence demands)
(3) Demands of the each individual sick.
In other words, demands to recover from illness, and to become healthy (healing demands)
It differs by degree of healing / independence, which demands come forwards among them. What we should pay attention, is that all these demands are contained within the sick in either stage. We should grasp precisely which demands is actualized concretely. And also, we should react with taking into account that demands of the sick are originally overall. These are duties imposed on us.
By the way, from the viewpoint of medical practice, to realize the remedying rights is not equal to accept all the "an Sich" demands of the sick. Of course it is nor to put all under conservation / management of medical persons.
What we must do is to support and instruct them, so that the sick recognizes the disease, controls himself as a sick, and accepts various limits demanded in medical care voluntarily. It is the support for "getting independent from support."
As the sick becomes independent, contents of demand grow more wealthy. It is not confined to protection demands only. It is the subjective reflection of his life situation which is changing with progress of a remedying process. It is important that we should confirm that there are some aims worth for living and wish to self-realization in the root of the demands.
Section 5 How to grasp the category of "freedom of a remedying"
In the remedying rights includes the right to run a remedying without a limit, in other words, "freedom of a remedying".
As mentioned at Section 1, the fight around medical care and social security has not let the freedom end in only declaration, but has been the fight to win as the real fact.
Also "freedom of a remedying" has the side of concrete "freedom", too. There includes the right to select and decide his own remedying policy freely, the right to select the medical institution to check up freely, and so on.
When we think about "freedom of remedying", there are some points to be clear as the basic viewpoint.
In the first
"Freedom of remedying" is the idea of origin to develop to the remedying rights. However it forms only a part of this right judging from our reforming viewpoint, how will realize the the remedying rights whole. "Freedom of remedying" remains in a limit of freedom of a citizen basically.
The remedying rights demand total flowering and total display of ability. It is the right, so to say, to open to the future. It contains a kind of protest to whom lead human beings to teratorial development, and leave them as means of capital reproduction.
The thought to respect the right ofo the sick, cannot explain from the "equality on the basis of a free treatment contract." Respect for the rights of the sick has its root in grasping the sick as the social weak.
Fundamentally, it comes from thought of social jointness, which thinks that the human rights of the sick must be secured completely just because they are the social weak.
It is not "negative freedom" for him to refuse limits added by medical persons. "Freedom of remedying" is freedom toward freedom of a human being. It is active and autonomous freedom demanded for accomplishment of remedying activity.
The contents or method of the whole living activities of remedying is what he no others decides by himself under his responsibility. If he entrusted this to other people, it cannot expect effective activity.
When we argue "freedom of remedying", we should not depart from the idea that seems to be opposed to "freedom of treatment" to describe later. The latter is freedom to originate from the remedying rights fundamentally, that should be overlapped with "freedom of remedying". It is the rights which people must protect equally, as like as "the freedom of remedying"
Efforts are seeked that will let two freedom be substantially equal while keeping freedom of remedying. At least, administrative regulation is not desirable.
It is the results which the whole nation have won historically. It is the freedom that should be enjoyed collectively. If we reduced all to its elements in an each person's problem like "right as customer" of a patient. remedying will become quite a "private affair." The remedying rights will become a mere "private right." Therefore, the viewpoint like to manage and control the medical system in the social process of community, will be neglected.
The relationship between remedying rights and "freedom of remedying" will come to the conclusion that universality and indivisuality of remedying activity / medical care practice is the profound theoretical problem. That is the basic thesis of class struggle. The work to solve this relation theoretically will become more important in future.
Section 6 Submission of "the rights to access"
When the sick are frontated with a various institution / system as a patient, remedying right is characterised as a right to receive treatment namely the rights to access. In Min-Iren, it is often expressed as "a right to become a patient."
What I will want to emphasize here is that we should not limit the remedying rights to the rights to access.
For the first,
The remedying rights is the right of the whole human being, however, right to receive service itself remains in " right in passive fashon." The remedying rights must be pushed out as an active right above all.
Even if we criticise government from a viewpoint of the rights to access, it remains in protest for a right infringement. It cannot become an appeal to lead to the prospects to culture / right to live.
It cannot explain the subjective and positive activity of medical persons only with the rights to access. The logics how medical persons can be subjective, is explained well for the first time when they are positioned as one of the essential component for peopleal remedying rights.
It does not become a slogan to promote the concentration to a national unified front aiming at the true community realization.
The rights to access demand systems to guarantee the remedying rights as a condition. It is positioned as one of the social rights. "Equal chance to access" is it's important pillar.
Therefore, the rights to access must be understood in relation with the state basically, while the personal medical supply system exist among it.
As for the security of the rights to access, the entirety of social mechanisms is responsible. The entirety means the whole nation principally. They are the state or the local governments institutionally. And they are various administratives / services concretely, including medical care to guarantee the rights to access.
At the same time, the security of the rights to accesss is not confined to mere system security. For wellfared realization of the remedying rights, solidarity of citizens including family and medical persons around the sick becomes the absolute condition.
Idea of "the rights to access" is also multilayal. First of all, it is social approval of demands to receive good medical care, or at least proper medical care. It is demands of realization of justice, equality, and fairness against society .
Today, the rights to access in Japan seems to realize equality by the universal care system. However, unfortunately, the situation which is hard to call equal moves in the indivisual spot of real life. For example, the livelihood protection, household, medical care for handicapped person, living alone / bedridden elderly person, fatherless families, and so on. Border domain problems between medical care and socail welfare pile up, and pressed for solution. Therefore, it is the reality that we must still insist on "equal chance for access" loudly.
However, even if there is such reality, it will be one sided judgement, when we grasp the access right only from the institutional side. The slogan of "Kind and good medical care at any time or anywhere!" is very important. However if it is limitted to "anywhere or any time" virtually, it is confined to point out poverty of a medical system.
To access the medical institution, is also the act to entrust with them. remedying is his own subjective activity. treatment by medical persons is the means of his own activity.
In other words, they have rights to hope and demand "to have a good medical care with good efforts" of medical persons. It comes down to medical persons as a kind of duty.
We should not let the rights to access remain in a problem on a system merely, but we should raise as another problem that guarantee the rights also in quality. For that purpose, it cannot avoid that medical persons change themselves in their quality with reference to total realization of the right to access.
The sicks are going to send life with a definite aim with a way to be fit for each, while bearing the various limitation. The medical care should respect those kind of process, and understood one by one step. Such medical care is necessary now. We should understood "good medical care at any time or anywhere!" in such context.
Chapter 3 The treatment rights
The treatment rights are based on two different principles, one is treatment authority and another is autonomy of a medical worker.
Section 1 treatment authority and the treatment rights
treatment authority occurs as one part of administration authority of state. The state has duty that it creates and manages all kinds of system for the the remedying rights conservation. Authority occurs by and within this limit. It is medical administrative power, and this is not the medical care right.
As a part of the authority, what is assumed execution authority of treatment or administration authority of a medical institution is given for medical persons. It is authority prescribed as various kinds of license.
The treatment rights of that situation is authority limited the range and power. Administration is theoretically recognized as expression of intention of community. The people's community bear responsibility for the conservation of the right of the sick directly, cooperating with medical persons.
At the same time, they act as sovereign to reflect the collective right in administrative policy. Administrative authority is originally effective because it derives from collective intention of this sovereign group.
Although it is not an administrative real figure. It is it only as a possible form which can be changed in reality by our practice.
Actually, administration is breaking its original limitation and making itself in one power. There is even the danger that they may limit or interfere the right of the sick.
In other sides, the state is carrying through the intention to evade duties around the the remedying rights conservation so long as it can be possible.
Section 2 "Freedom of treatment"
In medical employment, large autonomy is guaranteed in treatment act, originating from specialty of the duty.
Social approval of the manner that is to obey only conscience of self, to remove interference from circumference for accomplishment of the duty determinedly, and to make diagnosis and treatment, forms a general idea of "freedom of treatment."
In addition to treatment authority, the treatment rights keeps such a thought of autonomy for medical employment. Autonomy of employment is expressed as "professional freedom."
Autonomy of employment is prescribed in the scientific nature that the field of each specialty has, which is not controlled by situation.
Therefore, to support autonomy of specialist is meant to protect the scientific truth and common value of mankind determinedly. Autonomy of medical specialist is expressed as "freedom of treatment." Professionality of medical specialist request for it, in relation with essence of a medical process.
By the way, in traditional way of thinking, "freedom of treatment" is principally freedom to relate to social position of a doctor. It is basic idea of medical persons to do meeting demands of anybody without asking whether the patient is rich or poor.
In order to carry out this principle, doctors must not be subordinate to power of the time, and be independent and free overall.
This thought is also reflection of personalism of propertied bourgeoisie, who thought it natural to access to medical care freely at any time or any place, but if he only has money. Interference or limit to medical care by monarch or church are absolutely unwelcome there.
Historically reviewing, it is sure that "freedom of treatment" has had the side of resistance of medical specialist for interference of a nation. However, it is the principle of solitarism which eliminates control by a citizen in another hand.
If "Freedom of treatment" is positioned only as grounds to insist on freedom from power, and if doctors neglect their duty to the sick which is the background of freedom, this insistence becomes powerless.
In fact, the medical association conservatives use "freedom of treatment" as the pronoun of flunkyism "let them depend, not let them know"
The things are clear now. Traditional idea of "freedom of treatment" should bear half of responsibility about the tendensy that contradictory feelings around medical care spread between people.
The sick and people begin to feel that they should understand properly when they must treat, and should let the medical persons work tightly.
However, still on the other side, they feel the uneasiness that if medical persons is completely free from the social constant, they would suffer self-centered medical care.
Historically, the government thought that such a contradictory consciousness is a condition to be profitable to control medical services.
Now, when people / the sick / medical persons ties up and is going to stand up, more positive consensus of people becomes necessary about a general idea of "freedom of treatment".
Section 3 "Freedom of treatment" and "medical ethics"
"Freedom of treatment" is different from treatment authority. It has no essential limitation. Medical persons selects a remedying plan considered to be the best for a patient. It is related in internal freedom of medical specialist.
In relation of individual remedying with the sick, freedom of treatment is the same as freedom to infringe the body of patients in necessary limit, and thus to infringe the freedom of patients virtually.
Why such an infringement to freedom is accepted to patients? How that becomes supported positively? Those are the things to be questioned here. At this point, "freedom of treatment" and "an ethic of medicine" are in one and indivisible relation.
Of course it needs very stern ethics on receiving life. Recently we saw many episodes to think about medical ethics related with medical accident, intrahospital infection, and furthermore, internal organ transplant or cerebral death estimation.
Most of them are discussed in a negative meaning, as the line which medicine must not step over.
Ethics in medical care can be emphasized as "the holy ministry theory." Medical work may say "the holy ministry" if we watch them at viewpoint of specialist. At least I think we are good proudly in our mind.
However, so long as we remain in there, we cannot overcome "the holy ministry theory" as an ideology that force medical care on the sick as "a benefit", and force low wage, hard labor with no labor rights to medical worker.
Section 4 Conquest of the medical ministry theory
Simaltaneously as the sick will become "the life person who carried illness on its back" increasingly, medical persons is changing their character for the rank in working people rapidly. Now the sick and medical persons are forming relation as "living person / wage earner".
A new style of medeical ethics is emerging that is to look the sick as companion bearing illness, and to cope according to "the logic of a solidarity". This new ethics is bringing the collective active autonomy that is not limited to "freedom of treatment" tradition.
These changes appeared during these 30 years that had dramatic changes of the economic structure from the personal medical practitioner system to the hospital center modeled medical care.
It has not been a lone doctor and a few nurses who support medical care. The majority of young doctors became to work in hospitals, and strengthen collective consciousness as a wage earner. It became a team consisting of the many types of medical stuffs around doctors, that supports the real treatment place. I may well be called as a medical worker group.
On the other side, "Freedom" is taken away from medical workers under attack from the ruling layer day by day. Demands to "do good medical care" is extremely cut down, and width of choice is getting narrow.
It becomes a more and more important imminent problem to fight demanding conscientious "freedom of treatment" that is not tied to a manual and a remedying charge rule, and the freedom that life of medical workers need not be drived by miscellaneous trifles.
Struggle of a medical worker to demand such a freedom and a right cannot but become a fight to improve the condition to access of the sick. A large scale increase of the nurse staff, shortening of working hours, improvement of working environment, and security of autonomy in treatment study are the condition essential for patient to receive more substantial medical care. "Freedom of treatment" is asked again as that for medical workers now.
We can say the following thing now.
The working conditions for medical worker are important part of conditions for patient to treat. It resembles that propertied bourgeoisie supported freedom of social position of a doctor for "good medical care" in past.
Do have such relation between working conditions of medical persons and conditions to access of the sick, citizen supported and encouraged the fight of medical workers when citizen recognized well the meanings of the fight.
Section 5 From "freedom of treatment" to the treatment rights of medical persons
(1) "Freedom of treatment" as an active right
Principly, the treatment rights is assumed as indivisible with a duty to keep the remedying rights of the sick. Medical practice is activity to cure illness of a patient in a narrow meaning. However, it is practice to take a part of the remedying rights realization process on in a large meaning.
Therefore, we should regard "Freedom of treatment" as a right that include more active contents same as the remedying rights. If we pursue "freedom of treatment" truly, we cannot avoid judgment about the followings:
(1) Do treatment conditions such as an institution / facility / the staff, satisfy a premise which is necessary for realization of remedying activity?
(2) Does medical institution becomes one adopting an ultimate purpose of a remedying that is to "send life with a definite aim while suffering illness?"
(3) Does the system of public service including medical care get ready to fit for need of nation life?
Working conditions of medical persons are conditions of a remedying for people. The improvement of it is a national problem. Conscience of medical persons group as the labor subject must be asked while involving those judgment.
In other words, "freedom of treatment" is regrasped dialectically as one part of "free of conscience" or "freedom of the subject formation".
(2) The new horizon of the treatment rights
remedying activity is versatile and multilayal. It is the activity that will let self develop mediated with various systems and individuals while concluding relation with them. remedying activity acquires substantial contents for the first time, when a lot of social support activity is developed connecting to this.
Medical workers also become a patroness of the remedying rights as a acting subject, when they are drawn to those practice process. It is demands as specialist engaging in medical care to revolutionize medical contents and its environment more scientifically and humanistically. The democratic medical movement developed as practice supported by this basic "demands" of medical persons.
We must have the viewpoint that general change of medical care for the worse is the serious infringement of the treatment rights. This viewpoint becomes important increasingly. It is sure, this general change has direct aims in limitting the remedying rights and the rights to access of the sick. However, as a result, it also limited a role of medical person to show their ability and to serve for people.
Today, it becomes more and more important that we push a thought of the "universalized treatment rights" on the front of our fight, which is held up by a solidarity with people and the collective ethic of medical persons. The fight for improvement of treatment reward is positioned with such a viewpoint, too.
In the present day when remedying activity is developing as activity for the life whole, expectation and demands of a citizen to medical care are changing, too. The citizen does not deny entirely the old "freedom of treatment", but wishes to develop it democratically from the standpoint of people.
Furthermore, the citizen demands to display of various treatment functions corresponding to totality of remedying activity, and to develop medical care activity of new quality.
end the first part