Maximizing the product of human functions and longevity
Maximizing the production of functional competence and longevity is the medical profession’s mission. An ‘opportunity state’ for such an agency rests on two things: the available expertise and technology for body function betterment at any time and the autonomous choice or wish.
1. Human functions, the very central notion
The comprehensive set of information, expertise, and technologies that can improve human function, or increase longevity constitute the enterprise of medicine. Human functions include any goal-directed physical or mental ability or capacity. It may vary from such tangible faculties as the ability to walk to memory and mental serenity. The function here refers to higher-level functions, i.e., those wished, perceived, and exercised by an individual, and not visceral or ‘involuntary physiological’ functions.
Resources and function.
In order to achieve his goals, each human needs resources. Four types of resources can be delineated: material, social, spiritual, and bodily for which pencil, colleague, kindness, and memory are respective examples. The medical profession is defined by the actions that affect the latter category. (Bodily subsumes psychological.)
2. Principle of autonomy, in receiving care
There is a health opportunity state only when there is a desire to receive care; this desire is value-driven. For those without the capacity to make their own choices or declare their wish—due to some incapacitating injury or condition—surrogate decision-making approximates autonomy; this is wished by proxy.
Information
The individual dealing with a health opportunity decision is an ‘adequately’ informed one. In reality, an individual’s desire is developed, through a consultation and information exchange process, vis-à-vis the set of currently available actions: an individual or her guardian learns about options to improve memory An individual’s use of health services has a unique peculiarity among other economic goods: lack of information can severely and irreversibly curtail his usage of otherwise accessible and desired care. It is hardly conceivable that an individual with hypercholesterolemia does not want to be provided with advice on how to manage his condition.
Yet, hypercholesterolemia not receiving care is the norm rather than the exception in all communities. The question is: Is an uninformed hypercholesterolemic—practically ‘not wishing to receive’ health advice—a non-health opportunity? The answer is of course no; as otherwise the definition would be absurd. Hence, the test for health opportunity state—as a criterion for categorizing conditions—is meaningful only in a setting with ‘some’ health information.
3. Wish, as an economically-independent wish
Healthcare entails some cost; regardless of one’s degree of awareness, care consumption—where it is not fully covered by insurance—is affected by an individual’s income or financial resources. This means that an individual ‘overall’ wish is necessarily both value and economically driven. However, what is intended by wish here is wish in its more specific notion that is wish given a fully-covered situation. Even in the developed world, many uninsured individuals do not seek dental care.
Does that mean they do not ‘wish’ that care—and, hence that is a non-health opportunity situation? The answer is clearly negative—a positive answer would have been absurd. (This makes the case for the need for full insurance for any area of care if full access in that area is objective. Whether or how this insurance should be realized—mandated and operated by the government, through individuals’ own health savings accounts, or other means—is a relevant offshoot debate.)
