Health Care Should Not Be a Commodity: Reclaiming the Moral Purpose of Medicine – Dr Neil Nijhawan

Abstract: The commodification of health care — the framing of it as a purchasable good governed by market forces — represents one of the most profound ethical distortions in modern medicine. This paper argues that health care cannot and should not be treated as a commodity because its moral, social, and relational dimensions fundamentally resist market logic.

When care is priced, packaged, and profit-optimized, equity is undermined, professional values are distorted, and the human essence of medicine is diminished.

Drawing on historical, ethical, and policy perspectives, this narrative examines how commodification has reshaped the purpose of health systems and contrasts it with solidarity-based models grounded in compassion and human rights.

It proposes that palliative care offers a powerful corrective — a model rooted in dignity, interdependence, and shared humanity. Reclaiming health care as a public good is essential to restoring medicine’s moral foundations and achieving justice in global health.

 

Keywords: commodification, ethics, health systems, palliative care, equity, solidarity, GCC, public good

Introduction

Health care has never been simply an economic transaction. Rather, it is a moral undertaking dedicated to relieving suffering, affirming dignity, and preserving life. Yet in the twenty-first century, health systems around the world increasingly operate according to market logic.

Patients are reframed as consumers, clinicians as service providers, and hospitals as profit centres. This trend — the commodification of health care — threatens the ethical foundations that historically distinguished medicine from commercial enterprise. This paper argues that health care should not be treated as a commodity, because doing so undermines equity, solidarity, and the humanistic purpose of healing.

Health Care and the Limits of Market Logic

In classical economics, commodities are goods or services traded according to supply and demand. Their value is determined by scarcity, cost, and willingness to pay — not by intrinsic moral significance. Health care, by contrast, is not an optional consumer product: it is a social necessity and a human right, integral to the protection of life and wellbeing (World Health Organization, 2017).

Market logic assumes rational decision-making, competition, and informed choice. Illness, however, disrupts rationality. Patients cannot “shop around” in cardiac arrest or compare prices during chemotherapy. Nor do the most vulnerable — the poor, the elderly, the chronically ill — behave like traditional consumers.

When health systems adopt a market ethos, care risks becoming transactional rather than relational; attention shifts from healing to throughput, from compassion to cost recovery. Market forces cannot equitably allocate health care because illness does not follow economic laws.

 

Historical Shifts: From Solidarity to Marketisation

Historically, health care developed within moral and religious frameworks that emphasised duty, compassion, and collective care. In the Islamic world, bimaristans (ancient precursors to modern hospitals) were endowed through waqf charitable foundations to ensure universal access to treatment, regardless of faith, wealth, or background (Al Khalili, 2019). Similarly, early European hospitals were civic and religious institutions motivated by charity rather than profit.

The industrial revolution brought professionalisation, urbanisation, and insurance models that gradually shifted health care into the economic sphere. The later twentieth century, particularly under neoliberal reforms, saw accelerating privatisation and the rise of corporate health systems. The language of care became increasingly financial — efficiency, productivity, and return on investment — diluting the moral vocabulary of service, solidarity, and stewardship.

Consequences of Commodification

Treating health care as a commodity has wide-ranging ethical and social consequences:

1. Inequity of Access: Market-based systems distribute care according to ability to pay, entrenching disparities and excluding the most vulnerable (Klein, 2019).
2. Moral Distortion: Profit-driven incentives marginalise essential but less lucrative services — especially palliative care, primary care, and mental health (Dasgupta, 2021).
3. Erosion of Professional Integrity: Clinicians face growing pressures to meet financial targets, reducing autonomy and compromising the ethos of patient-centred care.
4. Dehumanisation of Patients: Individuals are reframed as consumers navigating opaque billing structures, undermining trust and relational continuity.
5. Loss of Public Confidence: When corporate priorities dominate, communities perceive health institutions as businesses rather than guardians of public wellbeing.

Palliative Care as a Corrective Model

Palliative care stands as a compelling counterpoint to commodified health systems. It prioritises comfort, dignity, meaning, and the alleviation of suffering — outcomes that resist monetisation and are poorly captured by traditional financial metrics. Its emphasis on compassion, communication, and holistic support exposes the limits of market-centred care.

Precisely because its benefits are relational rather than profitable, palliative care often struggles for funding in market-driven environments. Yet its moral clarity highlights what health care is fundamentally for: accompaniment through vulnerability, not revenue generation. Palliative care demonstrates that humane and sustainable systems are possible when care is guided by ethics rather than economics.

Health Care as a Social Contract

If health care cannot function effectively as a market, it must operate as a social contract. In this model, the state, professionals, and society share responsibility to ensure that no one is denied essential care on the basis of income, geography, or social position. This principle underpins solidarity-based systems such as those in Scandinavia and the UK (Klein, 2019).

In the GCC and wider Islamic tradition, the principle of takaful — mutual solidarity and shared responsibility — reinforces this view. Caring for the sick is understood as a communal obligation, not a discretionary consumer preference. These traditions provide ethical foundations for health systems that treat care as a public good.

Reframing the Debate: From Commodity to Common Good

Rejecting commodification does not demand rejecting efficiency or sound management. Instead, it requires a reorientation of purpose. Health care must be recognised as a common good — a shared resource sustained by society because it strengthens society.

Achieving this requires structural and cultural shifts:

– Policy frameworks that reward compassion and continuity, not volume or profitability

– Educational systems that embed ethics alongside clinical training

– Metrics that capture quality, dignity, and patient experience rather than throughput alone

– Financing models that prioritise equity, prevention, and community wellbeing

Conclusion

Health care accompanies people through birth, illness, frailty, and death — the most vulnerable points of the human experience. To subject such moments to market logic is to misunderstand the nature of care itself. Societies that allow health care to become a commodity risk losing not only fairness, but humanity.

Reasserting health care as a moral enterprise grounded in dignity, solidarity, and compassion is essential. Palliative care exemplifies the kind of relational, humane, and justice-oriented model that can guide this transformation. Ultimately, health care must be reclaimed not as a commodity, but as a public trust — a shared commitment to the wellbeing of all.

 

Dr Neil Arun Nijhawanh

Consultant in Hospice & Palliative Medicine, Burjeel Medical City, Abu Dhabi, UAE

Asst Professor Palliative Medicine, Gulf Medical University, Ajman, UAE

drneilnijhawan@gmail.com

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References

Al Khalili, R. (2019). Islamic bioethics and the duty of care. Journal of Islamic Ethics, 3(2), 155–168.

Dasgupta, R. (2021). Markets, ethics and the moral limits of medicine. The Lancet, 398(10312), 1120–1122.

Farmer, P. (2003). Pathologies of power: Health, human rights, and the new war on the poor. University of California Press.

Klein, R. (2019). The new politics of the NHS (8th ed.). Radcliffe Publishing.

World Health Organization. (2017). Health is a fundamental human right. Geneva: WHO.

WHO EMRO. (2022). Integrating palliative care into health systems in the Eastern Mediterranean Region. Cairo: WHO EMRO.