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Between the constitution and the clinic: Formal and de facto rights to healthcare

Published online by Cambridge University Press:  01 January 2024

Carol A. Heimer Open the ORCID record for Carol A. Heimer [Opens in a new window]  and
Arielle W. Tolman Open the ORCID record for Arielle W. Tolman [Opens in a new window]
Carol A. Heimer*
Affiliation:
Department of Sociology, Northwestern University, Evanston, Illinois, USA American Bar Foundation, Chicago, Illinois, USA
Arielle W. Tolman
Affiliation:
American Bar Foundation, Chicago, Illinois, USA
*
Carol A. Heimer, Department of Sociology, Northwestern University, 1810 Chicago Ave., Evanston, IL 60208, USA., Email: c-heimer@northwestern.edu
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Abstract

In no domain of global health has there been more talk of rights than in HIV/AIDS, yet little is known about how the right to HIV/AIDS care is mobilized at the clinic level. Drawing on interviews and field observations in the United States, South Africa, Thailand, and Uganda, we analyze the legal consciousness of caregivers in five HIV clinics. We identify three organizational factors—clinics' focus on the distribution rather than the adequacy of existing resources, the duties for caregivers that patients' rights create, and the dominant norms of exchange in healthcare—that help to explain the low penetration of formal rights talk into clinics despite its prevalence outside them. However, we also observe that within clinics, rights may accrue differently than public discourse about rights might lead us to expect. We find that patients often benefit from highly localized, tacit de facto rights that develop gradually over time with the support of state health infrastructure, clinic resources, and professional norms and commitments. These rights would be unlikely to stand up in a court of law but nevertheless have substantial impact on patients' access to care.

Type
Articles
Information
Law & Society Review , Volume 55 , Issue 4 , December 2021 , pp. 563 - 586
Copyright
© 2021 Law and Society Association.

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Footnotes

How to cite this article: Heimer, Carol A., Arielle W. Tolman. 2021. “Between the constitution and the clinic: Formal and de facto rights to healthcare.” Law & Society Review 55(4): 563-586. https://doi.org/10.1111/lasr.12577

Funding information American Bar Foundation; National Science Foundation, Grant/Award Number: NSF SES - 0319560

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