Theories of Justice and the Right to Health: The Case of Dialysis in Ecuador

Abstract

This article examines the right to health in Ecuador from the perspective of various theories of justice, focusing on the work of John Rawls and the expanded approaches of Norman Daniels, Jayna Fishman, and Douglas MacKay. Based on this theoretical framework, it analyzes access to dialysis treatment for individuals with End-Stage Chronic Kidney Disease, a group facing structural and persistent vulnerability in the country. Methodologically, the article employs a doctrinal, normative, and jurisprudential analysis, supplemented with secondary empirical sources on the state of the Ecuadorian healthcare system. It reviews the constitutional decision 16-16-JC/20 of the Constitutional Court, which reveals the existence of a gap between the law and its practical application. The article concludes that, despite the presence of a legal structure that incorporates principles of justice and the social determinants of health, Ecuador has failed to effectively guarantee access to dialysis treatment, putting at serious risk the lives and dignity of thousands of people. This demonstrates the long road ahead in achieving a true guarantee of human rights.