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In Search of Law's Residence: Towards the Creation of a Mosaic Health-Care State

Published online by Cambridge University Press:  18 July 2014

Ireh Iyioha
Affiliation:
Faculty of Law, University of British Columbia, Vancouver, BCireh.iyioha@utoronto.ca; ireh.patricia@gmail.com

Abstract

The legal pluralism debate attempts to locate law beyond the traditional precincts of the nation-state. This essay is about locating law; its aim is to examine the extent to which legal pluralism can serve as a valid theory for grounding self-governance for indigenous/alternative medical systems. The author contends that the pursuit of legitimacy for indigenous health systems must begin from within the state system, understood as a malleable and contestable system of laws, and goes on to argue that the hegemony and centrality of the state can be deployed in fostering an integrated pluralistic health-care system in which orthodox and indigenous health systems have equal recognition.

Résumé

Le débat qui porte sur le pluralisme juridique tente de situer le droit au-delà des frontières traditionnelles de l'État nation. Cet article cherche à repérer le droit. Le but est de déterminer à quel point le pluralisme juridique peut agir en tant que théorie valide capable de servir à fonder l'autorégulation des systèmes médicaux indigènes/alternatifs. L'article avance l'hypothèse que la légitimation des systèmes de santé indigènes doit prendre naissance à l'intérieur même du système étatique, compris comme un système normes malléable et contestable. De plus, cet article soutient que l'hégémonie et la centralité de l'État peuvent agir favorablement dans le sens d'un système de santé pluraliste et intégré où les systèmes de santé orthodoxes et indigènes jouissent d'une égale reconnaissance.

Type
Research Article
Copyright
Copyright © Canadian Law and Society Association 2009

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References

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18 Many developing countries, including Nigeria, have dual systems of health care, and this provides a classical case for the subject of analysis here. Specific examples are drawn from Nigeria, a country currently going through what may be termed an experimental period in its health system with the recent introduction of a National Health Insurance Scheme. Nigeria operates an inclusive system of health care in which the Western orthodox system is the country's official health-care system and indigenous and alternative health-care systems exist privately.

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49 According to Santos, writes, rhetoric is “a communication form and a decision-making strategy based on persuasion or conviction through the mobilization of the argumentative potential of accepted verbal and non-verbal sequences and artifacts.” Ibid., 86.

50 Ibid.: In Santos's words, bureaucracy is “a communication form and a decision-making strategy based on authoritative impositions through the mobilization of the demonstrative potential of regularized procedures and normative standards.”

53 Ibid., 86–87.

54 Santos' hypothesis is that “the higher the level of bureaucratic institutionalization of juridical production, the smaller the rhetorical space of the legal discourse, and vice versa; and the more powerful the instruments of violence in the service of juridical production, the smaller the rhetorical space of the legal discourse, and vice versa.” Ibid., 87.

55 Santos' “rhetoric” and “diatopical hermeneutics” enunciate the importance of cultural discourse between opposing knowledge systems based on the incompleteness of cultures. Standing astride two cultures creates a bridge across diversities. This, he contends, can be achieved through convivial discourse. See generally Santos, Boaventura de Sousa, “Towards a Multicultural Human Rights,” in Moral Imperialism: A Critical Anthology, ed. Hemandez-Truyol, Berta (New York: New York University Press, 2002)Google Scholar. See also Santos, , Toward a New Legal Common Sense, 474Google Scholar.

56 For example, Nigeria's National Health Insurance Act, one of the most important laws regulating health care in Nigeria, does not extend insurance coverage to Indigenous health care systems. This is one of several state medical laws that make specific provisions for the delivery of orthodox care.

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64 See generally McLaughlin v. Connecticut General Life Insurance Company, 565 F.Supp. 434 (N.D. Cal. 1983), which suggests a departure both from a reliance on the biomedical model for interpretation of what is medically necessary (and, hence, insurable) and from insurer's dependence on FDA approval to legitimize alternative treatments.

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67 Ibid. at 86–87.

68 Any such rhetorical enterprise resonates with Lon Fuller's interpretive agenda against legal positivism. See generally Fuller, Lon L., “Human Interaction and the Law,American Journal of Jurisprudence 14 (1969), 1CrossRefGoogle Scholar; Fuller, Lon L., “Positivism and Fidelity to Law: A Reply to Professor Hart,” Harvard Law Review 71 (1958)CrossRefGoogle Scholar; Fuller, Lon. L., The Morality of Law (New Haven, CT: Yale University Press, 1967)Google Scholar.

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72 Ibid., 458–59.

73 Notably, an essentialist view of law defines law in terms of a supposed set of categories or features that are considered to be its defining characteristics. Such a view also defines law in terms of the specific uses to which it can be put, based on the identified features or categories.

74 Santos, , Toward a New Legal Common Sense, 467Google Scholar. Other scholars have pointed out that Santos' thesis, in contexts outside that discussed above, is essentialist and falls into the category of functionally based definitions of law. See e.g., Tamanaha, “Towards a Non-essentialist Version of Legal Pluralism.”

75 Indeed, some scholars have asserted forcefully that “law has no essence.” See Tamanaha, ibid., 313.

76 Kleinhans and Macdonald, “Critical Legal Pluralism.” The emphasis on “critical” is the authors'.

77 Ibid., 29 (emphasis added).

78 Ibid., 34.

79 Ibid., 4–35.

80 Ibid., 35 (emphasis added).

81 Ibid., 38 (emphasis added).

84 Ibid., 36.

85 Ibid., 39.

86 See generally Fuller, “Human Interaction”; Fuller, “Positivism and Fidelity to Law”; Fuller, Morality of Law.

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90 This point will be used in emphasizing the downsides to a micro-governance or decentralization theory in which health consumers are left at the mercy of powerful, private actors.

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102 See ibid., 95.

103 This has been achieved in the US state of Washington. In a study conducted in 2002, the impact on alternative health-care expenditure of a 1996 Washington state law mandating that all health plans cover “every category of provider” was evaluated against the total cost of out-of-pocket health expenditures previously recorded. The results showed an impressively lowered cost of care. See Lafferty, W.E. et al. , “Insurance Coverage and Subsequent Utilization of Complementary and Alternative Medicine Providers,” American Journal of Managed Care 12 (2006), 397404Google ScholarPubMed.

104 This understanding is perceived to be achieved through the acceptance of the different standards (legal and otherwise) operating within indigenous health care, since the acceptance of the latter into the National Health Service is presently premised on its amenability to scientific standards.

105 Burris, , “Governance, Microgovernance,” 346Google Scholar, notes the importance of access to decision-making bodies when he states that democratic decision making about health may be defined in terms of access to decision-making nodes and a meaningful capacity to influence them. He also explains that, in collaboration with other scholars, he is putting questions of this nature to use in research “whose goal is to identify and support community efforts to change law enforcement practices that increase the spread of HIV in three cities in. Eastern Europe and the former Soviet Union”; the research is “an elaboration of the World Health Organization's Rapid Assessment and Response model” (ibid., 346, n. 39; emphasis added).

106 Santos, , Toward a New Legal Common Sense, 94Google Scholar.

107 Ibid., (emphasis mine).

108 This process may begin by contesting the TRIPS agreement or the Nigerian Patent Act, which has reified the philosophies of the Western intellectual property regime, or from within Nigeria's medical laws, which patently ignore, through lack of representation, the importance of the cultural narratives underlying indigenous health care systems and the role of governance in health-care outputs.

109 Otto, Dianne, “Subalternity and International Law: The Problems of Global Community and the Incommensurability of Difference,” in Laws of the Postcolonial, ed. Darian-Smith, Eve and Fitzpatrick, Peter (Ann Arbor: University of Michigan Press, 1999), 173Google Scholar.

110 Ibid.

111 Ibid.

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113 Tataryn, Douglas J. and Verhoef, Marja J., “Combining Conventional, Complementary and Alternative Health Care: A Vision of Integration,” in Perspectives on Alternative and Complementary Health Care: A Collection of Papers Prepared for Health Canada, vol. 7 (Ottawa: Health Canada, 2001), 105Google Scholar.

114 Ibid.

115 See generally s. 23(1)(b) of the Nigerian Health Bill, on file with author. See Cohen, Michael H., Beyond Complementary Medicine: Legal and Ethical Perspectives on Health Care and Human Evolution (Ann Arbor: University of Michigan Press, 2003), 3741Google Scholar.

116 See Tataryn, and Verhoef, , “Combining Conventional, Complementary and Alternative Health Care,” 103Google Scholar

117 Ibid.

118 Ibid.

119 Ibid., 104.

120 Ibid.

121 See generally Irehobhude O. Iyioha, “Deregulation of Complementary Medicine.”