Health as a fundamental human right in old age: bioethical and social implications

Abstract

Health, recognised internationally as a fundamental human right, assumes particular significance in old age, a stage marked by physical, social, and emotional vulnerabilities. In Latin America, the effective exercise of this right has faced persistent challenges stemming from the fragmentation of health systems, structural inequalities, and gaps in the enforcement of normative frameworks which, despite acknowledging universality, have not ensured fulfilment. Argentina, Ecuador, and Brazil, in particular, have undergone rapid demographic ageing, reshaping their epidemiological profiles with an increase in chronic and long-term conditions that demand models of continuous and comprehensive care. Yet, state responses have been heterogeneous, revealing a marked disjunction between legislative progress and difficulties of implementation. This situation underscores the need for integrated public policies with bioethical and social perspectives that secure not only access to medical services but also the preservation of dignity, autonomy, and justice in the distribution of resources. Drawing on a systematic literature review conducted under the PRISMA protocol, a comparative analysis of policies, legal frameworks, and healthcare practices in these three countries highlighted tensions between bioethical principles and operational limitations that compromise equity and justice in the care of older people, exposing the complex gap between rights formally recognised and their effective realisation.