Resumo Em recente decisão, o Supremo Tribunal Federal (STF) deu um passo na direção correta para o equacionamento da chamada “judicialização da saúde pública” no Brasil (ações judiciais que demandam medicamentos, tratamentos e outros benefícios de saúde contra o Estado com fundamento no direito à saúde reconhecido na Constituição Federal). A tese firmada no Recurso Extraordinário (RE) n. 657.718, sobre medicamentos experimentais e sem registro na Agência Nacional de Vigilância Sanitária (Anvisa), representou seguramente um avanço em relação à jurisprudência anterior. Decisão talvez ainda mais importante, porém, será a do Recurso Extraordinário n. 566.471, sobre os chamados “medicamentos de alto custo”, cujo julgamento será retomado em breve (até o momento três ministros já proferiram voto). Uma tese adequada nesse segundo RE poderá complementar a primeira de modo a dar uma solução praticamente definitiva ao problema da judicialização da saúde pública no Brasil. Este artigo analisa a decisão do RE n. 657.718 e os votos até aqui proferidos no RE n. 566.471, sugerindo ajustes importantes na tese a ser firmada nesse último, sem os quais, a meu ver, a oportunidade de se equacionar a judicialização da saúde no Brasil poderá ser desperdiçada.

Abstract In a recent ruling, the Brazilian Supreme Court has taken a step in the right direction to address the so-called “judicialization of public health” in Brazil (lawsuits demanding medicines, treatments, and other health benefits against the state grounded on the right to health recognized in the Brazilian Constitution). The decision in Extraordinary Appeal n. 657.718, concerning experimental treatments and medicines not approved by Anvisa (National Health Surveillance Agency), represented certainly an improvement on previous case law. Perhaps even more important, however, will be the decision of Extraordinary Appeal n. 566.471, on so-called high-cost medicines, whose judgement will soon be resumed (so far three ministers have already voted). An adequate decision in this second Extraordinary Appeal could complement the first so as to provide a practically definitive solution to the problem of the judicialization of public health in Brazil. This article analyzes the decision of the Extraordinary Appeal n. 657.718 and the votes cast so far in the Extraordinary Appeal n. 566.471, suggesting important adjustments in the latter’s decision without which, in my opinion, the opportunity to address the judicialization of health in Brazil could be wasted.

A Constituição brasileira de 1988 estabeleceu um extenso catálogo de direitos fundamentais e consagrou, como princípios fundamentais e objetivos da nova República Brasileira, a cidadania, a dignidade da pessoa humana e a construção de uma sociedade livre, justa e solidária, em que a pobreza deve ser eliminada, as desigualdades reduzidas e o bem-estar de todos deve ser promovido sem discriminação. Mas quão largo é o fosso entre as promessas de cidadania social e económica da Constituição Cidadã e a vida real da população brasileira? Apesar de problemas significativos de qualidade, eficiência e falta de investimento, os dados quantitativos, ainda que imperfeitos, indicam que os serviços públicos e o sistema de benefícios no Brasil, em larga medida criados pela Constituição, melhoraram, muitas vezes de modo significativo, o bem-estar da população brasileira nas últimas duas décadas.

The Brazilian Constitution of 1988 established an extensive catalogue of fundamental rights and set, as the fundamental principles and objectives of the new Brazilian republic, citizenship, the dignity of the human being, and the construction of a free, just and solidary society, in which poverty should be eradicated and inequalities reduced, and everyone's well-being should be promoted without any discrimination. But how wide is the gap still between the social and economic citizenship promises of the Citizen's Constitution and the real life of the Brazilian population? Despite significant problems of quality, efficiency and underfunding, the imperfect quantitative data indicates that the public services and benefits system in Brazil, a great part of which created by the Constitution, has improved, often significantly, the well-being of the Brazilian population in the past couple of decades.

This article discusses the right to health as provided by the Brazilian Constitution in light of the increasing number of court rulings that order government to supply health products and services that have not been incorporated into public policies by other means. Using the Constitution's concept of health as the point of departure, authors demonstrate that guaranteeing the right to health requires more comprehensive social and economic policies. They argue that scarcity of resources places a limit on the formulation of public policies and that equity should be the underlying principle for orienting resource allocation. The article contends that the interpretation of the right to health as the individual right to unlimited care (the predominant position in the Brazilian Judiciary) is sustained to the detriment of the Constitutional principles of equity and universality, and that this interpretation results in a reversal in the primary objectives of the Unified National Health System (SUS), transforming it into an instrument for the perpetuation of the country's persistently daunting health inequities.

Dans ce travail, on discute le droit à la santé figurant dans la Constitution brésilienne, à la lumière de nombreuses sentences judiciaires obligeant les pouvoirs publics à offrir des produits et services de santé absents des politiques publiques. On part de la conception de santé établie dans la Constitution pour montrer que sa mise en œuvre dépend d'une action plus globale des politiques sociales et économiques. On constate que le manque de ressources empêche le démarrage de ces politiques, dont le principe capital serait l'équité qui guiderait leur mise en place. On soutient que l'interprétation du droit à la santé comme droit individuel et illimité, tel que le Pouvoir Judiciaire le pratique, est maintenue aux dépens des principes d'équité et d'universalité établis dans la Constitution, interprétation menant à l'inversion des objectifs fondamentaux du Système Unique de Santé (SUS), qui en fait un instrument de perpétuation des iniquités dans le domaine de la santé au Brésil.