Patients have a right to refuse medical treatment. But what should happen after a patient has refused recommended treatment? In many cases, patients receive alternative forms of treatment. These forms of care may be less cost-effective. Does respect for autonomy extend to providing these alternatives? How for does justice constrain autonomy? I begin by providing three arguments that such alternatives should not be offered to those who refuse treatment. I argue that the best argument which refusers can appeal to is (...) based on the egalitarian principle of equality of outcome. However, this principle does not ultimately support a right to less cost-effective alternatives. I focus on Jehovah's Witnesses refusing blood and requesting alternative treatments. However, the point applies to many patients who refuse cost-effective medical care. (shrink)

Je resitue tout d'abord la notion d'égalité dans le contexte historique de la société industrielle moderne, afin d'en retracer la genèse. Cette approche vise à introduire le lecteur au problème de la saisie conceptuelle de la notion d'égalité et de la détermination de son contenu. C'est l'occasion de discuter si cette notion peut répondre à une fonction heuristique ou bien si elle n'a qu'un rôle éristique. L'hypothèse développée est qu'une telle notion constitue plutôt une représentation schématique de celle de justice. (...) La vacuité principielle du schème d'égalité a, par ailleurs, toujours pour effet de nous reconduire en définitive à l'examen de sa fonctionnalité opérationnelle.I set up at first the notion of equality within the historical context of modern industrial society, so that its genesis is recalled to mind. This way of approach aims at placing the reader in front of the problem which consists in apprehending conceptually the notion of equality and in determining its content. That gives the opportunity to inquire thereinto, if the considered notion may have an heuristic value or else only an eristic character. The unfolded hypothesis is that such a notion provides rather a schematic depiction for the one of justice. The vacuity in itself of the schema of equality compels moreover to ponder after all its operational functionality everywhere it is applied. (shrink)