This book provides a survey of the ethical aspects of health care resources distribution. It first distinguishes health from health care in an effort to clear up the ethical landscape. After this, still with the same purpose, it makes a distinction between problems of macro-allocation and micro-allocation. In the rest of the book two questions of macro-allocation are treated in some detail. First, several approaches – in particular: utilitarian, egalitarian, communitarian, and libertarian – to the question whether we have a (...) right to health care are assessed. Second, it is discussed how best, if we have such a right, health care resources are allocated given obvious budget constraints. Here again the major theories discussed are utilitarian, communitarian, and egalitarian. Although it is not the aim of the book to propose a new theory of the ethics of health care resource distribution, the critical approach throughout is broadly egalitarian in spirit. (shrink)

This paper deals with the third and most disputed principle of John Rawls’s theory of justice: the so-called difference principle. My reasoning has three parts. I first present and examine the principle. My investigation is driven by three questions: what considerations lead Rawls to the acceptance of the principle; what the principle’s relation to effectiveness is; and what and how much the principle demands. A proper understanding of the principle permits me to spend the second half of the paper with (...) exploring the difficulties the principle encounters. I first discuss four well-known objections and argue that all of them, partly or entirely, hold against the principle. I then discuss the applicability of the principle with special attention to the relations among the three Rawlsian principles and the notion of the social minimum. Investigation of the first issue shows that the two other principles leave enough room for the difference principle, whereas in the second case I conclude that parties to the Rawlsian original position would prefer a social minimum principle to the difference principle. Finally, at the end of the paper, I briefly summarize my reasoning repeating its most important findings. (shrink)