How should medical services be distributed within society? Who should pay for them? Is it right that large amounts should be spent on sophisticated technology and expensive operations, or would the resources be better employed in, for instance, less costly preventive measures? These and others are the questions addreses in this book. Norman Daniels examines some of the dilemmas thrown up by conflicting demands for medical attention, and goes on to advance a theory of justice in the distribution of health (...) care. The central argument is that health care, both preventive and acute, has a crucial effect on equality of opportunity, and that a principle guaranteeing equality of opportunity must underly the distribution of health-care services. Access to care, preventive measures, treatment of the elderly, and the obligations of doctors and medical administrations are fully discussed, and the theory is shown to underwrite various practical policies in the area. (shrink)

Instead of benefitting from open meetings and public discussions, the Clintons drafted their health care plan in private and asked that it be accepted in haste. They advance an ideology that claims we can receive the best care for all without any increase in cost or rationing, and then they use "ethicists" to justify this ideology through a supposedly common morality. However, there is no such common morality. In the context of American pluralism, one must look to the actual consent (...) of the governed and recognize the limits on state authority. The result will be a two tiered system of health care, with a basic tier focusing on cost-effective care for the poor that eliminates suffering rather than equalizing inputs, and a space for collateral private insurance. Keywords: Clinton health plan, egalitarianism of envy, egalitarianism of altrusim, limited democracy, moral pluralism CiteULike Connotea Del.icio.us What's this? (shrink)

The concept of basic healt.h care has grown steadily in importance in recent years as more and more of those who reflect on the issue of a right to health care conclude that we need to distinguish between kinds of health care to which people do have a right and others to which they do not have a right. There is little consensus on where to draw this line. But there does seem to be general agreement that, if this distinction (...) is valid, it is so because some kinds of health care are less important, less essential, less something than others, and because the right to health care (if there is such a thing) extends only to those kinds of health care that are more important, more essential, more whatever-it-is. A number of authors have used the term 'basic' to represent this something and this is the term which I shall use. In this article, I shall offer a theory of what we mean by basic health care. I shall do this by developing, in Section 1 of the paper, a general theory of kinds of needs. In Section 2 I will give a brief account of the special moral significance of the levels of need which I designate as basic. In Sections 3-4 1 shall try to identify, in the context of the health care resources available in our society, the health care needs which fall into the previously developed categories of basic need. (shrink)

Health, Luck, and Justice is the first attempt to systematically apply luck egalitarianism to the just distribution of health and health care.

This paper argues that the Quality Adjusted Life Year or QALY is fatally flawed as a way of priority setting in health care and of dealing with the problem of scarce resources. In addition to showing why this is so the paper sets out a view of the moral constraints that govern the allocation of health resources and suggests reasons for a new attitude to the health budget.

This book brings together ten influential essays on justice and healthcare, written by a major figure in bioethics and political philosophy. What emerges is a systematic and unified approach to the issues that challenges widely-held dogmas and unsettles the framing assumptions of a number of prominent debates. Unlike most work in bioethics, this book takes the problem of implementing justice seriously, exploring the relationship between institutions, incentives, and moral commitments.

The phrase "personalized medicine" has a built-in positive spin. Simple genetic tests can sometimes predict whether a particular individual will have a positive response to a particular drug or, alternatively, suffer costly and debilitating side effects. But little attention has been given to some challenging issues of justice raised by personalized medicine. How should we determine who would have a just claim to access particular treatments, especially very expensive ones? How effective do those treatments need to be?If there were a (...) thick, bright line separating minimal responders from maximal responders, then we could allocate these treatments in a fair and cost-effective way. But there is no bright line. The .. (shrink)

From the author of Setting Limits comes a challenging exploration of the proper goals of medicine in our rapidly changing society--a work destined to spark debate and influence policy for years to come.

Recognition of the need to ration care has focused attention on the concept of "basic care." It is often thought that care that is "basic" is also morally prior. This article questions that premise in light of the usual definitions of "basic." Specifically, it argues that Oregon's rationing scheme, which defines "basic" in terms of cost-effective care, fails to pay sufficient attention to important ethical principles such as justice.

Few in our society believe that access to health care should be determined primarily by ability to pay. We believe instead that society has an obligation to assure access to adequate health care for all. This is the view explicitly endorsed in the President's Commission Report Securing Access to Health Care. But there is an important moral ambiguity here, for this obligation may be construed as being either beneficence-based or justice -based. A beneficience-based construal would yield a much weaker obligation (...) with respect to the distribution of health care. In the first section of this paper I argue that the President's Commission is committed only to this weaker construal of this obligation. In the second section I argue that such a beneficence-based obligation is really rooted in a libertarian conception of justice, similar to that recently articulated by Engelhardt, and that this conception is seriously flawed when it comes to effecting a just distribution of health care. (shrink)