Healthcare (including public health) is special because it protects normal functioning, which in turn protects the range of opportunities open to individuals. I extend this account in two ways. First, since the distribution of goods other than healthcare affect population health and its distribution, I claim that Rawls's principles of justice describe a fair distribution of the social determinants of health, giving a partial account of when health inequalities are unjust. Second, I supplement a principled account of justice for health (...) and healthcare with an account of fair process for setting limits or rationing care. This account is provided by three conditions that comprise "accountability for reasonableness.". (shrink)

Libertarian views on rights tend to rule out coercive redistribution for purposes of public health care guarantees, whereas liberal conceptions support coercive funding of potentially unlimited access to medical services in the name of medical needs. Taking the “priority of liberty” seriously as supreme political value, a plausible prudential argument can avoid these extremes by providing systematic reasons for both delivering and limiting publicly financed guarantees. Given impending demographic change and rapid technical progress in medicine, only a two-tier system with (...) explicitly limited public guarantees and optional privately financed health services seems acceptable. (shrink)

In a questionnaire study on organ allocation 348 students of medicine (102) and economics (246) at the universities of Halle (114 students) and Hannover (234 students) responded to questions concerning their basic attitudes toward alternative criteria of organ allocation. Medical criteria were widely accepted by the respondents. Considerations concerning the patient's value to society were seen as being of minor importance. With respect to reciprocity, we could detect a high share of respondents who would favor former living donors and discriminate (...) against murderers. Among considerations of fairness, the criterion of waiting time gained the highest support. Furthermore, majorities favored the view that health-compromising behavior and differences in age should play a role. Economic considerations were strongly rejected as criteria of organ allocation. (shrink)