Just Caring: Oregon, Health Care Rationing, and Informed Democratic Deliberation
Fleck, Leonard M.
Journal of Medicine and Philosophy. 1994 Aug; 19(4): 367-388.
This essay argues that our national efforts at health reform ought to be informed by eleven key lessons from Oregon. Specifically, we must learn that the need for health care rationing is inescapable, that any rationing process must be public and visible, and that fair rationing protocols must be self-imposed through a process of rational democratic deliberation. Part I of this essay notes that rationing is a ubiquitous feature of our health care system at present, but it is mostly hidden rationing, which is presumptively unjust. Part II argues that the need for health care rationing is inescapable. Although Oregon is flawed as a model of health rationing, it gives us worthy moral lessons for health reform at the national level, which I analyze and defend in Part III. The most significant of these lessons is the importance of rational democratic deliberation in articulating fair rationing protocols for a community. In Part IV I sketch the philosophic justification for this approach and respond to some important criticisms from Daniels.
Caring; Costs and Benefits; Decision Making; Democracy; Economics; Freedom; Government; Health; Health Care; Health Care Delivery; Health Care Reform; Health Care Rationing; Indigents; Justice; Moral Policy; Obligations of Society; Physicians; Policy Analysis; Politics; Public Participation; Public Policy; Resource Allocation; Rights; Selection for Treatment; Standards; State Government;
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