Four Unsolved Rationing Problems: A Challenge
Hastings Center Report. 1994 Jul-Aug; 24(4): 27-29.
In his presentation to the inaugural congress of the International Association of Bioethics, Norman Daniels discussed four key problems that face those trying to provide medical care in a climate of scarce resources: to what extent we should favor best outcomes in allocating resources; what priority we ought to give to the neediest; when providing modest benefits to many should be privileged over providing significant benefits to fewer people; and when we ought to rely on democratic processes to determine what is a fair outcome of rationing. He argued that bioethics generally -- and current theories of justice particularly -- has failed to address these problems directly. In this symposium, we have invited Professor Daniels to issue his fourfold challenge again and invited responses from four distinguished scholars in philosophy, law, economics, and public policy. The following essays by Frances Kamm, Eric Rakowski, John Broome, and Mary Ann Baily begin the hard work of solving these four problems and so, in Daniels's words, begin to bridge the gap between principles of distributive justice and the creation of just institutions.
Bioethics; Common Good; Costs and Benefits; Decision Making; Democracy; Economics; Health; Justice; Law; Life; Moral Policy; Organ Transplantation; Philosophy; Prognosis; Public Participation; Public Policy; Quality of Life; Resource Allocation; Scarcity; Selection for Treatment; Transplantation; Treatment Outcome; Utilitarianism; Values;
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Daniels, Norman (1993-04)Conclusion: I conclude with a plea against provincialism. The four problems I illustrated have their analogues in the rationing of goods other than health care. To flesh out a principle that says "people are equal before the ...