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Medicine and Social JusticeEssays on the Distribution of Health Care$
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Rosamond Rhodes, Margaret Battin, and Anita Silvers

Print publication date: 2012

Print ISBN-13: 9780199744206

Published to Oxford Scholarship Online: May 2015

DOI: 10.1093/acprof:osobl/9780199744206.001.0001

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Why Justice Requires Rationing in Health Care

Why Justice Requires Rationing in Health Care

(p.143) 12 Why Justice Requires Rationing in Health Care
Medicine and Social Justice

Gopal Sreenivasan

Oxford University Press

This chapter explains why justice requires rationing in health care, arguing that justice not only permits but in principle requires a national health scheme to deny some people some effective medical treatment they need. The basic moral structure of a national health care system is defined by its answers to two questions: whom to treat and which medical services to offer (to those whom the system treats). At first glance, the most compelling answers to these questions are the simplest ones, namely, “everyone” and “everything.” Or, a little more precisely, “everyone, without regard to her ability to pay” and “every effective medical service that a sick person needs.” This chapter contends that the second answer is actually mistaken. Not only does morality— or, more specifically, justice—permit a national health care system to deny some sick people some effective medical services that they need, but it positively requires as much. The chapter also compares the “rationing” approach to what it calls the “reverse-engineered” approach and describes premises that are required to reach the conclusion that justice requires health care rationing.

Keywords:   justice, health care, medical services, morality, reverse-engineered approach, health care rationing

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