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J Med Ethics 37:526-529 doi:10.1136/jme.2010.042085
  • Feature article
  • Paper

Just health: on the conditions for acceptable and unacceptable priority settings with respect to patients' socioeconomic status

Editor's Choice
  1. Berit Bringedal2,3
  1. 1The Ethics Programme, IFIKK, University of Oslo, Oslo, Norway
  2. 2Harvard Medical School, Boston, Massachusetts, USA
  3. 3The Research Institute, The Norwegian Medical Association, Oslo, Norway
  1. Correspondence to Kristine Bærøe, The Ethics Programme, University of Oslo, IFIKK, Postboks 1020 Blindern, Oslo 0315, Norway; kristine.baroe{at}ifikk.uio.no
  • Received 22 December 2010
  • Revised 17 February 2011
  • Accepted 2 March 2011
  • Published Online First 8 April 2011

Abstract

It is well documented that the higher the socioeconomic status (SES) of patients, the better their health and life expectancy. SES also influences the use of health services—the higher the patients' SES, the more time and specialised health services provided. This leads to the following question: should clinicians give priority to individual patients with low SES in order to enhance health equity? Some argue that equity is best preserved by physicians who remain loyal to ‘ordinary medical fairness’ in non-ideal circumstances when health disparities persist; ie, doctors should allocate care according to needs only and treat everyone with equal regard by being neutral with respect to patients' SES. This paper furthers a discussion of this view by questioning how equitable needs relate to SES. To clarify, it distinguishes between four versions of ‘healthcare need’ and approaches an acceptable conceptualisation of the notion supported by Norman Daniels' theory on health equity. It concludes that doctors should remain neutral to patients' SES in cases in which several patients require the same health care. However, equitable health care requires considerations of the impact of socioeconomic factors (SEF) on patients' capacity to benefit from the care. Remaining neutral towards patients' SES in this respect does not promote equal regard. It follows that priority setting on the basis of SEF is required in fair clinical distribution of care, eg, through allocating more time to patients with low SES. In order to advance equity accurately, the concept of ordinary medical fairness should be amplified according to this clarification.

Footnotes

  • Funding KB is funded by the Ethics Programme, University of Oslo, Norway. BB is funded by the Commonwealth Fund, USA, and the Norwegian Research Council, Norway.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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